Changing Trends in Mastectomy and Breast Reconstruction. Analysis of a Single-institution Experience Between 2004-2016.

BACKGROUND/AIM: Recently, "conservative" mastectomy with immediate breast reconstruction (M-R) has become the gold standard when the breast must be removed. We analyzed the evolution in the choice of mastectomy type in our Unit, focusing on factors associated with renounce to reconstruction and risk factors for its failure. PATIENTS AND METHODS: Clinical-pathological and surgical features of 132 patients who underwent mastectomy in our Unit from 2004 to 2016 were analyzed. M-R rate and different mastectomy techniques' rates between 2004-2009 and 2010-2016 were compared. RESULTS: M-R was associated with younger age at diagnosis (p<0.001) and early tumor stage (p=0.03). M-R rate increased from 49.1% to 72.2% (p=0.002) in the last years, with prominent use of nipple-sparing-mastectomy (p<0.001). M-R failure rate was associated with previous or subsequent irradiation/chemotherapy in 92.3% of cases. CONCLUSION: M-R and particularly nipple-sparing-mastectomy represented the standard in more recent years; reconstruction failure was associated with irradiation/chemotherapy, especially in implant-based reconstructions.

[Advances in the research of application of skin-stretching device in wound closure].

Skin-stretching device as a new treatment method of wound closure has been recognized by many discipline fields. Through continuous improvement and adjustment in clinical application, it has achieved remarkable results in some departments. This article summarizes the basic theory, history, classification, and application of skin-stretching devices.

Hydrogels for Advanced Stem Cell Therapies: A Biomimetic Materials Approach for Enhancing Natural Tissue Function.

Stem-cell-based therapy is a promising approach for the treatment of a myriad of diseases and injuries. However, the low rate of cell survival and the uncontrolled differentiation of the injected stem cells currently remain key challenges in advancing stem cell therapeutics. Hydrogels are biomaterials that are potentially highly effective candidates for scaffold systems for stem cells and other molecular encapsulation approaches to target in vivo delivery. Hydrogel-based strategies can potentially address several current challenges in stem cell therapy. We present a concise overview of the recent advances in applications of hydrogels in stem cell therapies, with a focus particularly on the recent advances in the design and approaches for application of hydrogels in tissue engineering. The capability of hydrogels to either enhance the function of the transplanted stem cells by promoting their controlled differentiation or enhance the recruitment of endogenous adult stem cells to the injury site for repair is also reviewed. Finally, the importance of impacts and the desired relationship between the scaffold system and the encapsulated stem cells are discussed.

Aplicación de la terapia de vacío en el tratamiento de la dehiscencia completa de inserción mucocutánea del estoma / Vacuum-assited closure (vac) therapy in the treatment of the complete dehiscence of the mucocutaneous junction of the stoma

La aplicación de la terapia de vacío en la dehiscencia completa de la inserción mucocutánea de un estoma es algo novedoso, ya que hasta ahora, en el manejo de las complicaciones del estoma se limitaba su uso a dehiscencias parciales del mismo. Aunque es una complicación poco frecuente, tiene gran relevancia, ya que dificulta la adaptación de los dispositivos de ostomía, enlentece la cicatrización de la cavidad dehiscente, requiere el consumo de gran cantidad de recursos humanos y materiales e impacta directamente en la calidad de vida del paciente. El abordaje de este caso se realizó de manera multidisciplinar (Cirugía, Enfermería y Nutrición) implantando una dieta de absorción alta para reducir el débito del estoma, asociando el uso de la terapia de presión negativa en la cavidad dehiscente y dispositivos de ostomía adecuados para la situación

The use of vaccum-assisted therapy in the complete dehiscence of the mucocutaneous junction of the stoma is a new alternative since, to manage stoma complications, its use has been limited to partial dehiscence of the stoma during the last years. It is an uncommon complication, but it has a great relevance, because it complicates the stoma devices adaptation, it slows the healing of the wound, it requires spending more human and material resources and it has a direct impact over the quality of life of the patient. The approach to every case must be carried out in a multidisciplinary way (Surgery, Nursing and Nutrition) giving to the patient a special diet to reduce the stoma debit, associating the use of vaccum-assisted therapy in the dehiscent wound and employing suitable stoma devices for each situation

Biopsia mamaria asistida por vacío y guiada por estereotaxia. Correlación con la biopsia quirúrgica / Stereotactic vacuum-assisted breast biopsy. Correlation with surgical excisional biopsy

Objetivo. Valorar la eficacia de la biopsia percutánea asistida por vacío y guiada por estereotaxia como alternativa a la biopsia quirúrgica diagnóstica. Material y métodos. Estudio retrospectivo de 250 biopsias asistidas por vacío guiadas por estereotaxia realizadas entre marzo del 2006 y agosto del 2010. Se ha analizado la tasa de falsos negativos y la subestimación diagnóstica en relación con la biopsia quirúrgica. Resultados. La tasa de falsos negativos fue del 2% (1/63) y el valor predictivo positivo fue del 100%. La biopsia quirúrgica evidenció hallazgos de carcinoma en el 30% (3/10) de los casos diagnosticados como hiperplasia ductal atípica y en el 33,3% (2/6) de los carcinomas lobulillares in situ. De las 40 lesiones diagnosticadas como carcinoma ductal in situ, la biopsia quirúrgica evidenció carcinomas infiltrantes en 4 de los casos (10%). Conclusiones. La biopsia guiada por estereotaxia puede considerarse una alternativa válida a la biopsia quirúrgica diagnóstica, aunque persiste la posibilidad de subestimación diagnóstica (AU)

Objective. To evaluate the efficiency of stereotactic vacuum-assisted core breast biopsy as an alternative to diagnostic surgical biopsy. Material and methods. A retrospective study based on 250 stereotactic vacuum-assisted percutaneous biopsies was conducted from March 2006 to August 2010. The false-negative rate and underestimation of disease at percutaneous biopsy were determined in comparison with diagnostic surgical biopsy. Results. The false-negative rate was 2% (1/63) and the positive predictive value was 100%. Surgical excision revealed carcinoma in 30% (3/10) of the patients with atypical ductal hyperplasia at core biopsy and in 33.3% (2/6) of those with lobular carcinoma in situ. Among 40 lesions diagnosed as ductal carcinoma in situ at vacuum-assisted biopsy, surgery revealed invasive carcinoma in four (10%). Conclusions. Stereotactic core breast biopsy can be considered a valid alternative to diagnostic surgical biopsy, although diagnostic underestimation still occurs (AU)

Reconstrucción mamaria: colocación y manejo de expansores / No disponible

La reconstrucción mamaria es un campo asistencial donde los progresos técnicos, el desarrollo de nuevas metodologías de trabajo y la adquisición de habilidades ha cambiado radicalmente en los últimos años. No obstante, las técnicas de expansión tisular y protetización siguen ocupando un espacio importante dentro del espectro de la oferta reconstructiva de las pacientes que han sido sometidas a mastectomía. En esta revisión pretendemos establecer las indicaciones, las contraindicaciones, las peculiaridades técnicas y definir algoritmos de toma de decisiones basadas en la experiencia acumulada en este campo así como en la información contrastada con otras fuentes y autores. Con ello se pretende establecer una guía básica pero que a la vez resulte eficaz e ilustrativa en lo referente a la reconstrucción mamaria con expansores tisulares y prótesis(AU)

Breast reconstruction is a medical area where technical advance, new methods and skills have made it change dramatically. Nevertheless, tissue expansion and prosthesis keep on being a fundamental part of the reconstructive offer after mastectomy. In this review we intend to fix indications, contraindications, technical requirements and algorithms that led to experience based decisions supported not only by our own experience but also from different sources of information and diverse authors. To sum up, the aim of this review is to create a basic, efficient and illustrative guide related to breast reconstruction with tissue expanders and prosthesis(AU)

Reconstrucao da mamaria imediata e tardia com expansores de tecidos / Immediate and delayed reconstruction of the breast using tissue expanders

No periodo de 1988 a 1992 os autores realizaram 64 reconstrucoes mamarias nas quais utilizaram expansores de tecidos seguidos da introducao de implantes de silicone num segundo tempo cirurgico. As reconstrucoes foram imediatas ou tardias em pacientes submetidos a mastectomia radicais modificadas. Neste trabalho sao descritos detalhes dos tempos cirurgicos e analisadas as indicacoes, vantagens e desvantagens da tecnica. Com resultados satisfatorios em 85 por cento dos casos, considera-se que a expansao de tecidos e uma tecnica que deve permanecer como uma opcao valida para reconstrucao de mama.