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Breast (Edinburgh, Scotland) Jun 2023Simple breast conservation surgery (sBCS) has technically advanced onto oncoplastic breast procedures (OBP) to avoid mastectomy and improve breast cancer patients'... (Review)
Review
Simple breast conservation surgery (sBCS) has technically advanced onto oncoplastic breast procedures (OBP) to avoid mastectomy and improve breast cancer patients' psychosocial well-being and cosmetic outcome. Although OBP are time-consuming and expensive, we are witnessing an increase in their use, even for cases that could be managed with sBCS. The choice between keeping it simple or opting for more complex oncoplastic procedures is difficult. This review proposes a pragmatic approach in assisting this decision. Medical literature suggests that OBP and sBCS might be similar regarding local recurrence and overall survival, and patients seem to have higher satisfaction levels with the aesthetic outcome of OBP when compared to sBCS. However, the lack of comprehensive high-quality research assessing their safety, efficacy, and patient-reported outcomes hinders these supposed conclusions. Postoperative complications after OBP may delay the initiation of adjuvant RT. In addition, precise displacement of the breast volume is not effectively recorded despite surgical clips placement, making accurate dose delivery tricky for radiation oncologists, and WBRT preferable to APBI in complex OBP cases. With a critical eye on financial toxicity, patient satisfaction, and oncological outcomes, OBP must be carefully integrated into clinical practice. The thoughtful provision of informed consent is essential for decision-making between sBCS and OBP. As we look into the future, machine learning and artificial intelligence can potentially help patients and doctors avoid postoperative regrets by setting realistic aesthetic expectations.
Topics: Humans; Female; Breast Neoplasms; Mastectomy; Mastectomy, Segmental; Artificial Intelligence; Breast; Mammaplasty
PubMed: 36924556
DOI: 10.1016/j.breast.2023.03.006 -
World Journal of Surgical Oncology Apr 2016Mesh use in surgical breast reconstruction is becoming increasingly common; however, there is still no consensus on whether synthetic matrices or biological matrices... (Review)
Review
Mesh use in surgical breast reconstruction is becoming increasingly common; however, there is still no consensus on whether synthetic matrices or biological matrices produce the best outcomes. This review analyses these outcomes, namely the differences in aesthetic outcomes, cost, and the rates of the most commonly reported complications.The results indicate that breast reconstruction with a synthetic matrix produces comparable aesthetic outcomes to a biological matrix, with lower costs and complication rates. The individual results for complication rates show that biological matrixes are associated with lower infection rates and slightly lower capsular contracture, but higher haematoma rates, and slightly higher rates of skin necrosis and explantation--although many had post-op radiotherapy.The majority of the studies evaluated used biological matrices, and there are no randomised controlled trials directly comparing the two types of meshes; definite conclusions cannot be drawn from the available evidence. The authors suggest that a randomised controlled trial comparing these outcomes in synthetic and biological matrix use is needed.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Surgical Mesh
PubMed: 27102580
DOI: 10.1186/s12957-016-0874-9 -
In Vivo (Athens, Greece) 2023Silicone implants or tissue expanders placed under the pectoralis major (PM) muscle are often used for breast reconstruction. However, the disruption of PM insertions,... (Review)
Review
Silicone implants or tissue expanders placed under the pectoralis major (PM) muscle are often used for breast reconstruction. However, the disruption of PM insertions, which is often an inevitable part of the surgical procedure, is known to cause PM morbidity and, subsequently, problems with the use of the ipsilateral arm. In this systematic review, we present current knowledge regarding the effect of submuscular silicone-based breast reconstruction on the function of PM and the ipsilateral arm. A search of the relevant English literature was performed through PubMed and ten eligible studies were identified. Articles reporting breast augmentation were accepted as the techniques of implant insertion are similar to reconstruction. Questionnaires reporting the status of the arm, analysis of the range of motion of the shoulder with 3-D video, isometric or isokinetic dynamometry, ultrasound shear-wave elastography, volumetric MRI, electromyography and light and electron microscopy of the PM fibers were used for the assessment of PM and arm status. The insertion of implants under the PM, especially when combined with dissection of some of its insertions, seems to be associated with measurable abnormal microscopic, imaging, and dynamometric findings. However, the intact part of the muscle and possibly other nearby muscular structures are able to compensate for the lost part of PM. Thus, the insertion of implants fully or partially under the PM seems to have no or little effect on the function of the ipsilateral upper limb in daily life.
Topics: Pectoralis Muscles; Silicones; Mammaplasty; Prostheses and Implants; Magnetic Resonance Imaging; Breast Implants
PubMed: 37652471
DOI: 10.21873/invivo.13289 -
Annals of the Royal College of Surgeons... Feb 2017
Topics: Female; Humans; Mammaplasty; Nipples; Surgical Flaps
PubMed: 27659355
DOI: 10.1308/rcsann.2016.0307 -
Tidsskrift For Den Norske Laegeforening... Mar 2005It is estimated that approximately 50,000 Norwegian women have silicone breast implants following breast augmentation or breast reconstruction. Their numbers are growing... (Review)
Review
BACKGROUND
It is estimated that approximately 50,000 Norwegian women have silicone breast implants following breast augmentation or breast reconstruction. Their numbers are growing and doctors will more often be confronted with the health problems related to these implants.
MATERIAL AND METHODS
This review is based on information retrieved from Medline and our clinical experience.
RESULTS AND INTERPRETATION
The modern silicone breast implant is the product of four decades of development. The ongoing debate on health problems associated with the implants has been a vibrant stimulator for research, but a causal relationship between implants and the development of breast cancer and autoimmune defects has not been found. The implants are not, however, without complications; more research is required in order to improve the implants and for quality assurance of treatment and follow up.
Topics: Breast Implantation; Breast Implants; Female; History, 20th Century; History, 21st Century; Humans; Mammaplasty; Prosthesis Failure; Silicone Elastomers
PubMed: 15776068
DOI: No ID Found -
Editorial Comment on: One-Year Experience of Same-Day Mastectomy and Breast Reconstruction Protocol.Annals of Surgical Oncology Sep 2022
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Postoperative Complications; Retrospective Studies
PubMed: 35834143
DOI: 10.1245/s10434-022-12021-1 -
Advances in Clinical and Experimental... 2015Breast cancer remains the most common tumor in women, and new techniques for post- surgical breast reconstruction have been recently introduced. These new procedures... (Review)
Review
Breast cancer remains the most common tumor in women, and new techniques for post- surgical breast reconstruction have been recently introduced. These new procedures include autologous fat grafting with or without the enrichment with autologous stromal vascular fraction (SVF), platelet-derived growth factors and insulin. The reported improvement of fat graft viability with these techniques likely depends on the presence in the SVF of multipotent resident adipose derived-stem cells (ASCs). The clinical advantage derives from the plasticity of ASCs and their ability to generate new functional adipose tissue and vessels. However, there is an ongoing debate regarding the possible interplay between breast tumor cells and resident or transplanted ASCs for their capacity to locally secrete growth factors. Most of the data in the literature concerning ASCs is derived from in vitro models, whereas the knowledge of ASC behavior in vivo remains scarce. Recent reports concerning SVF/ASC enrichment of fat graft did not describe any significant worsening of prognosis for patients undergoing those procedures. However, further studies and longer follow-ups are needed to specifically define technical procedures and to confirm the safety of procedures of SVF/ASC enrichment during post-surgical breast reconstruction.
Topics: Adipose Tissue; Animals; Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Regenerative Medicine; Risk Factors; Stem Cell Transplantation; Treatment Outcome
PubMed: 26467147
DOI: 10.17219/acem/31673 -
The Cochrane Database of Systematic... Jul 2011Breast cancer is the most prevalent cancer in women and has a lifetime incidence of one in nine in the UK. Curative treatment requires surgery, and may involve adjuvant... (Review)
Review
BACKGROUND
Breast cancer is the most prevalent cancer in women and has a lifetime incidence of one in nine in the UK. Curative treatment requires surgery, and may involve adjuvant and neo-adjuvant therapy. In many women, post-mastectomy breast reconstruction is essential to restore body image and improve quality of life. Timing of reconstruction may be immediately at the time of mastectomy or delayed until after surgery. Outcomes such as psychosocial morbidity, aesthetics and complications rates may differ between the two approaches.
OBJECTIVES
To assess the effects of immediate versus delayed reconstruction following surgery for breast cancer.
SEARCH STRATEGY
We searched the Cochrane Breast Cancer Group (CBCG) Specialised Register on 22 July 2010, MEDLINE from July 2008 to 26 August 2010, EMBASE from 2008 to 26 August 2010 and the WHO International Clinical Trials Registry Platform (ICTRP) on 26 August 2010.
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing immediate breast reconstruction versus delayed or no reconstruction in women in any age group and stage of breast cancer. We considered any recognised methods of reconstruction to one or both breasts undertaken at the same time as mastectomy or at any time following mastectomy.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened papers, extracted trial details and assessed the risk of bias in the one eligible study.
MAIN RESULTS
We included only one RCT that involved that involved 64 women.We judged this study as being at a high risk of bias. Post-operative morbidity and mortality were not addressed, and secondary outcomes of patient cosmetic evaluations and psychosocial well-being post-reconstruction were inadequately reported. Based on limited data there was some, albeit unreliable, evidence that immediate reconstruction compared with delayed or no reconstruction, reduced psychiatric morbidity reported three months post-operatively.
AUTHORS' CONCLUSIONS
The current level of evidence for the effectiveness of immediate versus delayed reconstruction following surgery for breast cancer was based on a single RCT with methodological flaws and a high risk of bias, which does not allow confident decision-making about choice between these surgical options. Until high quality evidence is available, clinicians may wish to consider the recommendations of relevant guidelines and protocols. Although the limitations and ethical constraints of conducting RCTs in this field are recognised, adequately powered controlled trials with a focus on clinical and psychological outcomes are still required. Given the paucity of RCTs in this subject, in future versions of this review we will look at study designs other than RCTs specifically good quality cohort and case-controlstudies.
Topics: Breast Neoplasms; Female; Humans; Mammaplasty; Randomized Controlled Trials as Topic; Time Factors
PubMed: 21735435
DOI: 10.1002/14651858.CD008674.pub2 -
Medicine Mar 2023Currently, autologous fat grafting is the common surgery employed in the department of plastic and cosmetic surgery. Complications after fat grafting (such as fat... (Review)
Review
Currently, autologous fat grafting is the common surgery employed in the department of plastic and cosmetic surgery. Complications after fat grafting (such as fat necrosis, calcification, and fat embolism) are the difficulties and hotspots of the current research. Fat necrosis is one of the most common complications after fat grafting, which directly affects the survival rate and surgical effect. In recent years, researchers in various countries have achieved great results on the mechanism of fat necrosis through further clinical and basic studies. We summarize recent research progress on fat necrosis in order to provide theoretical basis for diminishing it.
Topics: Humans; Fat Necrosis; Adipose Tissue; Mammaplasty; Autografts; Transplantation, Autologous
PubMed: 36897702
DOI: 10.1097/MD.0000000000033220 -
Journal of Plastic, Reconstructive &... Mar 2012
Topics: Breast; Breast Diseases; Breast Implants; Female; Humans; Mammaplasty; Patient Satisfaction; Silicone Gels
PubMed: 21996441
DOI: 10.1016/j.bjps.2011.09.021