Comparison of long-term outcomes of breast conservation and reconstruction after mastectomy using BREAST-Q.

AIMS: Patients' post-operative wellbeing determines the impact and effectiveness of breast reshaping and reconstruction procedures. The aim of the study was to evaluate and compare four different types of breast reconstruction: bilateral therapeutic mammaplasty, DIEP flap, ELD with immediate lipomodelling and implant-based reconstruction using BREAST-Q. METHODS: Patients who underwent breast reconstruction by one of the above-mentioned methods were identified from a retrospective register and sent BREAST-Q questionnaires. Univariate and multivariate analysis of BREAST-Q scores and clinical characteristics were performed for identifying trends between and within groups. RESULTS: A total of 240 patients were identified with a response rate of 57%. Patients receiving implants were statistically less satisfied with breast reconstruction (mean 57%) and tended to be younger with lower BMI in comparison to other groups. There were no statistical differences in psychosocial wellbeing or patient experience between groups. Despite the fact that clinically these groups were heterogeneous, satisfaction with breast was similar in the remaining three autologous groups (range 70-75%). Detailed analysis and interpretation of quality-of-life scores, clinical differences and trends identified in the multivariate analysis along with nuances between surgical techniques used in our unit for breast reshaping and reconstruction, have been performed. CONCLUSIONS: The most important goal of breast reconstruction is to restore patients' quality of life and satisfaction with breast. Identifying factors which can potentially predict poor outcomes will improve the informed consent process and patient selection.

Preoperative implant selection for two stage breast reconstruction with 3D imaging.

Implants used for two-stage breast reconstruction are selected exclusively on the basis of the directly measured linear parameters. Therefore, the relevant implant is not always chosen despite the wide range of available products. The aim was to analyze the clinical usefulness of three-dimensional (3D) imaging in the breast implant selection. In 50 patients after unilateral two-stage breast reconstruction, height, width, projection and total volume of both breasts were triply obtained with measuring tape (anthropometric method), thermoplastic casting (thermoplastic method) and 3D imaging (optical method). We measured skin fold thickness with skin caliper. In the optical method, we subtracted the covering tissues and calculated the parameter - "estimated breast implant volume" (EBIV), together with the corresponding "anthropometrically estimated breast implant volume" (aEBIV) in the anthropometric method. Reliability of the three methods was described as repeatability and accuracy, both quantified with parameters: "technical error measurement" (TEM) and "reliability factor" (R). Repeatability showed variation among the repeated measurements. Accuracy determined variability between the real volume of the implant used for reconstruction and the obtained volumetric parameters. Repeatability was the highest for the optical method, comparing to anthropometric and thermoplastic methods (p<0.0001). Accuracy was the highest in the optical method for EBIV, comparing to aEBIV in the anthropometric method and the total volume in three methods (p<0.0001). Level of accuracy for EBIV was in the range of variability among the commercially available implants (p>0.05). In conclusion, implants for breast reconstruction are precisely selected with the 3D scanning method, in comparison to widely used direct measurements or thermoplastic casting.

Breast reconstruction with the denervated latissimus dorsi musculocutaneous flap.

OBJECTIVE: To analyze clinical implications of the thoracodorsal nerve division in the latissimus dorsi musculocutaneous flap breast reconstruction. PATIENTS AND METHODS: Prospective cohort study was conducted on 29 patients. Breast reconstruction with latissimus dorsi musculocutaneous flap was performed unilaterally in 20 patients or bilaterally in 9 women (38 breasts). Thoracodorsal nerve was divided during reconstruction of 20 breasts (group 1) and was preserved for 18 breasts (group 2). Height, width, projection, area of the covering skin and volume of the reconstructed and healthy breasts were measured on the 3D images of the anterior chest wall, taken 6 weeks and 6 months postoperatively with the Di3D 3D camera. Data regarding tissue consistency, painfulness and animation of the reconstructed breast, symmetry of both breasts and overall satisfaction after the surgery were collected at 6 months. RESULTS: The reconstructed and healthy breasts decreased in volume in group 1 (-45.85 cm(3) ± 48.41 cm(3), p = 0.0004; -29.13 cm(3) ± 14.98 cm(3), p = 0.0009) and in group 2 (-31.5 cm(3) ± 25.35 cm(3), p = 0.0001; -15.4 cm(3) ± 21.96 cm(3), p = 0.0537). There were no differences in decrease in volume between groups 1 and 2 (p > 0.05). Respondents in group 1 in comparison to group 2 showed similar satisfaction of the tissue consistency of the reconstructed breast (p > 0.05) and the level of symmetry between both breasts (p > 0.05), gave lower scores for painfulness (p < 0.0001), animation (p < 0.0001) and higher scores for the overall satisfaction about the reconstructed breast (p = 0.0001). CONCLUSION: We suggest that division of the thoracodorsal nerve during latissimus dorsi musculocutaneous flap breast reconstruction is a useful undertaking to minimize unnatural animation of the reconstructed breast.

Implant-based augmentation mammaplasty following breast conservation surgery.

BACKGROUND: Implant-based augmentation mammaplasty following breast-conserving cancer therapy (BCT) and radiotherapy has previously been cautioned against given concerns over complications and potential occult recurrence. METHODS: All patients who underwent BCT and radiotherapy followed by implant-based augmentation mammaplasty were included in the study. Retrospective case-note analysis was performed. RESULTS: In all, 23 delayed implant-based mammaplasty procedures following BCT for breast cancer were performed. Fifteen tumors were located in the superior half of the breast. The median weight of wide local excision was 71.0 g (range, 15-385). All implants were placed in a subglandular position with median volume of 140 mL (range, 80-370). Complications occurred in 10 breasts, and 6 breasts required revisional surgery. Capsular contracture occurred in 4 breasts. No patient developed locoregional recurrence. A questionnaire revealed excellent satisfaction of the patient, and all patients reported that they definitely or probably would recommend the procedure. CONCLUSIONS: Delayed implant-based augmentation mammaplasty after BCT and radiotherapy is feasible and gives good aesthetic results with high satisfaction of the patient. This technique is an important addition to the breast conservation surgery algorithm.

Congenital smooth muscle hamartoma of the nipple: a case report.

BACKGROUND: Hamartoma is a benign developmental disorder. This focal malformation is composed of mature tissues normally observed in a given organ but randomly distributed, often in disturbed quantitative ratio, with growth rate similar to that of the surrounding tissues. Congenital smooth muscle hamartoma presents as flesh-colored or variably pigmented plaque or macule. To our knowledge this is the first case of congenital smooth muscle hamartoma of the nipple reported in the available literature. CASE: A 44-year-old woman with a history of left breast cancer, for which she had mastectomy and axillary node clearance in 2007, presented to the plastic surgery outpatient department to discuss the reconstructive surgery of the left breast and to evaluate her right hypertrophic nipple. After surgical excision of the right nipple-areola complex, histopathological result revealed a previously unreported lesion of the nipple. Diagnosis of congenital smooth muscle hamartoma of the nipple was made after literature review of the previously described cases of congenital smooth muscle hamartoma. CONCLUSION: Congenital smooth muscle hamartoma of the nipple should be considered in the differential diagnosis of tumors of the nipple. Differentiating congenital smooth muscle hamartoma of the nipple from other types of nipple lesions avoids unnecessary excision of this benign condition.