ABSTRACT
Although autologous tissue reconstruction is the best option for breast reconstruction, using implants is still a reliable and simple method, offering acceptable aesthetic results. Becker-type implants are permanent implants that offer a 1-stage reconstructive option. A retrospective study was carried out in our center reviewing the clinical reports of 237 patients, in whom a total of 314 Becker-type prostheses were implanted. Overall survival was calculated using a Kaplan-Meier estimate. Cox proportional hazard models were used to calculate adjusted hazard ratios. At the end of the study, 214 expanders (68.15%) presented no complications, 40 (12.47%) developed significant capsular contracture, in 27 (8.60%) infection occurred, 24 (7.64%) suffered minor complications, and 9 (2.87%) ruptured. The mean survival time of the expanders was 120.41 months (95% CI: 109.62, 131.19). Radiotherapy, chemotherapy, high Molecular Immunology Borstel, age, mastectomy performed previously to the implant, ductal carcinoma, advanced tumoral stage, experience of the surgeon, and Becker 35-type implants were significantly related to a high number of complications in relation to the survival of the implants. Cox regression analysis revealed that the main risk factors for the survival of expander implants included radiotherapy and surgeon experience. The complication hazard ratio or relative risk caused by these 2 factors was 1.976 and 1.680, respectively. One-stage reconstruction using Becker-type expanders is an appropriate, simple, and reliable option in delayed breast reconstruction in patients who have not received radiotherapy and as long as the procedure is carried out by surgeons skilled in the technique.
Subject(s)
Breast Implantation/instrumentation , Breast Implants , Postoperative Complications/etiology , Tissue Expansion Devices , Adult , Breast Implantation/methods , Female , Follow-Up Studies , Humans , Kaplan-Meier Estimate , Mastectomy , Outcome Assessment, Health Care , Proportional Hazards Models , Prosthesis Failure/etiology , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: Madelung's disease (MD) is an uncommon pathology characterized by the presence of multiple masses of unencapsulated adipose tissue that is symmetrically distributed. The aim of this study was to investigate clinical and epidemiological features of patients diagnosed with MD in our department. Associated diseases and evolution after treatment were also investigated. METHODS: We reviewed the clinical histories of 22 patients diagnosed with MD from 1990 to 2010 and obtained their epidemiological and clinical characteristics. RESULTS: We found 21 patients with MD type 1 and one patient with MD type 2 according to Enzi's classification. All patients were male, 95.5% with high alcohol intake, and 59.1% with some hepatic disease. No family antecedents were significant; 40.9% had dyslipidemia, 22.7% arterial hypertension, 22.7% chronic obstructive pulmonary disease (COPD), 13.6% hyperuricemia, 9.1% hypothyroidism, 4.5% diabetes mellitus type 2, and 4.5% carbohydrate intolerance; 40.9% had a body mass index>30, and 27.3% presented gynecomastia/lipomastia. The region most frequently affected by fatty deposits was the neck. CONCLUSIONS: Madelung's disease affects mainly alcoholic males in their fourth decade of life. Hepatic diseases appear in most patients. Also associated with MD are high lipid blood levels, arterial hypertension, COPD, hyperuricemia, and obesity. MD type 1 is the most frequent phenotype and the neck the most common location for fatty masses. Recurrence after surgery, in the same location or different locations, is a frequent event, even in patients who later abstain from alcohol intake. LEVEL OF EVIDENCE IV: 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 at www.springer.com/00266 .
Subject(s)
Adipose Tissue/surgery , Lipectomy/methods , Lipomatosis, Multiple Symmetrical/surgery , Plastic Surgery Procedures/methods , Adipose Tissue/pathology , Adult , Body Mass Index , Cohort Studies , Comorbidity , Follow-Up Studies , Humans , Hypertension/diagnosis , Hypertension/epidemiology , Lipomatosis, Multiple Symmetrical/diagnosis , Lipomatosis, Multiple Symmetrical/epidemiology , Liver Cirrhosis/diagnosis , Liver Cirrhosis/epidemiology , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Recurrence , Reoperation , Retrospective Studies , Risk Assessment , Treatment OutcomeABSTRACT
Dupuytren's disease is a palmar fascia pathology characterised by flexion contracture of the involved fingers in late stages. It has been described a higher prevalence in northern populations, especially in men in the fifth or sixth decade of life.1 Alcohol consumption, liver disease, diabetes mellitus, epilepsy and some of its treatments, tobacco smokers or hand workers are only a example of the different aetiologies proposed. There are a group of patients presenting with more aggressive clinical manifestation named Dupuytren's diathesis. This subtype could frequently present a positive family history, ectopic fibromatosis and bilateral hand affectation. The authors present a 24-year-old woman referred to the Plastic Surgery Department because severe fingers contracture with an associated aggressive plantar fibromatosis. She referred familial history in her first degree relatives (mother and three of seven brothers and sisters). The first clinical manifestations in her hand began when she was 7 years old.