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AME Case Reports 2024Breast augmentation through the injection of polyacrylamide hydrogel (PAAG) was a popular procedure in the past, but it has since been prohibited due to various...
BACKGROUND
Breast augmentation through the injection of polyacrylamide hydrogel (PAAG) was a popular procedure in the past, but it has since been prohibited due to various complications, including masses, migration, infection, inflammation, and even cancer. However, there were rare cases of granulomatous mastitis with pectoralis major muscle defect following PAAG injection for breast augmentation.
CASE DESCRIPTION
A 40-year-old female patient presented with a swollen and suppurative mass in her left breast and was insensitive to antibiotics. She was admitted to our department for further treatment after 7 months with progressive local and general symptoms. Ultrasound imaging showed ill-defined heterogeneous echoes, and contrast-enhanced magnetic resonance imaging (MRI) revealed non-mass enhancement lesions in the multiregional distribution in Breast Imaging-Reporting and Data System 4A (BI-RADS 4A) with oedema in the retroglandular space and multiple enlarged lymph nodes in the ipsilateral axilla. Intraoperative observations revealed necrotic tissues, multiple abscesses, residual mucoid PAAG prosthesis diffused into the mammary glands and intramuscularly into the pectoralis muscle, and partial loss of pectoralis major muscle. Histopathological results revealed foreign-body granulomas accompanied by gel-like granular PAAG and proliferative inflammatory cells. She recovered after undergoing the characteristic surgical management in our center under general anesthesia and had no recurrence during the 2-year follow-up.
CONCLUSIONS
This case revealed that PAAG injection for augmentation mammaplasty, even after the removal operation, could result in subsequent complications, including granulomatous mastitis and pectoralis major muscle damage. PAAG filler complications are difficult to treat, therefore, it is essential to establish appropriate and effective therapeutic procedures.
PubMed: 38711878
DOI: 10.21037/acr-23-174 -
Journal of Robotic Surgery May 2024Breast reconstruction is an integral part of breast cancer management. Conventional techniques of flap harvesting for autologous breast reconstruction are associated... (Meta-Analysis)
Meta-Analysis Comparative Study Review
Breast reconstruction is an integral part of breast cancer management. Conventional techniques of flap harvesting for autologous breast reconstruction are associated with considerable complications. Robotic surgery has enabled a new spectrum of minimally invasive breast surgeries. The current systematic review and meta-analysis study was designed to retrieve the surgical and clinical outcomes of robotic versus conventional techniques for autologous breast reconstruction. An extensive systematic literature review was performed from inception to 25 April 2023. All clinical studies comparing the outcomes of robotic and conventional autologous breast reconstruction were included for meta-analysis. The present meta-analysis included seven articles consisting of 783 patients. Of them, 263 patients received robotic breast reconstruction, while 520 patients received conventional technique. Of note, 477 patients received latissimus dorsi flap (LDF) and 306 were subjected to deep inferior epigastric artery perforator (DIEP) flap. There was a significantly prolonged duration of surgery (MD 58.36;95% CI 32.05,84.67;P < 0.001) and duration of anaesthesia (MD 47;95% CI 16.23,77.77;P = 0.003) among patients who underwent robotic surgery. There was a similar risk of complications between robotic and conventional surgeries. The mean level of pain intensity was significantly lower among patients who received robotic breast surgery (MD- 0.28;95% CI - 0.73,0.17; P = 0.22). There was prolonged length of hospitalization among patients with conventional DIEP flap surgery (MD- 0.59;95% CI - 1.13,- 0.05;P = 0.03). The present meta-analysis highlighted the feasibility, safety, and effectiveness of robotic autologous breast reconstruction. This included the successful harvesting of LDF and DIEP flap with acceptable surgical and functional outcomes.
Topics: Robotic Surgical Procedures; Humans; Mammaplasty; Female; Treatment Outcome; Breast Neoplasms; Operative Time; Transplantation, Autologous; Postoperative Complications; Superficial Back Muscles; Perforator Flap; Surgical Flaps
PubMed: 38693427
DOI: 10.1007/s11701-024-01913-x -
In Vivo (Athens, Greece) 2024To compare implant sparing irradiation with conventional radiotherapy (RT) using helical (H) and TomoDirect (TD) techniques in breast cancer patients undergoing... (Comparative Study)
Comparative Study
BACKGROUND/AIM
To compare implant sparing irradiation with conventional radiotherapy (RT) using helical (H) and TomoDirect (TD) techniques in breast cancer patients undergoing immediate breast reconstruction (IBR).
PATIENTS AND METHODS
The dosimetric parameters of 40 patients with retropectoral implants receiving 50.4 Gy delivered in 28 fractions were analyzed. Three plans were created: H plan using conventional planning target volume (PTV) that included the chest wall, skin, and implant; TD plan using conventional PTV; and Hs plan using implant-sparing PTV. The H, TD, and Hs plans were compared for PTV doses, organ-at-risk (OAR) doses, and treatment times.
RESULTS
Dose distribution in the Hs plan was less homogeneous and uniform than that in the H and TD plans. The TD plan had lower lung, heart, contralateral breast, spinal cord, liver, and esophagus doses than the Hs plan. Compared to the Hs plan, the H plan had lower lung volume receiving 5Gy (V5) (39.1±3.9 vs. 41.2±3.9 Gy; p<0.001), higher V20 (12.3±1.3 vs. 11.5±2.6 Gy; p=0.02), and higher V30 (7.5±1.6 vs. 4.4±1.7 Gy; p<0.001). H plan outperformed Hs plan in heart dosimetric parameters except V20. The Hs plan had significantly lower mean implant doses (43.4±2.1 Gy) than the H plan (51.4±0.5 Gy; p<0.001) and the TD plan (51.9±0.6 Gy; p<0.001). Implementing an implant sparing technique for silicone dose reduction decreases lung doses.
CONCLUSION
Conventional H and TD plans outperform the implant sparing helical plan dosimetrically. Because capsular contracture during RT is unpredictable, long-term clinical outcomes are required to determine whether silicon should be spared.
Topics: Humans; Female; Breast Neoplasms; Radiotherapy Planning, Computer-Assisted; Radiotherapy, Intensity-Modulated; Radiotherapy Dosage; Organs at Risk; Middle Aged; Mammaplasty; Adult; Breast Implants; Radiometry; Aged
PubMed: 38688603
DOI: 10.21873/invivo.13583 -
Asian Pacific Journal of Cancer... Apr 2024Breast cancer is a common disease that affects women globally and causes physical and emotional challenges. Breast reconstructive surgery aims to restore the shape of... (Meta-Analysis)
Meta-Analysis Comparative Study
INTRODUCTION
Breast cancer is a common disease that affects women globally and causes physical and emotional challenges. Breast reconstructive surgery aims to restore the shape of the breast after a mastectomy. Two common approaches used today are tissue-based or autologous and implant-based reconstruction. Autologous breast reconstruction has the advantage of being more affordable, but the resulting shape is less attractive. At the same time, the implant technique produces a more pleasing shape at a more expensive cost.
OBJECTIVE
To compare the level of patients' satisfaction after breast reconstruction using the implant technique with the autologous technique using the Breast-Q questionnaire.
METHODS
This research was a meta-analytic study to compare patients' satisfaction levels with breast reconstruction using the autologous technique compared with the implant technique. We searched several research articles from PubMed, EMBASE, and the Cochrane Library from 2014 to 2023. Then, we conducted an analysis using Revman 5.4. The results of the study were presented in a forest plot diagram.
RESULTS
From the search results, there were 3980 studies. Then, exclusion and inclusion were carried out, and the results obtained were 16 research articles. Of the 16 studies, analysis was then carried out, and the results obtained were satisfaction in breast patients with a sample size of 7284. The standard result of the mean difference was 0.55 (95% CI 0.41-0.68) p < 0.00001. Satisfaction with the reconstruction results with a sample size of 2935. The standard result of the mean difference was 0.48 (95% CI 0.28-0.69) p < 0.00001. Patients' sexual satisfaction with a sample size of 7149. The standard result of the mean difference was 0.27 (95% CI 0.17-0.37) p < 0.00001. Patients' satisfaction with nipple shapes with a sample of 426. The standard result of the mean difference was 0.22 (95% CI -0.00-0.44) p = 0.06. Patients' satisfaction with plastic surgeons with a sample size of 272. The standard result of the mean difference was 0.52 (95% CI 0.25-0.80) p= 0.0002.
CONCLUSION
The autologous breast reconstruction technique is better than the implant-based reconstruction technique in terms of patient satisfaction with the breast, reconstruction outcome, sexual satisfaction, nipple shapes, and plastic surgeons based on the Breast-Q questionnaire. The findings of this comprehensive study indicate that breast cancer survivors who choose autologous reconstruction have higher levels of satisfaction across multiple domains than those who decide implant-based reconstruction.
Topics: Female; Humans; Breast Implantation; Breast Implants; Breast Neoplasms; Mammaplasty; Mastectomy; Patient Satisfaction; Surveys and Questionnaires; Transplantation, Autologous
PubMed: 38679979
DOI: 10.31557/APJCP.2024.25.4.1205 -
Pharmaceutics Apr 2024Breast cancer ranks among the most commonly diagnosed cancers worldwide and bears the highest mortality rate. As an integral component of cancer treatment, mastectomy...
Breast cancer ranks among the most commonly diagnosed cancers worldwide and bears the highest mortality rate. As an integral component of cancer treatment, mastectomy entails the complete removal of the affected breast. Typically, breast reconstruction, involving the use of silicone implants (augmentation mammaplasty), is employed to address the aftermath of mastectomy. To mitigate postoperative risks associated with mammaplasty, such as capsular contracture or bacterial infections, the functionalization of breast implants with coatings of cyclodextrin polymers as drug delivery systems represents an excellent alternative. In this context, our work focuses on the application of a mathematical model for simulating drug release from breast implants coated with cyclodextrin polymers. The proposed model considers a unidirectional diffusion process following Fick's second law, which was solved using the orthogonal collocation method, a numerical technique employed to approximate solutions for ordinary and partial differential equations. We conducted simulations to obtain release profiles for three therapeutic molecules: pirfenidone, used for preventing capsular contracture; rose Bengal, an anticancer agent; and the antimicrobial peptide KR-12. Furthermore, we calculated the diffusion profiles of these drugs through the cyclodextrin polymers, determining parameters related to diffusivity, solute solid-liquid partition coefficients, and the Sherwood number. Finally, integrating these parameters in COMSOL multiphysics simulations, the unidirectional diffusion mathematical model was validated.
PubMed: 38675147
DOI: 10.3390/pharmaceutics16040486 -
Canadian Journal of Surgery. Journal... 2024Breast cancer is the most common cancer affecting females in Canada, and about half of females with breast cancer are treated with mastectomy. We sought to evaluate...
BACKGROUND
Breast cancer is the most common cancer affecting females in Canada, and about half of females with breast cancer are treated with mastectomy. We sought to evaluate geographic variation in breast reconstruction surgery in Alberta, Canada.
METHODS
Using linked population-based administrative databases, we extracted data on all Alberta females aged 18 years and older who were diagnosed with breast cancer and treated with mastectomy during 2004-2017. Analyses included regression modelling of odds of reconstruction at 1 year and a spatial scan to identify geographic clusters of lower numbers of reconstruction.
RESULTS
A total of 16 198 females diagnosed with breast cancer were treated with a mastectomy, and 1932 (11.9%) had reconstruction within 1 year postmastectomy. Those with reconstruction were more likely to be younger (adjusted odds ratio [OR] 16.7, 95% confidence interval [CI] 13.7-20.3; aged 21-44 yr v. ≥ 65 yr) and were less likely to be from lower-income neighbourhoods. They were more likely to have at least 1 comorbidity and were more likely to have advanced stages of cancer and to require chemotherapy (adjusted OR 0.55, 95% CI 0.47-0.65) or radiotherapy after mastectomy (adjusted OR 0.59, 95% CI 0.39-0.87) than females without reconstruction. We identified rural northern and southeastern clusters with frequencies of reconstruction that were 69.6% and 41.6% of what was expected, respectively.
CONCLUSION
We found an overall postmastectomy rate of breast reconstruction of 11.9%, and we identified geographic variation. Predictors of reconstruction in Alberta were similar to those previously described in the literature, specifically with patients in rural communities having lower rates of reconstruction than their urban counterparts. These results suggest that further interventions are required to identify the specific barriers to reconstruction within rural communities and to create strategies to ensure equitable access to all residents.
Topics: Humans; Female; Alberta; Breast Neoplasms; Mastectomy; Adult; Middle Aged; Mammaplasty; Aged; Young Adult
PubMed: 38670581
DOI: 10.1503/cjs.003823 -
Journal of Plastic, Reconstructive &... Jun 2024Little research has been conducted on factors influencing the decision-making process for immediate breast reconstruction (IBR) options from the perspective of...
Factors influencing the decision-making process in breast reconstruction from the perspective of reconstructive surgeons: A qualitative study involving Korean plastic surgeons.
BACKGROUND
Little research has been conducted on factors influencing the decision-making process for immediate breast reconstruction (IBR) options from the perspective of reconstructive surgeons, despite its significant impact on doctor-patient communication and shared decision-making. This study aims to explore the multiple factors and the mechanisms by which they interact using a qualitative methodology. We also address potential barriers to shared decision-making in IBR.
METHODS
Semistructured interviews were conducted with a purposive sample of reconstructive surgeons. Thematic analysis was used to identify key influences on IBR decision-making process from the perspective of reconstructive surgeons.
RESULTS
Four major themes were identified: 1. Patient clinical scenarios; 2. Nonclinical practice environments; 3. Reconstructive surgeon preferences; and 4. Patient consultation. Reconstructive surgeons demonstrated diverse approaches to patient clinical scenarios. High-volume centers were significantly influenced by nonclinical factors such as scheduling and operating room allocation systems. Reconstructive surgeons often had strong personal preferences for specific IBR options, shaped by their expertise, experience, and clinical environment. Based on the preliminary decision, surgeons provided information with varying degrees of neutrality. Patients varied in their knowledge and participation, resulting in variation in the final decision authority among surgeons.
CONCLUSIONS
This study highlights the need to address nonclinical environmental constraints to improve shared decision-making process in IBR. Surgeons should recognize power imbalances in the doctor-patient relationship and be aware of their biases.
Topics: Humans; Mammaplasty; Female; Qualitative Research; Surgeons; Physician-Patient Relations; Republic of Korea; Decision Making; Adult; Attitude of Health Personnel; Middle Aged; Interviews as Topic; Decision Making, Shared; Breast Neoplasms; Patient Participation
PubMed: 38670035
DOI: 10.1016/j.bjps.2024.04.016 -
Current Oncology (Toronto, Ont.) Apr 2024Post-mastectomy pain syndrome (PMPS), characterized by persistent pain lasting at least three months following mastectomy, affects 20-50% of breast surgery patients,... (Meta-Analysis)
Meta-Analysis
Post-mastectomy pain syndrome (PMPS), characterized by persistent pain lasting at least three months following mastectomy, affects 20-50% of breast surgery patients, lacking effective treatment options. A review was conducted utilizing EMBASE, MEDLINE, and all evidence-based medicine reviews to evaluate the effect of fat grafting as a treatment option for PMPS from database inception to 29 April 2023 (PROSPERO ID: CRD42023422627). Nine studies and 812 patients in total were included in the review. The overall mean change in visual analog scale (VAS) was -3.6 in 285 patients following fat grafting and 0.5 in 147 control group patients. There was a significant reduction in VAS from baseline in the fat grafting group compared to the control group, = 395, mean difference = -2.17 (95% CI, -2.95 to -1.39). This significant improvement was also noted in patients who underwent mastectomy without reconstruction. Common complications related to fat grafting include capsular contracture, seroma, hematoma, and infection. Surgeons should consider fat grafting as a treatment option for PMPS. However, future research is needed to substantiate this evidence and to identify timing, volume of fat grafting, and which patient cohort will benefit the most.
Topics: Female; Humans; Adipose Tissue; Breast Neoplasms; Mammaplasty; Mastectomy; Pain, Postoperative; Treatment Outcome
PubMed: 38668055
DOI: 10.3390/curroncol31040152 -
Scientific Reports Apr 2024In this article, we present a modification of the NS/SRM technique in which the mastopexy design for skin reduction is undertaken with a wide-base bipedicled (WIBB)...
In this article, we present a modification of the NS/SRM technique in which the mastopexy design for skin reduction is undertaken with a wide-base bipedicled (WIBB) flap. The WIBB flap can be applied in both autologous and implant-based breast reconstruction. Our reconstructive algorithm is also presented. The clinical data of patients operated on from June 2017 to November 2022 were collected: 51 patients for a total of 71 breasts. Personal data, BMI, type and volume of implants used, and major and minor complications were analyzed by descriptive statistics. The mean age was 48.3 years. BMI ranged between 21.5 and 30.9 kg/m. Thirty-one patients underwent unilateral mastectomy, while twenty patients underwent bilateral surgery. In 25 breasts, immediate reconstruction was performed with implants and ADM. In 40 breasts, reconstruction was performed with a subpectoral tissue expander, and in 6 breasts, reconstruction was performed with a DIEP flap. We observed only one case (1.4%) of periprosthetic infection requiring implant removal under general anesthesia. Minor complications occurred in 14.1% of patients. The use of both the WIBB flap and our algorithm maintained a low complication rate in our series, ensuring oncological radicality and a good aesthetic result at the same time.
Topics: Humans; Female; Middle Aged; Surgical Flaps; Mastectomy; Mammaplasty; Nipples; Adult; Breast Neoplasms; Aged; Postoperative Complications
PubMed: 38649704
DOI: 10.1038/s41598-024-52396-7 -
Scientific Reports Apr 2024This study aimed to evaluate the survival outcomes of neoadjuvant radiochemotherapy (NARCT) for early breast cancer. Female patients ≤ 80 years old with...
This study aimed to evaluate the survival outcomes of neoadjuvant radiochemotherapy (NARCT) for early breast cancer. Female patients ≤ 80 years old with unilateral T1-T4 invasive ductal breast cancer treated with neoadjuvant chemotherapy (NAC) and radiation therapy (RT) between 2006 and 2015 were enrolled from SEER database. Baseline differences in clinical and pathological characteristics were evaluated using chi-square test. The survival outcomes were estimated by Kaplan-Meier analysis and compared using Cox hazards models. The effects of baseline differences on survival outcome in patients treated with neoadjuvant radiation therapy (NART) and post-operation radiation therapy (PORT) were circumvented by propensity score matching (PSM). Altogether 14,151 patients receiving NAC and RT were enrolled, among whom 386 underwent NART. Based on a 1:4 PSM cohort, NART was an independent unfavorable prognostic factor for breast cancer-specific survival (BCSS) and overall survival (OS) for the whole cohort. However, among patients receiving breast conserving surgery (BCS) (HR 1.029, P = 0.915 for BCSS; HR 1.003, P = 0.990 for OS) or implant-based immediate breast reconstruction (IBR) (HR 1.039, P = 0.921 for BCSS; HR 1.153, P = 0.697 for OS), those treated with NART had similar survival outcomes compared with patients treated with PORT. In conclusion, NARCT was a safe and feasible approach for patients undergoing BCS and IBR.
Topics: Humans; Female; Breast Neoplasms; Neoadjuvant Therapy; Mastectomy, Segmental; Middle Aged; Aged; Adult; Mammaplasty; Kaplan-Meier Estimate; Treatment Outcome; Chemoradiotherapy; Aged, 80 and over; Prognosis; Retrospective Studies
PubMed: 38649431
DOI: 10.1038/s41598-024-59961-0