Source: NHS England - 10 July 2018 -
Publisher: NHS England
NHS England is seeking views on the
proposed policy for reducing the delivery of clinically ineffective
interventions. Consultation ends on 28 September 2018.
Tuesday, 14 August 2018
Complementary therapies, relaxation and wellbeing (BCC55) [PDF]
Source: Breast Cancer Care - 26 June 2018
(via NICE)
This booklet is about relaxation and wellbeing during and
after breast cancer treatment. It looks at complementary therapies such as
acupuncture, Reiki and massage. It also describes some popular relaxation
techniques, including meditation and mindfulness, and has information on yoga,
Tai Chi and Chi Gung. We discuss why people might use these complementary
therapies and relaxation techniques after a diagnosis of breast cancer, and
what you may need to think about before trying them. We also explain what
herbal medicines and homeopathy are.
*Please let me know whether resources like this are of any use to you. If so, I'll just do a NICE search in relation to breast surgery each month to accompany the research articles.
Modified Nipple Flap with Free Areolar Graft for Component Nipple-Areola Complex Construction: Outcomes with a Novel Technique for Chest Wall Reconstruction in Transgender Men
1 Plastic and
Reconstructive Surgery by
Frey, Jordan D.; Yu, Jessie Z.; Poudrier, Grace; Motosko, Catherine C.; Saia,
Whitney V.; Wilson, Stelios C.; Hazen, Alexes
Background: A primary
goal in chest wall reconstruction (“top surgery”) for trans men is achieving a
symmetric, aesthetically pleasing position of the reconstructed male
nipple-areola complex. Methods: The senior author’s (A.H.) technique for
component nipple-areola complex creation in chest wall reconstruction for trans
men with a modified skate flap and free areolar graft, in conjunction with
double-incision mastectomy, is described. A retrospective analysis of 50
consecutive patients who underwent primary, bilateral chest wall reconstruction
with this technique was undertaken for the period of March of 2015 to October
of 2016. Results: The average patient age was 30.64 years, and the average body
mass index was 28.54 kg/m2. Eighty-two percent of the sample received
preoperative testosterone therapy, and average operative time was 2 hours 59
minutes. Average overall mastectomy specimen weight was 627.80 g, average
length of hospital stay was 0.96 days, and average follow-up duration was 19.02
months. Complications occurred in five patients (10 percent), including seroma
(4 percent), cellulitis (2 percent), hematoma (2 percent), and suture granuloma
(2 percent). Only five patients (10 percent) underwent postoperative revision
to adjust nipple-areola complex size, projection, or symmetry. Twenty-eight
patients (56 percent) underwent secondary revisions, including scar revisions
(56 percent), liposuction (12 percent), and fat grafting (2 percent).
Conclusion: The use of a modified nipple flap and free areola graft in
transgender chest wall reconstruction for trans men allows for flexible,
component construction of the male nipple-areola complex in a safe and
effective manner. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Risk Factors for Delays in Adjuvant Chemotherapy following Immediate Breast Reconstruction
by Cohen, Oriana; Lam, Gretl; Choi,
Mihye; Ceradini, Daniel; Karp, Nolan
Background: Concerns
exist that immediate breast reconstruction may delay adjuvant chemotherapy
initiation, impacting oncologic outcomes. Here, the authors determine how
postoperative complications impact chemotherapy timing, and identify factors
associated with greater risk for delays. Methods: Retrospective chart review
identified patients undergoing immediate breast reconstruction and adjuvant
chemotherapy at a single institution from 2010 to 2015. Patients were analyzed
based on occurrence of postoperative complications and time to chemotherapy.
Results: A total of 182 patients (244 breast reconstructions) were included in
the study; 210 (86 percent) reconstructions did not experience postoperative
complications, and 34 (13.9 percent) did. Patients who experienced
postoperative complications had an older mean age (53.6 years versus 48.1
years; p = 0.002) and higher rates of diabetes (23.5 percent versus 3.8
percent; p < 0.001). The complication group had delays in initiation of
chemotherapy (56 versus 45 days; p = 0.017). Patients who initiated
chemotherapy more than 48.5 days after reconstruction were of older mean age
(55.9 years versus 50.7 years; p = 0.074) and had increased rates of diabetes
(36.8 percent versus 6.7 percent; p = 0.053) and immediate autologous
reconstruction (31.6 percent versus 0 percent; p = 0.027). A predictive model
determined that patients with at least one of these three risk factors have a
74 percent chance of experiencing prolonged times to chemotherapy initiation.
Conclusions: Risk factors for delayed chemotherapy in the context of
postoperative complications are age older than 51.7 years, diabetes, and
autologous reconstruction. Reconstructive candidates who fit this profile are
at highest risk and merit extra consideration. CLINICAL QUESTION/LEVEL OF
EVIDENCE: Risk, III.
[Perspectives] Breast cancer in a Renaissance Book of the Dead
The Lancet
Oncology by Emma Nicholls
PERSPECTIVES|HISTORY OF MEDICINE| VOLUME
19, ISSUE 8, P1023-1024, AUGUST 01, 2018
Walking around galleries
of great Renaissance art, many visitors have found themselves staring in
puzzlement at female nudes who seem to have oddly shaped breasts. In recent
years, a number of medical specialists, working in partnership with art
historians, have argued that we should be less quick to dismiss these apparent
malformations as the result of artistic ineptitude. Instead, they argue that to
the trained eye, these bulges, depressions, and retractions unmistakably signal
the willingness of Renaissance artists to depict women with breast pathologies.
[News] Mammography deficiencies: the result of poor positioning
Poor patient positioning
is the leading cause of clinical image deficiencies and accreditation failures
in mammography, according to a recent investigation.
Comparing Therapeutic versus Prophylactic Nipple-Sparing Mastectomy: Does Indication Inform Oncologic and Reconstructive Outcomes?
by Frey, Jordan D.; Salibian, Ara A.;
Karp, Nolan S.; Choi, Mihye
Background: Initially
performed only in prophylactic cases, indications for nipple-sparing mastectomy
have expanded. Trends and surgical outcomes stratified by nipple-sparing
mastectomy indication have not yet been fully examined. Methods: Demographics and
outcomes for all nipple-sparing mastectomies performed from 2006 to 2017 were
compared by mastectomy indication. Results: A total of 1212 nipple-sparing
mastectomies were performed: 496 (40.9 percent) for therapeutic and 716 (59.1
percent) for prophylactic indications. Follow-up time was similar between both
the therapeutic and prophylactic nipple-sparing mastectomy groups (47.35 versus
46.83 months, respectively; p = 0.7942). Therapeutic nipple-sparing
mastectomies experienced significantly greater rates of major (p = 0.0165) and
minor (p = 0.0421) infection, implant loss (p = 0.0098), reconstructive failure
(p = 0.0058), and seroma (p = 0.0043). Rates of major (p = 0.4461) and minor (p
= 0.2673) mastectomy flap necrosis and complete (p = 0.3445) and partial (p =
0.7120) nipple necrosis were equivalent. The overall rate of locoregional
recurrence/occurrence per nipple-sparing mastectomy was 0.9 percent: 2.0
percent in therapeutic nipple-sparing mastectomies and 0.1 percent in
prophylactic nipple-sparing mastectomies (p < 0.0001). Conclusions:
Approximately 40 percent of nipple-sparing mastectomies are currently performed
for therapeutic indications. Therapeutic nipple-sparing mastectomies had higher
rates of infectious complications and reconstructive failure. Rates of
locoregional cancer recurrence/occurrence are low, but occur significantly more
often after therapeutic nipple-sparing mastectomy. CLINICAL QUESTION/LEVEL OF
EVIDENCE: Therapeutic, III.
The Lumbar Artery Perforator Flap in Autologous Breast Reconstruction: Initial Experience with 100 Cases
by Opsomer, Dries; Stillaert, Filip;
Blondeel, Phillip; Van Landuyt, Koenraad
Background: The lumbar
artery perforator flap is an alternative flap in breast reconstruction for
those patients who are not eligible for a deep inferior epigastric artery
perforator (DIEAP) flap. Shaping of this flap is easier compared with other
flaps because of the quality of the lumbar fat and the gluteal extension.
Methods: Between October of 2010 and June of 2017, a total of 100 lumbar artery
perforator free flap breast reconstructions were performed in 72 patients.
Patient demographics, indications, flap specifics, and complications were
reviewed retrospectively. Results: Twenty-eight bilateral and 44 unilateral
breast reconstructions with a lumbar artery perforator flap were performed.
Mean patient age was 48 years, and the average body mass index was 23.11 kg/m2.
The authors report 43 preventive mastectomies for elevated cancer risk with
subsequent immediate reconstruction, 34 secondary reconstructions, and 14
tertiary reconstructions. Mean operative time was 7 hours 4 minutes, including
the mastectomy in primary cases. Mean flap weight was 499 g (range, 77 to 1216
g) and mean follow-up time was 30 months. The revision rate was 22 percent and
nine flaps were lost. Conclusions: The lumbar artery perforator flap is a
valuable alternative to the DIEAP flap in breast reconstructive surgery. It is
an excellent flap for BRCA-positive patients who are typically young and have
limited excess tissue at the conventional donor sites. Despite higher revision
rates compared with the DIEAP flap, the lumbar flap is superior in mimicking
the shape and feel of native breast tissue. Scarring at the donor site remains
a sore point but can be easily treated and used to an advantage to contour the
flanks. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
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