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Businaro Fernandes João T, de Oliveira VM, Bagnoli F, Bastos MCS, Rinaldi JF, Brenelli FP, Mateus EF. How well are Brazilian mastologists (breast surgeons) trained in breast reconstruction and oncoplastic surgery? A study of the impact of a breast reconstruction and oncoplastic surgery improvement course. Front Oncol 2023; 13:1139461. [PMID: 37287926 PMCID: PMC10242663 DOI: 10.3389/fonc.2023.1139461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/24/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction The breasts are a female symbol, impacts self-image and self-esteem. Breast reconstructive and oncoplastic surgeries have an important role in minimizing injuries. In Brazil less than a third of public health system (SUS) users have access to immediate reconstructive surgery. The low rate of breast reconstructions has multiple causes and the deficiency in availability and surgeons' technical qualification play a role. In 2010, the Breast Reconstruction and Oncoplastic Surgery Improvement Course was created by professors of the Mastology Department of Santa Casa de São Paulo and State University of Campinas (UNICAMP). The objectives of this study were to evaluate the impact of the techniques learned on patients' management by the surgeons enrolled in the Course, as well as to characterize their profile. Methods All students enrolled in the Improvement Course between 2010 and 2018 were invited to answer an online questionnaire. Students who did not agree to answer the questionnaire or answered them incompletely were excluded. Results Total students included: 59. The mean age: 48.9 years, male (72%) with more than 5 years of Mastology practice (82.2%), from all regions of Brazil, 1.7% from the North, 33.9% from the Northeast, 44.1% from the Southeast, and 12% from the South. Most of the students considered they had little or no knowledge of breast reconstruction (74.6%) and 91,5% did not consider they had enough aptitude to perform breast reconstructions after finishing residency. After the Course, 96.6% considered themselves apt to perform such surgeries. Over 90% of the students considered the Course had impacted their practice and changed their surgical strategy view. Before the Course, 84.8% of the students stated that less than half of their patients who were operated on for breast cancer had breast reconstruction, compared to 30.5% after the Course. Conclusion The Breast Reconstruction and Oncoplastic Surgery Improvement Course studied here positively impacted the mastologists' management of patients. New training centers worldwide can help a lot of women with breast cancer.
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Affiliation(s)
- Thais Businaro Fernandes João
- Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP); Faculty of Medical Sciences of Santa Casa de São Paulo (FCMSCSP), São Paulo, Brazil
| | - Vilmar Marques de Oliveira
- Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP); Faculty of Medical Sciences of Santa Casa de São Paulo (FCMSCSP), São Paulo, Brazil
| | - Fábio Bagnoli
- Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP); Faculty of Medical Sciences of Santa Casa de São Paulo (FCMSCSP), São Paulo, Brazil
| | - Maria Carolina Soliani Bastos
- Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP); Faculty of Medical Sciences of Santa Casa de São Paulo (FCMSCSP), São Paulo, Brazil
| | - José Francisco Rinaldi
- Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP); Faculty of Medical Sciences of Santa Casa de São Paulo (FCMSCSP), São Paulo, Brazil
| | - Fabrício Palermo Brenelli
- State University of Campinas (UNICAMP), Campinas, Brazil
- Beneficiência Portuguesa de São Paulo, São Paulo, Brazil
| | - Evandro Fallaci Mateus
- Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP); Faculty of Medical Sciences of Santa Casa de São Paulo (FCMSCSP), São Paulo, Brazil
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Imai S, Narushima M, Banda CH, Shiraishi M, Shimizu K, Okada Y, Mitsui K, Danno K, Ishiura R, Yuzuriha S, Ohmori K. Tsugishige Kondo, The Father of Japanese Surgery: Exploring the History of Hideyo Noguchi's Hand Reconstruction With a Forearm Flap Before the Establishment of Plastic Surgery in Japan. Ann Plast Surg 2023; 90:209-213. [PMID: 36796041 DOI: 10.1097/sap.0000000000003396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
ABSTRACT Hideyo Noguchi is one of the most famous scientists in Japan's history, and his portrait has adorned the ¥1,000 banknotes since 2004. He had a childhood burn injury resulting in severe hand scarring and contracture that plagued his early life and education.The resulting hand deformity required 3 separate reconstructions with the third and most complex surgery performed by Professor Tsugishige Kondo just before Noguchi's final medical doctor license examination in 1897. In this surgery, Kondo released the contractures using the first radial forearm flap performed in Japan long before the establishment of plastic surgery in the country.Reviewing the history of Kondo, we find that he likely learned the art of reconstructive surgery along with many other surgical techniques during his stay in Europe from 1891 to 1896 where he was mentored by 4 prominent surgeons of the era: Christian Albert Theodor Billroth, Vincenz Czerny, James Israel, and Carl Nicoladoni. During this period, Czerny reported performing the world's first breast reconstruction using lipoma transfer, and Nicoladoni performed the world's first thumb reconstruction with a chest flap and with toe-to-thumb transfer. Kondo may have watched these world's first operations and may have also been taught these innovative techniques including the forearm flap directly by these pioneers. He returned to Japan and successfully applied these reconstructive surgery methods in his practice and teaching, as evidenced by the landmark surgery of Hideyo Noguchi's hand, and laid the foundations for the development of plastic surgery in Japan.
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Affiliation(s)
- Shoichi Imai
- From the Department of Plastic and Reconstructive Surgery, Mie University, Mie
| | - Mitsunaga Narushima
- From the Department of Plastic and Reconstructive Surgery, Mie University, Mie
| | - Chihena H Banda
- From the Department of Plastic and Reconstructive Surgery, Mie University, Mie
| | - Makoto Shiraishi
- From the Department of Plastic and Reconstructive Surgery, Mie University, Mie
| | - Kotaro Shimizu
- From the Department of Plastic and Reconstructive Surgery, Mie University, Mie
| | - Yoshimoto Okada
- From the Department of Plastic and Reconstructive Surgery, Mie University, Mie
| | - Kohei Mitsui
- From the Department of Plastic and Reconstructive Surgery, Mie University, Mie
| | - Kanako Danno
- From the Department of Plastic and Reconstructive Surgery, Mie University, Mie
| | - Ryohei Ishiura
- From the Department of Plastic and Reconstructive Surgery, Mie University, Mie
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Nagano
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Noreña-Rengifo BD, Sanín-Ramírez MP, Adrada BE, Luengas AB, Martínez de Vega V, Guirguis MS, Saldarriaga-Uribe C. MRI for Evaluation of Complications of Breast Augmentation. Radiographics 2022; 42:929-946. [PMID: 35559662 DOI: 10.1148/rg.210096] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Breast augmentation is one of the most common aesthetic procedures performed in the United States. Several techniques of breast augmentation have been developed, including the implantation of breast prostheses and the injection of autologous fat and other materials. The most common method of breast augmentation is to implant a prosthesis. There are different types of breast implants that vary in shape, composition, and the number of lumina. The rupture of breast implants is the leading cause of implant removal. The rupture rate increases substantially with the increasing age of the implant. Most implant ruptures are asymptomatic. Implant complications can be grouped into two categories: local complications in the breast and adjacent soft tissue, and systemic complications associated with rheumatologic or neurologic symptoms. The onset of local complications may be early (infection and periprosthetic collections including seromas, hematomas, or abscesses) or late (capsular contraction, implant rupture, gel bleed, or breast implant-associated anaplastic large cell lymphoma). Although mammography is the imaging modality for breast cancer screening, noncontrast breast MRI is the imaging modality of choice for evaluation of the integrity of breast implants and the complications of breast augmentation, for equivocal findings at conventional imaging, and as a supplement to mammography in patients with free injectable materials. The fifth edition of the Breast Imaging Reporting and Data System (BI-RADS) provides a systematic outline for MRI evaluation of patients with breast implants. Silicone- and water-selective sequences provide useful supplemental information to confirm intracapsular and extracapsular rupture. Breast MRI for evaluation of implant integrity does not require intravenous contrast material. The use of MRI contrast material in patients with breast augmentation is indicated when infection or malignancy is suspected. Radiologists should have a thorough understanding of the different techniques for breast augmentation, normal imaging features, and complications specific to breast augmentation. An invited commentary by Ojeda-Fournier is available online. ©RSNA, 2022.
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Affiliation(s)
- Brian D Noreña-Rengifo
- From the Department of Radiology, University of Antioquia, Cra 51d #62-29, Medellín 050010, Colombia (B.D.N.R., M.P.S.R.); Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.E.A., M.S.G.); Department of Breast Imaging, Clínica Las Américas Auna, Medellín, Colombia (A.B.L., C.S.U.); and Department of Diagnostic Imaging, Hospital Universitario Quirón Madrid, Madrid, Spain (V.M.d.V.)
| | - Maria Paulina Sanín-Ramírez
- From the Department of Radiology, University of Antioquia, Cra 51d #62-29, Medellín 050010, Colombia (B.D.N.R., M.P.S.R.); Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.E.A., M.S.G.); Department of Breast Imaging, Clínica Las Américas Auna, Medellín, Colombia (A.B.L., C.S.U.); and Department of Diagnostic Imaging, Hospital Universitario Quirón Madrid, Madrid, Spain (V.M.d.V.)
| | - Beatriz E Adrada
- From the Department of Radiology, University of Antioquia, Cra 51d #62-29, Medellín 050010, Colombia (B.D.N.R., M.P.S.R.); Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.E.A., M.S.G.); Department of Breast Imaging, Clínica Las Américas Auna, Medellín, Colombia (A.B.L., C.S.U.); and Department of Diagnostic Imaging, Hospital Universitario Quirón Madrid, Madrid, Spain (V.M.d.V.)
| | - Ana Beatriz Luengas
- From the Department of Radiology, University of Antioquia, Cra 51d #62-29, Medellín 050010, Colombia (B.D.N.R., M.P.S.R.); Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.E.A., M.S.G.); Department of Breast Imaging, Clínica Las Américas Auna, Medellín, Colombia (A.B.L., C.S.U.); and Department of Diagnostic Imaging, Hospital Universitario Quirón Madrid, Madrid, Spain (V.M.d.V.)
| | - Vicente Martínez de Vega
- From the Department of Radiology, University of Antioquia, Cra 51d #62-29, Medellín 050010, Colombia (B.D.N.R., M.P.S.R.); Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.E.A., M.S.G.); Department of Breast Imaging, Clínica Las Américas Auna, Medellín, Colombia (A.B.L., C.S.U.); and Department of Diagnostic Imaging, Hospital Universitario Quirón Madrid, Madrid, Spain (V.M.d.V.)
| | - Mary S Guirguis
- From the Department of Radiology, University of Antioquia, Cra 51d #62-29, Medellín 050010, Colombia (B.D.N.R., M.P.S.R.); Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.E.A., M.S.G.); Department of Breast Imaging, Clínica Las Américas Auna, Medellín, Colombia (A.B.L., C.S.U.); and Department of Diagnostic Imaging, Hospital Universitario Quirón Madrid, Madrid, Spain (V.M.d.V.)
| | - Cristina Saldarriaga-Uribe
- From the Department of Radiology, University of Antioquia, Cra 51d #62-29, Medellín 050010, Colombia (B.D.N.R., M.P.S.R.); Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (B.E.A., M.S.G.); Department of Breast Imaging, Clínica Las Américas Auna, Medellín, Colombia (A.B.L., C.S.U.); and Department of Diagnostic Imaging, Hospital Universitario Quirón Madrid, Madrid, Spain (V.M.d.V.)
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Impact of insurance payer and socioeconomic status on type of autologous breast reconstruction. Surg Oncol 2021; 39:101661. [PMID: 34534730 DOI: 10.1016/j.suronc.2021.101661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Autologous breast reconstruction has evolved from more morbid procedures that sacrificed the abdominal muscle (the TRAM or transverse rectus abdominus muscle flap) to "perforator" flaps. Commercial insurers recognized the higher technical demand of perforator flaps by creating procedural codes with higher professional fees. This study examined whether procedure code discrepancies between insurance payers disproportionally incentivize perforator flaps among the commercially insured. METHODS Autologous breast reconstructions identified from the National Inpatient Sample (NIS) were subdivided into microvascular perforator (85.74, 85.75, 85.76), microvascular TRAM (85.73), and pedicled TRAM flaps (85.72). Demographics, comorbidities and access to care were compared. A logistic regression comparing microvascular reconstructions only was used to identify predictors for perforator flap reconstruction. RESULTS A total of 66,968 cases of autologous breast reconstruction were identified. Perforator flaps were more likely among the commercially insured (p < 0.001) and higher insurance quartiles (p < 0.001).When comparing microvascular reconstruction, perforator flaps were 1.72 (p < 0.001) times more likely among the commercially insured. As compared to the lowest income quartile, the fourth quartile had an odds ratio of 1.36 (p < 0.001) for perforator flap reconstruction. CONCLUSION The presence of a separate perforator flap billing code among the commercially insured may be exacerbating existing socioeconomic disparities in breast cancer reconstruction.
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Abdul-Al M, Zaernia A, Sefat F. Biomaterials for breast reconstruction: Promises, advances, and challenges. J Tissue Eng Regen Med 2020; 14:1549-1569. [PMID: 32841503 DOI: 10.1002/term.3121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/31/2020] [Accepted: 08/05/2020] [Indexed: 12/23/2022]
Abstract
Breast reconstruction is the opportunity that provides the chance of having breast after undergoing surgical removal of the breast tissue due to cancer-related surgery. However, this varies on the stage of the cancer diagnosis and the procedure undertaken. There are many regenerative medicine methods that provide several initiatives and direct solutions to problems such as the development of "bioactive tissue," which can regenerate adipose tissues with similar normal functions and structures. There have been several studies which have previously explored for the improvement of breast reconstruction including different variations of biomaterials, different fabrication and processing techniques, cells as well as growth factors which enable bioengineers and tissue engineers to reconstruct a suitable breast for patients with breast cancer. Many factors such as shape, proper volume, mechanical properties have been studies but very scattered with not adequate solution for existing patients worldwide. This review article aims to cover recent advances in the biomaterials, which can be used for reconstruction of breasts as well as looking at the various factors that might lead to individuals needing reconstruction and the materials that are available. The focus would be to look at the various biomaterials that are available to use for reconstruction, their properties, and their structural integrity.
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Affiliation(s)
- Mohamed Abdul-Al
- Department of Biomedical and Electronics Engineering, School of Engineering, University of Bradford, Bradford, UK
| | - Amir Zaernia
- Department of Biomedical and Electronics Engineering, School of Engineering, University of Bradford, Bradford, UK
| | - Farshid Sefat
- Department of Biomedical and Electronics Engineering, School of Engineering, University of Bradford, Bradford, UK.,Interdisciplinary Research Centre in Polymer Science & Technology (Polymer IRC), University of Bradford, Bradford, UK
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Abstract
Purpose: The optimal approach to the integration of postmastectomy reconstruction and radiation therapy is not well-established. This review will summarize current literature pertaining to the most common types of reconstruction in the setting of postmastectomy radiation therapy (PMRT). Data Sources: Literature from PubMed was reviewed from 2000 to 2016. Study Selection: Studies were selected with relevance to “postmastectomy breast reconstruction,” “breast reconstruction,” and “breast reconstructive methods and PMRT.” Surgical outcomes, patient satisfaction, and cost-effectiveness were examined. Data Extraction: Data from publications was extracted, summarized, and converted to a table. Results of Data Synthesis: Implant-based techniques are on the rise, in the setting of PMRT. Implant-based methods are more affordable in the short term and result in immediate breast-mound formation compared to autologous methods. When compared to implant-based reconstruction with PMRT, autologous reconstruction with PMRT results in better quality of life (QoL) and sensory recovery as well as fewer complications and failures. Among autologous flaps, deep inferior epigastric perforator flaps are considered superior to transverse rectus abdominal muscle (TRAM) pedicled flaps and may be more suitable for PMRT. Latissimus dorsi and muscle-sparing free TRAM flaps are also viable options. In delayed autologous, which may be advantageous for high-risk patients, the optimal timing to delay surgery after radiation therapy is unknown. Reconstruction with a 2-stage tissue expander-implant technique offers good to excellent cosmetic outcomes in the setting of PMRT, although there may be complications in this 2-stage process. Conclusion: Surgical, cosmetic, quality of life, and life expectancy must be taken into account when selecting the way to integrate breast reconstruction and PMRT.
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Affiliation(s)
- Johanna H Yun
- 1 Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Roberto Diaz
- 2 Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Amber G Orman
- 2 Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
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Abstract
The author describes the method and technique used for augmenting the breast through autograft of fat obtained from liposuction. Care should be taken in the collection, preparation, and use of the aspirate in order to preserve the adipocytes' vitality. Thirty-one cases are presented with good results and few complications. Two complications that may occur are resorption, which can be reduced through knowledge of the proper technique, and microcalcifications, which, according to some researchers, may confuse the radiologic diagnosis of mammary carcinoma. The author does not agree. The method is a good alternative to augmentation mammaplasty with prosthesis. Although the method is innocuous, beginners should exercise caution.
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Combellack EJ, Jessop ZM, Naderi N, Griffin M, Dobbs T, Ibrahim A, Evans S, Burnell S, Doak SH, Whitaker IS. Adipose regeneration and implications for breast reconstruction: update and the future. Gland Surg 2016; 5:227-41. [PMID: 27047789 PMCID: PMC4791352 DOI: 10.3978/j.issn.2227-684x.2016.01.01] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/17/2015] [Indexed: 12/20/2022]
Abstract
The evolution of breast reconstruction and management of breast cancer has evolved significantly since the earliest descriptions in the Edwin Smith Papyrus (3,000 BC). The development of surgical and scientific expertise has changed the way that women are managed, and plastic surgeons are now able to offer a wide range of reconstructive options to suit individual needs. Beyond the gold standard autologous flap based reconstructions, regenerative therapies promise the elimination of donor site morbidity whilst providing equivalent aesthetic and functional outcomes. Future research aims to address questions regarding ideal cell source, optimisation of scaffold composition and interaction of de novo adipose tissue in the microenvironment of breast cancer.
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Pollhammer MS, Duscher D, Schmidt M, Huemer GM. Recent advances in microvascular autologous breast reconstruction after ablative tumor surgery. World J Clin Oncol 2016; 7:114-121. [PMID: 26862495 PMCID: PMC4734933 DOI: 10.5306/wjco.v7.i1.114] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 10/19/2015] [Accepted: 12/11/2015] [Indexed: 02/06/2023] Open
Abstract
Breast cancer is a ubiquitous disease and one of the leading causes of death in women in western societies. With overall increasing survival rates, the number of patients who need post-mastectomy reconstruction is on the rise. Especially since its psychological benefits have been broadly recognized, breast reconstruction has become a key component of breast cancer treatment. Evolving from the early beginnings of breast reconstruction with synthetic implants in the 1960s, microsurgical tissue transfer is on the way to become the gold standard for post oncology restoration of the breast. Particularly since the advent of perforator based free flap surgery, free tissue transfer has become as safe option for breast reconstruction with low morbidity. The lower abdominal skin and subcutaneous fat tissue typically offer enough volume to create an aesthetically satisfying breast mound. Nowadays, the most commonly used flap from this donor site is the deep inferior epigastric artery perforator flap. If the lower abdomen is not available as a donor site, the gluteal area and thigh provide a number of flaps suitable for breast reconstruction. If the required breast volume is small, and there is enough tissue available on the upper medial thigh, then a transverse upper gracilis flap may be a practicable method to reconstruct the breast. In case of a higher amount of required volume, a gluteal artery perforator flap is the best choice. However, what is crucial in addition to selecting the best flap option for the individual patient is the timing of the operation. In patients with confirmed post-mastectomy radiation therapy, it is advisable to perform microvascular breast reconstruction only in a delayed fashion.
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Mir M, Shahdhar M, Ganaie K, Syed Q. Oncological safety of immediate rectus abdominis myocutaneous breast reconstruction in patients with locally advanced disease (stage IIb and III). South Asian J Cancer 2014; 2:239-42. [PMID: 24455647 PMCID: PMC3889050 DOI: 10.4103/2278-330x.119921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The management of locally advanced (Stage IIb and III) breast cancer is challenging. It often includes multimodal treatment with systemic therapy and/or radiation therapy and surgery. Immediate breast reconstruction has not traditionally been performed in these patients. We review the results of immediate rectus abdominis musculo-cutaneous (TRAM/VRAM) flap in 60 patients treated for Stage IIb and III breast cancer. MATERIALS AND METHODS Data were collected prospectively on 60 patients diagnosed with Stage IIb (32 patients) and Stage III (28 patients) breast cancer between May 2008 and May 2012. All patients had mastectomy and immediate rectus abdominis myocutaneous reconstruction (TRAM in 40 patients and VRAM in 20 patients). All patients received primary systemic therapy, and all patients received postoperative radiotherapy to the operative site. RESULTS Mean age was 40.13 (range 28-53) years, mean hospital stay was 8.86 days and mean follow-up for the group was 28 months. Neither of them developed local disease recurrence in the operative site till the last follow-up. Eight (13.3%) patients had some delay in chemo-radiation therapy due to flap-related complications. Flap-related complications were present in eight patients (partial flap failure in four and superficial skin necrosis in four). There was no adverse effect of chemo-radiation therapy on reconstructed breast. CONCLUSION Immediate TRAM/VRAM breast reconstruction for locally advanced breast cancer is not associated with a significant delay in adjuvant therapy or an increased risk of local relapse. Radiation therapy can be delivered to the reconstructed breast when indicated without difficulty. Breast reconstruction facilitates surgical resection of locally advanced breast cancer with primary closure and should be considered if the patient desires immediate breast reconstruction.
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Affiliation(s)
- Mushtaq Mir
- Department of Surgery, SMHS Hospital, Srinagar, Jammu and Kashmir, India
| | - Muddassir Shahdhar
- Department of Surgery, SMHS Hospital, Srinagar, Jammu and Kashmir, India
| | - Khurshid Ganaie
- Department of Surgery, SMHS Hospital, Srinagar, Jammu and Kashmir, India
| | - Quibtiya Syed
- Department of Surgery, SMHS Hospital, Srinagar, Jammu and Kashmir, India
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Julián JF, Navinés J, Botey M, Pascual I, Balibrea JM, Fernández-Llamazares J, Grífols JR, Mariscal A. [Use of platelet gel in breast reconstruction after breast-conserving cancer surgery]. Cir Esp 2012; 90:582-8. [PMID: 22726447 DOI: 10.1016/j.ciresp.2012.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 03/07/2012] [Accepted: 03/09/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION With the aim of decreasing breast defects after conservative cancer surgery, we present a new breast reconstruction technique using breast volume restitution with platelet gel. PATIENTS AND METHOD A pilot study was conducted on 20 breast cancer patients undergoing tumorectomy with placement a gel obtained by plateletpheresis of a healthy allogeneic donor in the surgical cavity. Patients had a clinical, photographic and histological follow-up, as well as an assessment of the aesthetic outcome. RESULTS The mean age was 50.5±8.6 years (range 42-70 years) and with a mean Charlson comorbidity index of 1.1±1.2 (range 0-5). The mean tumour volume was 63.1±31.1 ml (range 30-160 ml) and the mean restitution volume with platelet gel was 111.5±60.9 ml (range 40-250 ml). After a mean follow-up of 17 months, 80% of the patients maintained the breast volume and no further operations were needed due to surgical margin involvement. No recurrences were observed in any patient. CONCLUSIONS Platelet gel allows restitution of the breast volume adjusted to the tumorectomy volume, minimising the usual retractions and deformities after conservative surgery. It enables wide resections and safety margins.
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Affiliation(s)
- Joan Francesc Julián
- Servicio de Cirugía General y Digestiva, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
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Shaikh IAA, Thomas H, Vidyadharan R, Verghis V, Iype V, Abraham SJ. Post mastectomy immediate breast reconstruction 13 years experience in a single centre. Indian J Surg Oncol 2011; 1:250-5. [PMID: 22693373 DOI: 10.1007/s13193-011-0051-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 02/08/2010] [Indexed: 11/30/2022] Open
Abstract
Early diagnosis and multi-modality treatment has resulted in prolonged survival of many patients with carcinoma of breast. It is important that the surgeons who handle breast malignancies look at the psychological and cosmetic aspects without compromising the oncologic principles of surgery in carcinoma of the breast. Post mastectomy immediate breast reconstruction (IBR) addresses the psychological and cosmetic problems that follow mastectomy. There are various techniques available for post mastectomy primary breast reconstruction. The technique should be affordable to the large number of economically poor patients and should be less time consuming. During the period of 13 years from January 1996 to December 2008, we have operated 2932 cases of carcinoma breast, of which 546 patients had IBR using various procedures. In our centre, TRAM flap was found to be the best procedure for post mastectomy immediate breast reconstruction. Immediate reconstruction whenever possible is the best option. Presence of the tissue used for reconstruction was not found to affect any form of local adjuvant treatment like radiotherapy, or delay the detection of local recurrent disease.
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A meta-analysis of optimum plane placement and related morbidity in primary breast augmentation. EUROPEAN JOURNAL OF PLASTIC SURGERY 2010. [DOI: 10.1007/s00238-010-0425-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Rozen WM, Rajkomar AKS, Anavekar NS, Ashton MW. Post-mastectomy breast reconstruction: a history in evolution. Clin Breast Cancer 2009; 9:145-54. [PMID: 19661037 DOI: 10.3816/cbc.2009.n.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although the need for mastectomy has been evident for many years, postmastectomy reconstruction has been recognized as an achievable outcome for only a little over a century. A review of the evolution of both autologous and prosthetic options for reconstruction was undertaken. The earliest attempts at reconstruction used autologous techniques that were either unsuccessful, not reproducible, or were associated with significant morbidity. Prosthetic techniques became sought after, with silicone prostheses widely used until concerns about potential adverse effects led to the investigation of alternate options. With these concerns shown to be unfounded, silicone and saline prostheses evolved with successive generations of implants. Concurrent advances in reconstructive surgery led to a revival in autologous techniques for breast reconstruction, with microsurgical free-tissue transfer potentiating a new range of potential donor sites. The abdominal wall became the donor site of choice, and with the advent of perforator flaps, morbidity associated with flap harvest was minimized. In cases where the abdominal wall is unsuitable, flaps such as the superior and inferior gluteal artery perforator flaps, the musculocutaneous gracilis flap, and the "stacked" deep inferior epigastric artery perforator flap are frequently used options. The development of minimally invasive techniques for implant placement and flap harvest, such as endoscopy, continue to evolve, and research in tissue engineering offers a vision for a future without the need for a donor site.
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Affiliation(s)
- Warren M Rozen
- Department of Anatomy and Cell Biology, Jack Brockhoff Reconstructive Plastic Surgery Research Unit, University of Melbourne, Victoria 3050, Australia.
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Rozen WM, Ashton MW, Taylor GI. Defining the role for autologous breast reconstruction after mastectomy: social and oncologic implications. Clin Breast Cancer 2008; 8:134-42. [PMID: 18621609 DOI: 10.3816/cbc.2008.n.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Breast reconstruction plays a significant role in the management of breast cancer. The removal of a breast has implications for the psychologic, social, and sexual well-being of the patient, establishing the need for discussion of postmastectomy breast reconstruction with suitable patients. However, operative morbidity and the potential for diminished oncologic safety are ongoing issues of contention. A Medline literature review was performed to evaluate the interplay between the psychosocial need for breast reconstruction in patients after mastectomy and the issues surrounding its oncologic safety. Immediate breast reconstruction does not impair the oncologic safety of breast cancer management, with no increase in local recurrence rates, and no delays in the initiation of adjuvant chemotherapy or radiation therapy (RT). Immediate breast reconstruction in the setting of chemotherapy is not associated with greater complication rates; however, there is some evidence for increased complications in the setting of adjuvant RT. Breast reconstruction has a positive effect on the psychosocial outcomes of mastectomy and is oncologically safe in the immediate and delayed settings. Ultimately, the decision-making process of whether to reconstruct, how to reconstruct, and when to reconstruct requires a multidisciplinary approach, with the patient, plastic surgeon, oncologic surgeon, medical oncologist, and radiation oncologist all contributing.
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Affiliation(s)
- Warren Matthew Rozen
- Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, The University of Melbourne, Parkville, Victoria, Australia.
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Consensus and Controversy in Breast Reconstruction a Review of Current Opinion and Practice. POLISH JOURNAL OF SURGERY 2008. [DOI: 10.2478/v10035-008-0078-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Willeke F, Lehnert T. Vincenz Czerny: carrying concepts into the 21st century. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 1997; 23:253-6. [PMID: 9236902 DOI: 10.1016/s0748-7983(97)92532-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Vincenz Czerny, as a pupil of Theodor Billroth and as head of the surgical departments of the Universities of Freiburg and Heidelberg between 1871 and 1906, markedly influenced the surgical development of the 19th century. Major contributions to the field of surgery included hernia operations, abdominal surgery and vaginal hysterectomy. Most importantly he recognized that surgery alone would not be able to control cancer and he developed concepts for multimodality treatment.
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Affiliation(s)
- F Willeke
- Department of Surgery, University of Heidelberg, Germany
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Cooper GG, Webster MH, Bell G. The results of breast reconstruction following mastectomy. BRITISH JOURNAL OF PLASTIC SURGERY 1984; 37:369-72. [PMID: 6743903 DOI: 10.1016/0007-1226(84)90081-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This paper is a retrospective study of the techniques, complications and results of breast reconstruction following mastectomy in 82 patients, 66 of whom had breast cancer. The mean length of follow-up was 3 years 8 months. Of the 74 patients who were reviewed 61 were pleased with the results. Eight patients died, 7 of them from disseminated breast cancer. In our experience breast reconstruction is a very worthwhile procedure in motivated patients and may reduce the psychiatric morbidity of mastectomy.
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