-
Journal of Plastic, Reconstructive &... May 2024With increasing interest in swift postoperative recovery, there has been a trend toward omitting drains in deep inferior epigastric perforator (DIEP) flap-based breast...
With increasing interest in swift postoperative recovery, there has been a trend toward omitting drains in deep inferior epigastric perforator (DIEP) flap-based breast reconstruction, ideally aiming to avoid drains in the breasts and abdomen. This study evaluated our transition toward total drainless reconstruction, focusing specifically on the safety of omitting drains in the breasts. Patients who underwent breast reconstruction with DIEP flap from 2018 to 2023 were reviewed. They were divided into 3 groups: group A (with drains in the abdomen and breast), group B (drains only in the breast), and group C (total drainless). For group C, routine ultrasound examinations were performed to check for fluid accumulation. Complication profiles were compared among the groups. In total, 294 cases were included, comprising 77 in group A, 112 in group B, and 105 in group C. Chronologically, a gradual increase in the proportion of cases in group C was observed, with the complication rates remaining stable. On comparing the complication profiles of the recipient and donor sites among the 3 groups, no significant differences were found. Breast seroma, persisting 1 month postoperatively, was exclusively detected in 6 (5.7%) cases within group C, all of whom were treated with outpatient clinic-based aspiration. When restricting the analysis to group C, a greater weight of mastectomy specimen and axillary lymph node dissections exhibited an independent association with breast seroma development. Smooth transition to total drainless DIEP breast reconstruction appears safe, without significantly increasing the risks of complication.
PubMed: 38909599
DOI: 10.1016/j.bjps.2024.05.027 -
Computer Methods in Biomechanics and... Jun 2024This study aimed to use a musculoskeletal model to predict changes in spinal moments following simulated breast surgery. A female full body musculoskeletal model with a...
This study aimed to use a musculoskeletal model to predict changes in spinal moments following simulated breast surgery. A female full body musculoskeletal model with a fully articulated thoracolumbar spine and independent moveable breast segments was customised for this study. Key findings suggest that the simulated removal of breast tissue (750 g to 1501 g) can reduce the magnitude of lumbar spine extensor moments by >0.05 Nm/kg during walking and jogging. A customised female whole-body musculoskeletal model is capable of providing a first approximation of changes in spinal loading following simulated breast surgery.
PubMed: 38907664
DOI: 10.1080/10255842.2024.2364819 -
Journal of Plastic, Reconstructive &... Jun 2024Breast reconstruction involves collaborative decision-making between patients and surgeons, but the need for multiple revisions after the initial reconstructive surgery...
BACKGROUND
Breast reconstruction involves collaborative decision-making between patients and surgeons, but the need for multiple revisions after the initial reconstructive surgery process can burden patients and the healthcare system. This study explored how the type of breast reconstruction (autologous [ABR], immediate implant-based reconstruction [IBR], or two-stage IBR) impacts postreconstruction revision rates.
METHOD
Using MarketScan Databases, a retrospective database study (2007-2021) was conducted, identifying revision procedures through Current Procedural Terminology codes. Statistical analysis with linear models, adjusted for patient characteristics and surgical factors, used a significance threshold of p < 0.05.
RESULTS
Among 58,264 patients, 6.2% of ABR patients, 3.8% of immediate IBR patients, and 3.6% of two-stage IBR patients underwent future revisions. IBR had a 51% lower incidence rate of revision operations than ABR (incidence rate ratio = 0.49, p < 0.001). Within IBR, there was no significant difference in the number of operations between immediate IBR (0.06 ± 0.32) and two-stage IBR (0.05 ± 0.32, p = 0.95). Immediate IBR demonstrated 12% (OR = 0.88, p = 0.0022) and 70% (OR = 0.30, p < 0.001) lower odds of requiring breast revision and fat grafting compared to ABR, respectively. Two-stage reconstruction had 66 % lower odds of requiring only fat grafting than ABR (OR = 0.34, p < 0.001).
CONCLUSION
ABR necessitated a higher number of total revision procedures after completion of the initial reconstruction. These findings will better equip providers and patients to counsel patients in understanding their reconstructive journey, planning their reconstructions and timing, and provide more accurate estimates of the number of procedures that will be required to reach their aesthetic goals and final outcome.
PubMed: 38905789
DOI: 10.1016/j.bjps.2024.05.048 -
American Family Physician Jun 2024Gender-affirming surgery includes a range of procedures that help align a transgender or gender diverse person's body with their gender identity. As rates of...
Gender-affirming surgery includes a range of procedures that help align a transgender or gender diverse person's body with their gender identity. As rates of gender-affirming surgery increase, family physicians will need to have the knowledge and skills to provide lifelong health care to this population. Physicians should conduct an anatomic survey or organ inventory with patients to determine what health screenings are applicable. Health care maintenance should follow accepted guidelines for the body parts that are present. Patients do not require routine breast cancer screening after mastectomy; however, because there is residual breast tissue, symptoms of breast cancer warrant workup. After masculinizing genital surgery, patients should have lifelong follow-up with a urologist familiar with gender-affirming surgery. If a prostate examination is indicated after vaginoplasty, it should be performed vaginally. If a pelvic examination is indicated after vaginoplasty, it should be performed with a Pederson speculum or anoscope. After gonadectomy, patients require hormone therapy to prevent long-term morbidity associated with hypogonadism, including osteoporosis. The risk of sexually transmitted infections may change after genital surgery depending on the tissue used for the procedure. Patients should be offered the same testing and treatment for sexually transmitted infections as cisgender populations, with site-specific testing based on sexual history. If bowel tissue is used in vaginoplasty, vaginal bleeding may be caused by adenocarcinoma or inflammatory bowel disease. (Am Fam Physician. 2024;109(6):560-565.
Topics: Humans; Female; Sex Reassignment Surgery; Male; Transgender Persons; Sexually Transmitted Diseases
PubMed: 38905554
DOI: No ID Found -
Cureus May 2024Adenomyoepitheliomas of the breast are rare tumors that are characterized histologically as having both epithelial and myoepithelial components. While...
Adenomyoepitheliomas of the breast are rare tumors that are characterized histologically as having both epithelial and myoepithelial components. While adenomyoepitheliomas are considered benign lesions, existing literature supports their potential for malignant transformation. These tumors also exhibit nonspecific and variable findings on noninvasive imaging, posing additional challenges in management. We present a rare case of an adenomyoepithelioma diagnosed in a 65-year-old female who was treated with surgical resection of her tumor, with histopathology negative for malignant transformation. By describing this patient's management course, we aim to contribute to existing literature analyzing adenomyoepitheliomas and help guide future treatment.
PubMed: 38903269
DOI: 10.7759/cureus.60801 -
Plastic and Reconstructive Surgery.... Jun 2024The study investigated the expectations of patients undergoing immediate breast reconstruction after mastectomy, considering factors such as the cause for mastectomy...
BACKGROUND
The study investigated the expectations of patients undergoing immediate breast reconstruction after mastectomy, considering factors such as the cause for mastectomy (cancer versus prophylactic due or gene mutations), age, marital status, and education.
METHODS
The study had a cross-sectional design. Eligible patients at Oslo University Hospital received a link to the BREAST-Q Expectations questionnaire, which they filled out before surgery from 2019 to 2022.
RESULTS
One hundred forty-six patients completed the questionnaire (79.8% response rate). The mean age was 46.6 years, and the majority (95.1%) were undergoing reconstruction with implants. Most patients (86.9%) wanted to be involved in the decision-making. The highest expectation was for breast appearance and the lowest for sensation after surgery. Patients not diagnosed with cancer (n = 27) before surgery expected significantly more pain after surgery compared with patients diagnosed with cancer ( = 0.016). Patients 40 years or younger had higher expectation of pain after surgery than patients 41 years or older, 73.2 versus 54.2, < 0.001, respectively. After 10 years, 26.7% of the patients expected that further reconstruction procedures might be necessary.
CONCLUSIONS
Our study's results regarding patient's expectations with breast reconstruction, as assessed using the BREAST-Q Expectations module, align with previous research in terms of overall trends. However, our study provides a more nuanced understanding by exploring variations within different patient subgroups. These differences emphasize the need for personalized preoperative counseling and support to align patient's expectations with realistic outcomes.
PubMed: 38903141
DOI: 10.1097/GOX.0000000000005928 -
International Journal of Surgery Case... Jul 2024Pseudoangiomatous stromal hyperplasia (PASH) is a rare breast stromal lesion that typically manifests clinically as a palpable unilateral, painless lump that is freely...
Innovative technique for managing extreme relapsing bilateral pseudoangiomatous stromal hyperplasia (PASH) in a young woman: A case report highlighting a novel intervention in reconstruction.
INTRODUCTION
Pseudoangiomatous stromal hyperplasia (PASH) is a rare breast stromal lesion that typically manifests clinically as a palpable unilateral, painless lump that is freely movable and has a rubbery or firm consistency. The diagnosis can be confirmed by a core needle biopsy (CNB) or surgical excision. Treatment options include medical treatment with hormonal management for asymptomatic patients or local excision and breast reduction in rare cases.
CASE PRESENTATION
We reported the case of a 24-year-old woman with a history of taking contraceptive pills for about a year. Examination revealed extremely enlarged, sore, and swollen breasts, particularly the right side, marking her third PASH relapse. The patient underwent a surgical skin-reducing mastectomy (SRM) using a novel technique with an immediate prepectoral implant covered by a dermal flap to reconstruct the breast shape due to the large PASH lesions and aiming for optimal cosmetic outcomes. The procedure was complication-free with no recurrence after 18 months of follow-up.
DISCUSSION
Mastectomy followed by immediate implantation offers benefits such as prompt restoration of breast shape with fewer surgeries.
CONCLUSION
This case report highlights the successful use of immediate implantation in reconstructing large recurrent benign breast diseases. The outcomes indicate that immediate implantation shows promise as a suitable choice for carefully selected patients managing large, relapsing bilateral benign breast diseases. However, due to common complications such as infection and implant loss, it is not generally recommended for benign lesions. The decision should be made on a case-by-case basis, considering the size, recurrence, and individual suitability.
PubMed: 38901382
DOI: 10.1016/j.ijscr.2024.109873 -
Cancer Radiotherapie : Journal de La... Jun 2024Breast-conserving surgery followed by reirradiation for a localized ipsilateral breast tumour relapse may increase the radiation dose delivered to the heart and result...
PURPOSE
Breast-conserving surgery followed by reirradiation for a localized ipsilateral breast tumour relapse may increase the radiation dose delivered to the heart and result in a greater risk of cardiac adverse events. This study aimed to compare the incidence of cardiac mortality in patients treated for a localized ipsilateral breast tumour relapse, either with breast-conserving surgery followed by reirradiation or with total mastectomy between 2000 and 2020.
MATERIALS AND METHODS
All patients treated for a primary non-metastatic breast cancer with breast-conserving surgery and adjuvant radiotherapy were identified in the Surveillance, Epidemiology, and End Results (SEER) program database, and those who subsequently experienced a localized ipsilateral breast tumour relapse treated with breast-conserving surgery and reirradiation ("BCS+ReRT" group, n=239) or with total mastectomy ("TM" group, n=3127) were included. The primary objective was to compare the cardiac mortality rate between the patients who underwent breast-conserving surgery followed by reirradiation and total mastectomy. Secondary endpoints were overall survival and cancer specific survival.
RESULTS
Cardiac mortality was significantly higher in patients treated with breast-conserving surgery followed by reirradiation (hazard ratio [HR]: 2.40, 95% confidence interval [95% CI]: 1.19-4.86, P=0.006) in univariate analysis; non-statistically significant differences were observed after adjusting for age, laterality and chemotherapy on multivariate analysis (HR: 1.96, 95% CI: 0.96-3.94, P=0.067), age being the only confounding factor. A non-statistically significant difference towards lower overall survival was observed in patients who had breast-conserving surgery followed by reirradiation compared with those who underwent total mastectomy (HR: 1.37, 95% CI: 0.98-1.90, P=0.066), and no differences were observed in terms of cancer specific survival (HR: 1.01, 95% CI: 0.56-1.82, P=0.965).
CONCLUSION
In this study, the incidence of cardiac mortality was low, and breast-conserving surgery followed by reirradiation did not independently increased the risk of cardiac mortality for a localized ipsilateral breast tumour relapse.
Topics: Humans; Female; Mastectomy, Segmental; Middle Aged; Neoplasm Recurrence, Local; Re-Irradiation; Aged; Radiotherapy, Adjuvant; Adult; SEER Program; Breast Neoplasms; Mastectomy; Unilateral Breast Neoplasms; Retrospective Studies; Incidence
PubMed: 38897883
DOI: 10.1016/j.canrad.2024.03.001 -
Journal of Cancer Survivorship :... Jun 2024Long-term upper extremity symptoms after breast cancer treatment may impact patient-reported financial difficulty. In this cross-sectional investigation, we hypothesized...
PURPOSE
Long-term upper extremity symptoms after breast cancer treatment may impact patient-reported financial difficulty. In this cross-sectional investigation, we hypothesized that severity of arm symptoms would be associated with greater financial difficulty.
METHODS
Stage 0-III breast cancer patients treated at our institution from 2002 to 2012 were recruited for a 2018 survey study appraising disease-specific patient-centered outcomes using EORTC-QLQ-BR23 and EORTC-QLQ-C30 questionnaires. The association between Arm Symptom (AS) score and Financial Impact (FI) score was assessed, adjusting for clinically relevant variables.
RESULTS
Of 1126 interested participants, 882 (78%) responded to surveys. Three hundred fourteen (36%) with incomplete responses were excluded. Median time from surgery was 9 years; 181 (32%) and 117 (21%) had mastectomy with or without reconstruction, 126 (22%) received postmastectomy radiation (PMRT), and 221 (39%) underwent axillary lymph node dissection. 76 (13%) reported some degree of financial difficulty; 10 (2%) the highest degree of difficulty. Of 217 (38%) patients experiencing arm symptoms, 60 (28%) had severe symptoms. Seven (70%) of those with highest degree of financial difficulty had severe arm symptoms. Younger age at surgery (p = .029), mastectomy with reconstruction (p = 0.003), Hispanic ethnicity (p < 0.001), PMRT (p = 0.027), recurrence (p < 0.001), and higher AS score (p < 0.001) were associated with greater financial difficulty. On multivariable analysis, AS score, younger age, Hispanic ethnicity, and recurrence remained associated with financial difficulty.
CONCLUSION
In this study, younger age, Hispanic ethnicity, and arm morbidity were associated with increased risk for financial difficulty. Clarifying how treatment-related adverse events such as arm morbidity increase financial hardship may guide interventions to mitigate this burden.
PubMed: 38896173
DOI: 10.1007/s11764-024-01628-w -
Breast Cancer (Tokyo, Japan) Jun 2024Immediate breast reconstruction (IBR) is a common oncoplastic procedure used in breast cancer surgery. This study aims to investigate compliance with prosthetic breast...
BACKGROUND
Immediate breast reconstruction (IBR) is a common oncoplastic procedure used in breast cancer surgery. This study aims to investigate compliance with prosthetic breast reconstruction guidelines and its impact on perioperative treatment.
METHODS
We reviewed data from the National Clinical Database-Breast Cancer Registry between January 2019 and December 2020. We compared perioperative treatment implementation between the IBR and non-IBR groups by subtype matching for age, menopausal status, T stage, N stage, and histology.
RESULTS
A total of 8,860 patients with breast cancer who underwent IBR (6,075 breast prostheses, 2,492 autologous tissues, and 293 others) were identified. The compliance rate with the guidelines for prosthetic breast reconstruction was 97.7%. After matching, chemotherapy for luminal A-like diseases was significantly less frequent in the IBR group than in the non-IBR group (16.3% vs 20.5%, p < 0.001), and radiotherapy was less frequent in luminal A-like and HER2-positive patients (7.2% vs 9.0%, p = 0.010 and 7.1% vs 11.4%, p = 0.005, respectively). Among the 1-3 node-positive cases, fewer patients with prosthetic IBR received radiotherapy than those without IBR (15.7% vs 26.4%, p < 0.001).
CONCLUSION
Prosthetic breast reconstruction was performed with strict adherence to the Japanese guidelines. The implementation rates of chemotherapy and radiotherapy were lower in the specific IBR group than those in the non-IBR group. Therefore, large-scale, long-term follow-up data are required.
PubMed: 38896169
DOI: 10.1007/s12282-024-01604-3