Evaluation of Aesthetic and Quality-of-Life Results after Immediate Breast Reconstruction with Definitive Form-Stable Anatomical Implants.

BACKGROUND: Although there are many reports on different techniques in breast reconstruction, there are few data regarding immediate breast reconstruction with definitive form-stable anatomical implants in terms of aesthetics and quality-of-life outcomes. METHODS: Ninety-four patients underwent mastectomy with immediate breast reconstruction using anatomical implants and contralateral symmetrization. Aesthetic results were evaluated by three different methods: the patient's self-report, the assessment of four independent specialists (two breast surgeons and two plastic surgeons from different institutions), and the BCCT.core software. Quality of life was evaluated by means of the BREAST-Q instrument. RESULTS: Average age ± SD was 52.1 ± 11.6 years. Most of patients had medium size breasts and T1 tumors. Patients had evaluated their aesthetic results better than did software and specialists. There was no significant difference in the comparison between software and specialist's evaluation. Multifactorial analysis showed that age older than 70 years and radiotherapy were significant risk factors for poor aesthetic outcomes after immediate breast reconstruction with implants. Considering quality of life, most of the patients were satisfied with their outcome and psychosocial and sexual well-being. CONCLUSION: Immediate breast reconstruction with implants and contralateral symmetrization had a positive impact on the quality of life and showed satisfactory outcomes when evaluated by subjective and objective methods.

Long-Term Comparison of Aesthetical Outcomes After Oncoplastic Surgery and Lumpectomy in Breast Cancer Patients.

BACKGROUND: Lumpectomy may result in major deformities and asymmetries in approximately one-third of patients. Although oncoplastic surgery (OP) could be a useful alternative to avoid them, lack of strong data is causing some debate. The purpose of this study was to compare aesthetic outcomes in patients undergoing OP versus lumpectomy using three different assessment methods. METHODS: A total of 122 patients were included in this cross-sectional multicentric study; 57 underwent OP (46.7 %), and 65 underwent lumpectomy (53.3 %). Two breast surgeons and two plastic surgeons from different institutions using the Garbay scale independently evaluated aesthetic outcomes. BCCT.core software was applied in both groups, and the patients evaluated their aesthetic outcomes answering a questionnaire about their satisfaction rate. RESULTS: OP group had a higher proportion of excellent aesthetic results according to the BCCT.core software analysis (p = 0.028) and the specialists (p = 0.002). Multifactorial analyses showed that age ≥70 years (RP = 6.02; 95 % confidence interval [CI] 1.73-21.0; p = 0.005), tumors in the medial, inferior, and central quadrants (RP = 4.21; 95 % CI 1.88-9.44; p < 0.001), and large breasts (RP = 7.55; 95 % CI 2.48-23.0; p < 0.001) were significant risk factors for poor aesthetic outcomes after lumpectomy. The patients classified their results as better than those by the specialists and by the software, with no statistical difference between the groups. CONCLUSIONS: Excellent aesthetic results were more frequent in the OP group according to BCCT.core software analysis and specialists. In addition, some clinical conditions and tumor locations in the breast can be considered risky factors for poor aesthetic outcomes in lumpectomy.

Surgery for malignant maxillary tumors involving the middle cranial fossa.

The purpose of this study was to evaluate the disease-free survival (DFS) of patients with maxillary malignant tumors invading the middle cranial fossa (MCF) who underwent a lateral or anterolateral skull base resection. This study was a retrospective analysis in a tertiary referral center and included 62 patients with maxillary malignant tumors invading the MCF (stage T4b) treated with surgery with or without postoperative radiotherapy. All patients had sharp pain and involvement of at least one branch of the trigeminal nerve. Twenty-eight patients had not been treated previously, and 34 had previously been treated elsewhere. The MCF dura was infiltrated and resected in 36 cases, and in nine of these, there was an intradural extension of the tumor, with temporal lobe and/or cavernous sinus invasion. Thirty-six patients underwent reconstruction with a temporalis muscle pedicled flap, and 26 patients with a free flap. There was a 22% overall rate of postoperative complications, but no intraoperative deaths. The median follow-up time was 49 months (range 2 to 186). Overall DFS was 33.9% and was higher for untreated patients (46.4% versus 23.5%) and for patients in whom clean margins were achieved (51.4% versus 12.5%). The survival time for patients who died of disease was 9 months for squamous cell carcinoma and 38 months for adenoid-cystic carcinoma. All patients experienced anesthesia in the territory of the resected trigeminal branches, but their pain vanished, and their quality of life improved. Lateral skull base surgery may achieve satisfactory oncologic results for patients with low-grade tumors, with improved quality of life for almost all patients.