Sports Medicine-Related Breast and Chest Conditions-Update of Current Literature.

ABSTRACT: This article reviews the most up-to-date evidence-based recommendations pertaining to breast and upper chest conditions, specifically for the sports medicine physician. Because of the unique circumstances of the team physician, they can see a wide breadth of pathology. Athletes may not have a primary care physician and may prefer to present to their team physician for breast and upper chest conditions. It is often more comfortable and convenient for athletes to seek treatment in the team setting. Therefore, it is important that the medical professional be aware of not only common pathology but also of that which is rarer. Any delay in evaluation can result in unnecessary morbidity and lead to complications or extended time lost from sport. Consequently, it also is important to facilitate an atmosphere encouraging early presentation and workup.

Post-traumatic necrotising fasciitis of the breast: a case study with literature review.

Necrotising fasciitis is a rare infection of the skin and underlying soft tissue. It primarily involves the extremities and rarely the breast. Primary necrotising fasciitis of the breast in a non-lactating, healthy female is rarer still. The authors present the case report of a patient presenting with primary necrotising fasciitis of the breast after sustaining a penetrating injury. The patient was managed successfully with serial debridement and negative pressure wound therapy (NPWT). To our knowledge only 19 such cases have been reported in the indexed literature so far. This is also the eighth case globally of primary necrotising fasciitis of the breast in a non-lactating female without any associated immunosuppression, which is the basis of reporting this case.

Trauma on a Recently Augmented Breast as a Trigger for Mondor's Disease.

Mondor's disease is the eponym used to describe a self-limited phlebitis or thrombophlebitis of the superficial veins localized mainly on the thoracoabdominal area of the human body. Its clinical manifestation includes painful superficial cords causing skin retraction. This medical condition could be idiopathic, iatrogenic or a manifestation of underlying pathology such as breast cancer and seems to be more common than has been previously thought. The vast majority of the clinical studies and case reports to date focus on Mondor's disease as a disorder which is more or less directly related to a previous surgical intervention. In this case report, the author discusses the possible role of breast surgery as a predisposing factor only and the trauma on the operated breast as a trigger for onset and earlier manifestation of Mondor's disease. A special emphasis is put on the importance of trauma prevention in breast augmentation surgery, especially when maneuvers like postoperative massages are considered.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Occurrence, Causes and Perceived Performance Effects of Breast Injuries in Elite Female Athletes.

Female breasts are vulnerable to direct blows or frictional injuries during sport; however, little research has investigated breast injuries experienced by female athletes. This study aimed to investigate the occurrence, causes and perceived performance effects of breast injuries in elite female athletes across a wide range of sports. A custom-designed survey was distributed to female athletes aged over 18 years who were competing nationally or internationally in their chosen sport. The survey included questions about breast injuries sustained during training and competition and any perceived performance effects of these injuries. 504 elite female athletes from 46 different sports completed the survey. 36% of participants (n = 182) reported experiencing breast injuries and 21% (n = 37) perceived that their breast injury negatively affected their performance. Contact breast injuries were reported by significantly more athletes involved in contact or combat sports and by athletes with larger breasts or a higher body mass index. Frictional breast injuries were reported by significantly more older athletes or those with larger breasts. Less than 10% of participants who experienced breast injuries reported their injury to a coach or medical professional and only half used any prevention strategies. Athletes, coaches and medical professionals associated with women's sport need to be made aware of the occurrence and potential negative effects of breast injuries. It is critical to normalise conversations around breast health so that athletes can be encouraged to report and, when necessary, receive treatment for breast injuries. Further research is also required to better understand factors that affect breast injuries in sport in order to develop evidence-based breast injury prevention strategies.

Autologous Breast Reconstruction Using a Tensor Fascia Lata/Anterior Lateral Thigh-Freestyle Flap After Extensive Electric Burn: A Case Report.

AIMS: Reconstruction of breasts and chest wall deformities in female patients after severe burn injury is a challenge for reconstructive surgeons. In these patients, neither implant-based procedures nor standard free flaps are sometimes applicable because of limited skin quality and unavailability of donor sites at the abdomen, back, buttock, or medial thigh. METHODS: We present a case of a young female patient with a history of 80 % total body surface area burn after electric high-voltage injury. The burn occurred at the age of 9 years, and during the initial treatment, the right breast required amputation because of deep, full-thickness burn. Because the rigid and instable scar including chronic wound developed and an implant-based breast reconstruction was not feasible, the choice of possible free flaps was limited to the right lateral/proximal thigh. Preoperative computed tomography angiography demonstrated 2 intact perforators branching off the lateral femoral circumflex artery and a combined 17 × 24-cm tensor fascia lata/anterior lateral thigh perforator flap with in-flap anastomosis was transferred to the right breast after wound debridement and histological exclusion of Majolin ulcer in the instable scar. The internal mammary vessels were chosen as recipient vessels, and the donor site was covered with a split-thickness skin graft. RESULTS: The postoperative course was uneventful at the right breast; however, the recipient site healed secondarily at the proximal pole. The resulting breast asymmetry was corrected by lipofilling of the central zone of the reconstructed breast and new definition of the inframammary fold as well as a minor liposuction at the cranial margin of the flap. The patient was very satisfied with the result, and no further correction was necessary. CONCLUSIONS: Autologous breast reconstruction is a valuable option for patients after severe burn injury. However, microsurgical expertise and an individualized and flexible surgical strategy are required for optimal reconstructive results. Computed tomography angiography is helpful for preoperative planning of the procedure.

A Novel Treatment of Very Rare Anomaly; Breast Pseudoaneurysm Developed During Pregnancy.

Pseudoaneurysms (PA) in the arterial supply of the breast are quite rare and mostly iatrogenic secondary to biopsies. Breast PAs after blunt trauma is even rarer. In this paper, a case of breast PAs secondary to blunt trauma and its percutaneous treatment using human thrombin injection and after N-butyl cyanoacrylate is presented.

Imaging Features Associated With Posttraumatic Breast Neuromas.

OBJECTIVE: The aim of this study is to review the clinical and imaging features of patients with a histopathologic diagnosis of posttraumatic breast neuromas. MATERIALS AND METHODS: We report eight biopsy-proven posttraumatic neuromas in six patients with a history of breast surgery. Mammographic, sonographic, and breast MRI examinations were reviewed according to the BI-RADS lexicon. In addition, the tail sign, a specific sign known to be associated with neuromas in other parts of the body, was assessed. RESULTS: Mammographic, MRI, and sonographic examinations were performed in three, four and all six patients, respectively. The neuromas were occult on the three mammograms performed but all of them were identified on ultrasound as hypoechoic masses with parallel orientation; seven of the eight neuromas (87.5%) had an oval shape with circumscribed margins. Strain elastography performed for two patients (three neuromas) showed benign features (benign elasticity scores and fat-to-lesion ratio). Half of the masses showed a tail sign (focal thickening of the nerve adjacent to posttraumatic neuroma, similar to the dural tail sign). Of five lesions investigated by MRI, two were occult on MRI. The remaining three were visible as isointense foci on T1-weighted images, with a benign type 1 enhancement curve. CONCLUSION: In patients who underwent breast surgery, a mass with benign features raises the possibility of a neuroma. Although the tail sign was present in half of the posttraumatic neuromas, imaging-guided biopsy remains the standard of care.

Nodular Fasciitis of the Breast: A Case and Literature Review.

Nodular fasciitis is a benign fibroblastic proliferation in soft tissue that is most commonly found in the upper extremities, trunk, head, and neck region. Its occurrence in the breast has been rarely reported. The most characteristic features are the sudden appearance and rapid growth of a palpable lesion. Nodular fasciitis can clinically, radiologically, and histopathologically mimic a breast carcinoma. We present a case of nodular fasciitis of the breast and a review of the relevant literature.

Breast emergencies: types, imaging features, and management.

OBJECTIVE: The objective of this article is to describe the types of breast emergencies that can be encountered in a breast imaging practice, discuss the characteristic imaging features of these emergencies, and explain the most common methods and interventions used for the treatment of breast emergencies and complications. CONCLUSION: Breast emergencies are uncommon but require prompt identification and management when they do occur. Patients with mastitis or a breast abscess may be seen for either diagnosis or treatment. Most complications are the result of interventional procedures. Pseudoaneurysms, postbiopsy hematoma, and localization wire migration are the most common situations encountered. A milk fistula resulting from a core biopsy is uncommon. Fortunately, seat-belt injuries to the breast are rare. Knowledge of these entities--of the usual presentation, management, and appropriate follow-up protocols--is essential for breast imagers.

[Thoracodorsal pedicled perforator flap for chest wall and breast reconstruction in children: Illustration with two clinical cases]. / Utilisation du lambeau perforant thoracodorsal dans les séquelles traumatiques cutanées thoracomammaires de l'enfant : illustration par deux cas cliniques.

Perforator flaps represent a new approach in reconstructive surgery including the thoracodorsal perforator flap. It can be used as a free or pedicled tissue transfer. By exposing two clinical cases, we demonstrate that this flap is an interesting option for children and adolescents chest wall skin coverage with less morbidity compared to myocutaneous latissimus dorsi flap.

Breast amputation correction of a horse bite using the lipomodeling technique.

UNLABELLED: Mammary gland development is an important phase of puberty, and it marks the passage into adulthood for women, so any trauma leading to mammary deformities has an important physical and psychological impact. Often, classic techniques are difficult to use in the treatment of traumatic breast lesions. In this article, the authors present an exceptional case of breast reshaping by lipomodeling in a teenage patient who had experienced a horse bite. Treatment included 2 fat grafting sessions with fasciotomies, nipple reconstruction using a bifoliated flap, and areolar tattooing, all without any complications. We achieved a satisfactory result with a symmetric volume, a natural tissue consistency, and sensation improvement, all of which were maintained as the patient grew. In our experience, fat transfer was a safe and reliable technique that provided a good and stable aesthetic result, improving the volume and shape without additional scarring or implant devices. LEVEL OF EVIDENCE: 5.

[Surgical treatment of sequelae of deep breast burns: a 25-year experience]. / Traitement chirurgical des séquelles de brûlures profondes du sein : 25ans d'expérience.

INTRODUCTION: Deep chest burns in prepubescent girl prevent the development of the mammary gland, because scar contracture becomes an inextensible envelope. In adults, scar contracture can deform the breast shape. The aim of this work is to define the interest of tissue expansion in breast reconstruction of prepubescent's and adult's post-burns scars. PATIENTS AND METHODS: We conducted a 25-year retrospective study including patients treated surgically for deep thoracomammary burns. We studied following parameters: surgical techniques step by step, average time between each intervention, and morphologic and aesthetic results achieved. RESULTS: Twenty-eight patients have been operated between 1983 and 2008. Each patient has been operated on average 4.5 times (two to 12 times) during 6.3 years on average (1-19 years). Adult patients have showed a higher number of response (5.5 on average) than prepubescent girls (2.4 on average). Number of skin expansion has been 1.2 (0 to three) per patient. Sixty-two expanders have been placed (one to eight), 390cm(3) volume on average (180-1200). Delay of skin expansion has been about 7 months (4-10). Twenty-five breast implants have been raised on average 11 months (6-17) after debridement. Three changes of breast implant have occurred on average 5.3 years after insertion (3-8). Reconstruction of the areolonipple complex and controlateral symetrisation were conducted generally in the same time, 1 year after the last intervention. All patients will receive the possible additional volume (breast implant). Alternatives in breast volume reconstruction are lipomodelling and musculocutaneous expanded flaps. They are also discussed. Breast reconstruction in post-burns scars give clever cosmetic and morphologic despite of breast shape imperfections and apparent scars persistence satisfied cosmetic and morphologic results. These results, analyzed over a period of 25 years, show a qualitative change and decreased postoperative complications. DISCUSSION: Locoregional tissue expansion provide very clever results. In pre-pubescent grils, skin expanded flaps allow a near-normal mammary gland development. In adult women, they make the envelope that will receive the possible additional volume (breast implant). Alternatives in breast volume reconstruction are lipomodelling and musculo-cutaneous expanded flaps. They are also discussed. Breast reconstruction in post-burns scars give clever cosmetic and morphologic despite of breast shape imperfections and apparent scars persistence.

[Primitive neuroendocrine cancer of the breast. Post-traumatic discovery of a man]. / Tumeur neuroendocrine primitive du sein. Découverte post-traumatique chez un homme.

We report a primitive neuroendocrine breast tumor (NET) in a male. This situation is uncommon by its mode of discovery. We have treated a 74-year-old man with a lesion in the left areola initially considered as an organized hematoma due to a severe trauma. The ablation was performed by direct access under local anesthesia. The analysis of the piece has showed a NET of the breast due to the positivity of the neuroendocrine, cytokeratin and hormone markers. No other NET lesion was found, excluding the secondary origin of the breast tumor. Complementary therapies associated mastectomy, lymphadenectomy, hormonotherapy. Male breast cancer is rare. NET are exceptional, only a dozen of male NET is reported. These tumors affect a specific population and have a better prognosis than infiltrating ductal carcinoma. In our case, no causal link can be demonstrated between trauma and tumor microenvironment necessary for the growth of quiescent cancer cells.

[A micro-education programme for breastfeeding women: a pilot study to investigate the educations' effect on injured and painful nipples]. / Mikroschulungsprogramm für stillende Wöchnerinnen: Pilotstudie zur Auswirkung der Schulungen auf schmerzende und wunde Mamillen.

Injured and painful nipples are frequently occurring events in nursing women during the first days after giving birth. These problems often result in a premature termination of breastfeeding despite the mother's wish to nurse. Unsystematic instructions given to women regarding correct breastfeeding increase the risk that these complications will arise. The objective of the study was to investigate the effect of a systematic micro-education programme for nursing women by means of a pilot study or a quasi-experiment. The study included 100 mother and child pairs each in the experimental group and in the control group (N = 200). The pain experienced by all women during nursing was measured using the Visual Analogue Scale (VAS) and the degree of injury to the nipples after nursing was measured with a tool specially developed for this purpose, the Nipple Wound Score (NWS). Women who received instructions by means of the micro-education programme exhibited significantly less injured nipples (on the third day: experimental group 55 % and control group 77 %, p < 0.00; on the fourth day: 56 % and 80 %, p < 0.00).No differences were observed between the study groups in regard to the occurrence of pain (on the fourth day p = 0.68). The variables of birthing method, parity, age or nationality of the women had no effect on the degree of injury of the nipples or on the intensity of pain. The results of this pilot study suggest that repeated micro-education for breastfeeding women should be implemented during the first days after giving birth.

Reconstructive challenge of dermatofibrosarcoma protuberans in the female breast.

Dermatofibrosarcoma protuberans is an uncommon locally aggressive malignant neoplasm that most frequently appears in the trunk, followed by the extremities, head, and neck. But occurrence in the breast is extremely rare. We present a case of a 28-year-old woman, who had a history of trauma 5 years previously and excision 1 year before presentation at our clinic. We performed wide excision, together with microscopic and immunohistochemical analysis. No postoperative oncologic treatment was used and she remains disease-free 1 year after the surgery without any tumor recurrence. Here, we report a case of dermatofibrosarcoma protuberans in the female breast and present a detailed discussion of the diagnosis and treatment with reference to available literatures.

[Post-traumatic panniculitis (decubitus ulcer?) of the breast--a clinical case]. / Posttraumatická annikulitida (dekubitus?) prsu--klinicý prípad.

The authors describe the case of an eighty-year-old woman. Several hours of pressure on the right breast during a coma was the cause of inflammation which appeared to be phlegmon or inflammatory breast cancer. Histological examination excluded a malignant process and general treatment was to administer corticosteroids with antimicrobial drugs which resulted in the recovery of the patient.

[Sequelae of burns of the breast and their reconstruction]. / Les séquelles de brûlures des seins et leur reconstruction.

Sequelae of burns on the breast are essentially cosmetic. Requests for their reconstruction take place after the request for the face and hands. The problems is to face the consequences by considering the growth of mammary gland either hormonal in case of children or breast reconstruction as if in case of malgnancy in adult female. We propose a classification, which is helpful to choose the surgical treatment. Our technique of choice is tissue expansion (local or regional cutaneous flaps or full skin graft).

[Breast rupture: presentation, diagnosis and treatment of two cases]. / Fracture du sein : présentation, diagnostic et prise en charge chirurgicale de deux cas.

INTRODUCTION: Breast rupture is an uncommon event that has become more frequent from the 1980s, with the generalisation of the seat belt, so that we can now speak of seat belt related injuries. The trauma is often forgotten and leaves a fibrous band in the breast as only mark. In this way, the breast can be deformed by the scar as much as the retraction is important. The clinical presentation can mime that of a breast cancer, so it is really important to do an echography and a mammography of the lesion. If some dilemma remains, IRM or core biopsy can be helpful. PATIENTS AND METHODS: We report two cases of breast rupture. A breast cancer has been excluded with echography and mammography. We performed a reduction mammoplasty, with inverted T scars, conserving a posterior glandular flap. We will present the observations in the article. DISCUSSION: A breast trauma often leads to haematomas, necrosis of fat and lipid cyst formation. Typically, these lesions are located in regard to the passage of the seat belt on the thorax. The surgical treatment should correct an oblique deformation. It is important to excise all the fibrous tissue and to reharmonize the glandular content. Moreover, in the accidentally discovered forms, one should take in mind the vascular damage determined by the lesions and be able to recognise its presentation before the operation. CONCLUSIONS: Breast rupture is a rare situation that should be known. The treatment is simple and consists in excising the fibrous tissue and replacing it with a well-vascularised tissue. The posterior glandular flap is a helpful tool in these situations.

14-year-old girl • history of bullying • lack of social support • multiple linear scars on breasts • Dx?

► History of bullying ► Lack of social support ► Multiple linear scars on breasts.

Breast Hematoma: An Under-Recognized and Under-Reported Female-Specific Traumatic Injury and Its Clinical Significance.

Female-specific traumatic injury patterns have not been well researched and are potentially not well documented. Our aim was to examine the prevalence of breast hematomas (BHs) after blunt chest trauma, and to evaluate if there were risk factors associated with BH requiring intervention. A retrospective review from 2013 to 2018 was performed, identifying female patients ≥18 years sustaining blunt chest trauma. BH was defined as the presence of a collection of blood within the breast parenchyma, and clinically significant breast hematoma (CSBH) as BH requiring blood transfusion, surgical, or interventional radiology intervention. Univariate analysis was performed comparing CSBH with BH in terms of demographics, injury severity, antithrombotic agent use, and body mass index (BMI). Of 871 female patients meeting criteria, 59 (7%) had BH. Of these, 10 (17%) had CSBH (transfusion only, n = 3; angioembolization, n = 4; operation, n = 3). Compared to BH not requiring intervention, CSBH patients were older (mean age, 80 vs 69, P = .006), but had similar rates of motor vehicle crashes (90% vs 78%), seatbelt use (70% vs 71%), antiplatelet use (10% vs 12%), and anticoagulant use (10% vs 6%). Median Injury Severity Scores and median BMI (34 vs 34) were similar between the groups.