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1.
FP Essent ; 496: 16-20, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32902242

RESUMO

Benign breast conditions are heterogenous, with varying clinical presentations. These conditions commonly include nipple discharge, breast pain, palpable masses, common breast lesions, and high-risk breast lesions. Signs and symptoms of these conditions range from pain and abnormal physical examination findings to asymptomatic abnormalities detected on breast imaging. A combination of clinical examination, patient history, and diagnostic studies should be used to make a diagnosis. The primary challenges in addressing new breast symptoms are determination of a clear diagnosis and creation of a management plan, as well as evaluation of future risk of malignancy related to benign diagnoses. Risk assessment can prove difficult in patients of certain racial groups, given the differences in risk attributed to specific benign conditions. This also can prove challenging given the lack of racial diversity in early trials assessing risk in benign breast disease. Many benign breast conditions are diagnosed and managed in the family medicine setting, but some patients may require consultation with a breast subspecialist.


Assuntos
Neoplasias da Mama , Mama , Humanos , Exame Físico , Medição de Risco
2.
Tokai J Exp Clin Med ; 45(3): 117-120, 2020 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-32901898

RESUMO

Background; Until 2018, the Breast and Endocrine surgery had no student calendar. A questionnaire survey was conducted on how students felt by creating a weekly schedule of individual students from 2019. METHOD: 6th-year elective courses, targeted at students who selected Breast and Endocrine surgery clinical clerkship. The schedule clarifies the contents of the training as follows; outpatient visits, small group study (preparation for graduation and national exams including mammography reading), simulator training, and surgery. The questionnaire adopted an anonymous five-point evaluation method (5; I think very much; 4; Somewhat I think; 3; Normal; 2; Somewhat I don't think; 1; I don't think), and provided a free text box. The following seven questions were asked; A. I was able to send a good training, B. I was useful for studying national and graduation exams, C. Time constraints were appropriate, D. I could fully experience surgery, E. Appropriately experienced outpatients, F. Assignments (presented at conference) appropriate, G. I was interested in Breast and Endocrine surgery. RESULTS: Average values were A. 4.7, B. 4.9, C. 4.6, D. 4.9, E. 4.8, F. 4.7, G. 4.7. However, C and F received low ratings of 1 and 2. In the free text box, there were favorable opinions such as the fact that it was good to prepare for the national examination and that reading mammography was helpful. Conversely, there were some negative opinions, such as a time spent outpatient was too long, a difference in enthusiasm among the instructors, and a hope to see more at the first visit and to cope with the procedure. DISCUSSION: Preparing a weekly calendar of individual students generally yielded satisfactory results, but also highlighted the potential for future improvements in clinical clerkship.


Assuntos
Mama/cirurgia , Calendários como Assunto , Estágio Clínico , Educação Médica/métodos , Satisfação Pessoal , Estudantes de Medicina/psicologia , Feminino , Humanos , Masculino , Inquéritos e Questionários
3.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(4): 562-566, 2020 Apr 30.
Artigo em Chinês | MEDLINE | ID: mdl-32895136

RESUMO

OBJECTIVE: To evaluate the diagnostic efficacy of Kaiser score for breast lesions presenting as non-mass enhancement. METHODS: We collected data from patients with breast lesions presenting as non-mass enhancement on preoperative DCE-MRI between January, 2014 and June, 2019. All the cases were confirmed by surgical pathology or puncture biopsy. With pathology results as the gold standard, we evaluated the diagnostic efficacy of Kaiser score and MRI BI-RADS classification and the consistency between the diagnostic results by the two methods and the pathological results. RESULTS: A total of 90 lesions were detected in 88 patients, including 28 benign lesions (31.1%) and 62 malignant lesions (68.9%). For diagnosis of the lesions, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Kaiser Score were 100%, 75%, 89.9%, 100% and 92%, as compared with 93.5%, 46.4%, 79.5%, 76.5% and 78.9% of MRI BI-RADS, respectively. The diagnostic specificity of Kaiser score was significantly higher than that of BI-RADS classification (P=0.021). CONCLUSIONS: The Kaiser score system provides a diagnostic strategy for BI-RADS classification of breast lesions with non-mass enhancement and has a better diagnostic efficacy than BI-RADS classification alone. The use of Kaiser score can significantly improve the diagnostic specificity of such breast lesions for inexperienced radiologists.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Mama , Humanos , Imagem por Ressonância Magnética
4.
Medicine (Baltimore) ; 99(33): e21736, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872060

RESUMO

RATIONALE: Pilot studies have reported that patients with systemic lupus erythematosus (SLE) appear more likely to develop into neoplasia, especially lymphatic hyperplasia diseases. To our knowledge, this is the first case report of the concomitant onset of SLE and primary breast diffuse large B-cell lymphoma (PB-DLBCL). PATIENT CONCERNS: We reported an unusual case of the occurrence of primary breast diffuse large B-cell lymphoma in a 25-year-old female patient who had been diagnosed with SLE and treated with immunosuppressive drugs for about 4 years. She presented a 7-week history of a painless mass above the left breast and no history suggestive of any nipple discharge, fever, and weight loss. DIAGNOSIS: Ultrasonography of the breast showed that there was 1 mass in the left breast. After breast mass surgical resection, histopathological examinations were performed and revealed that it was primary breast diffuse large B-cell lymphoma. INTERVENTIONS: Treatment strategy with vincristine and dexamethasone was used to improve symptoms. However, the patient's renal function deteriorated and the blood potassium rose continuously and she and their family members refused the follow-up treatments. OUTCOMES: The patient died 8 months after she was discharged from the hospital. LESSONS: PB-DLBCL is a rare occurrence in SLE patients. Therefore, a careful examination is very important in SLE cohort, as activity of the disease and malignancy may mimic each other. Meanwhile, when symptoms cannot be explained or insensitive to treatment, the occurrence of malignant tumors must be highly considered.


Assuntos
Neoplasias da Mama/complicações , Mama/patologia , Falência Renal Crônica/etiologia , Lúpus Eritematoso Sistêmico/complicações , Linfoma Difuso de Grandes Células B/complicações , Adulto , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Evolução Fatal , Feminino , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/terapia , Radiografia , Ultrassonografia
5.
Medicine (Baltimore) ; 99(35): e21449, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871867

RESUMO

BACKGROUND: Pulsed electromagnetic fields shows some potential in alleviating pain after mammaplasty. This systematic review and meta-analysis is conducted to investigate the analgesic efficacy of pulsed electromagnetic fields for pain control after mammaplasty. METHODS: The databases including PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases are systematically searched for collecting the randomized controlled trials regarding the impact of pulsed electromagnetic fields on pain intensity after mammaplasty. RESULTS: This meta-analysis has included 4 randomized controlled trials. Compared with control group after mammaplasty, pulsed electromagnetic fields results in remarkably reduced pain scores on 1 day (MD = -1.34; 95% confidence interval [CI] = -2.23 to -0.45; P = .003) and 3 days (MD = -1.86; 95% CI = -3.23 to -0.49; P = .008), as well as analgesic consumption (Std. MD = -5.64; 95% CI = -7.26 to -4.02; P < .00001). CONCLUSIONS: Pulsed electromagnetic fields is associated with substantially reduced pain intensity after mammaplasty.


Assuntos
Mama/cirurgia , Campos Eletromagnéticos/efeitos adversos , Mamoplastia/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Adolescente , Adulto , Idoso , Analgésicos/farmacologia , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
6.
Plast Reconstr Surg ; 146(2): 215-225, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740564

RESUMO

BACKGROUND: Autologous fat grafting is a useful adjunct following breast reconstruction. The impact of autologous fat grafting on oncologic safety and surveillance remains questionable, particularly following breast conservation therapy. METHODS: The authors performed a retrospective review of patients who underwent delayed fat grafting following breast conservation therapy between 2006 and 2016. A control group of conservatively managed patients without grafting was matched for cancer stage, age, body mass index, and follow-up. Outcomes included locoregional recurrence and oncologic surveillance. RESULTS: Seventy-two patients were identified per cohort. There were no differences in median age (50 years versus 51 years; p = 0.87), body mass index (28.2 kg/m versus 27.2 kg/m; p = 0.38), or length of follow-up (61.9 months versus 66.8 months; p = 0.144) between controls and grafted patients, respectively. Overall, four patients in each cohort experienced recurrence (5.6 percent; p = 1.00) with similar cumulative incidence estimates observed (log-rank test, p = 0.534). There were no significant differences in palpable mass (9.7 percent versus 19.4 percent; p = 0.1), fat necrosis (34.7 percent versus 33.3 percent; p = 0.86), calcifications (37.5 percent versus 34.7 percent; p = 0.73), or indication for breast biopsy (15.3 percent versus 22.2 percent; p = 0.23) between breast conservation and breast conservation therapy plus autologous fat grafting cohorts, respectively. CONCLUSIONS: Overall, the authors found no difference in recurrence rates after breast conservation with or without delayed fat grafting. Furthermore, there were no differences in the rates of fat necrosis, palpable mass, and abnormal radiographic findings. This study represents the longest follow-up to date in in a large matched study of autologous fat grafting with breast conservation therapy demonstrating oncologic safety and no interference with follow-up surveillance. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Tecido Adiposo/transplante , Neoplasias da Mama/cirurgia , Mama/cirurgia , Mamoplastia/métodos , Mastectomia Segmentar/métodos , Adulto , Idoso , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
7.
Plast Reconstr Surg ; 146(2): 117e-126e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740565

RESUMO

BACKGROUND: Occult breast carcinoma is occasionally found in breast reduction specimens. Although its incidence varies widely, there is a trend toward an increased incidence for women with a history of breast cancer. The authors performed a systematic review and meta-analysis of occult carcinoma incidence in breast reduction specimens. METHODS: The MEDLINE and Embase databases were searched for peer-reviewed studies with no language restrictions for studies that recorded the incidence of occult carcinoma in breast reduction specimens. Cancer incidence per specimen was pooled for women with and without a history of breast cancer. RESULTS: Forty-two studies were eligible for inclusion, of which 29 were quantitatively analyzed. The pooled incidence of carcinoma was higher within specimens from women with breast cancer (3.4 percent; 95 percent CI, 2.2 to 5.3 percent) than without (0.6 percent; 95 percent CI, 0.4 to 0.8 percent), and this increased likelihood was significant when populations were compared directly (OR, 6.02; 95 percent CI, 3.06 to 11.86; p < 0.0001). CONCLUSIONS: Women with a history of breast cancer have an increased incidence of occult breast carcinoma within their breast reduction specimens compared with women with no breast cancer history. There is a need for preoperative radiology screening, counseling, and histopathology guidelines to ensure adequate diagnosis and management of these women.


Assuntos
Neoplasias da Mama/cirurgia , Mama/cirurgia , Mamoplastia/efeitos adversos , Programas de Rastreamento/métodos , Mastectomia Segmentar/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Mama/patologia , Neoplasias da Mama/diagnóstico , Feminino , Saúde Global , Humanos , Incidência , Achados Incidentais , Recidiva Local de Neoplasia/etiologia
8.
Plast Reconstr Surg ; 146(2): 238-245, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740567

RESUMO

BACKGROUND: Antifibrinolytic medications, such as tranexamic acid, have recently garnered increased attention. Despite its ability to mitigate intraoperative blood loss and need for blood transfusion, there remains a paucity of research in breast reconstruction. The authors investigate whether intravenous tranexamic acid safely reduces the risk of hematoma following implant-based breast reconstruction. METHODS: A single-center retrospective cohort study was performed to analyze all consecutive patients undergoing immediate two-stage implant-based breast reconstruction following mastectomy between 2015 and 2016. The incidence of postoperative hematomas and thromboembolic events among all patients was reviewed. The patients in the intervention group received 1000 mg of intravenous tranexamic acid before mastectomy incision and 1000 mg at the conclusion of the procedure. Fisher's exact test and the Mann-Whitney-Wilcoxon test were used. Multivariate logistic regression models were performed to study the impact of intravenous tranexamic acid after adjusting for possible confounders. RESULTS: A total of 868 consecutive breast reconstructions (499 women) were reviewed. Overall, 116 patients (217 breasts) received intravenous tranexamic acid, whereas 383 patients (651 breasts) did not. Patient characteristics and comorbidities were similar between the two the groups. Patients who received tranexamic acid were less likely to develop hematomas [n = 1 (0.46 percent)] than patients who did not [n = 19 (2.9 percent)] after controlling for age, hypertension, and type of reconstruction (prepectoral and subpectoral) (p = 0.018). Adverse effects of intravenous tranexamic acid, including thromboembolic phenomena were not observed. Multivariate analysis demonstrated that age and hypertension independently increase risk for hematoma. CONCLUSIONS: Intravenous tranexamic acid safely reduces risk of hematoma in implant-based breast reconstruction. Further prospective randomized studies are warranted to further corroborate these findings. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Implantes de Mama/efeitos adversos , Mama/irrigação sanguínea , Hematoma/prevenção & controle , Mamoplastia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Tromboembolia/prevenção & controle , Ácido Tranexâmico/administração & dosagem , Adulto , Antifibrinolíticos/administração & dosagem , Neoplasias da Mama/cirurgia , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Hematoma/etiologia , Humanos , Injeções Intravenosas , Mastectomia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tromboembolia/etiologia , Resultado do Tratamento
9.
Plast Reconstr Surg ; 146(2): 127e-136e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740569

RESUMO

BACKGROUND: Reduction mammaplasty is the standard of care for symptomatic macromastia. The process of requesting insurance coverage for reduction mammaplasty is cumbersome and potentially controversial, and insurance policies vary significantly. The goal of our analysis is to identify trends in insurance coverage rates, assess for the presence of disparities, and propose ways to increase chances of successful preauthorization. METHODS: The authors performed a retrospective review of preauthorizations for reduction mammaplasty at a single institution from 2012 to 2017. Insurance company names were deidentified. Preauthorization denial rates were assessed by year, insurance carrier, and reason for denial. Multiple regression analysis was performed to identify predictors for predetermination denial by insurance companies. RESULTS: Among 295 preauthorizations, 212 were approved (72 percent) and 83 were denied (28 percent), among which 18 were appealed, 13 successfully. Rates of insurance denials have been increasing steadily, from 18 percent to 41 percent. Medicaid had the lowest denial rates (9.3 percent), whereas private carriers denials ranged from 21.4 to 62.1 percent. In terms of reason for denial, 30 percent were because of contract exclusion, 39 percent were because of inadequate documentation or not meeting medical criteria, and 12 percent were because of inadequate predicted resection weight. Certain private insurance carriers were the only independent predictors of predetermination denial. CONCLUSIONS: Rate of preauthorization denials is high and has been increasing steadily. Insurance criteria remain arbitrary. A proper documentation and appeal process by the plastic surgeon may improve rates of insurance approval. Although resection weight does not correlate with symptom relief, predicted breast tissue resection weight continues to be critical for insurance approval.


Assuntos
Mama/anormalidades , Hipertrofia/cirurgia , Reembolso de Seguro de Saúde/economia , Mamoplastia/economia , Garantia da Qualidade dos Cuidados de Saúde/normas , Adulto , Mama/cirurgia , Feminino , Seguimentos , Humanos , Cobertura do Seguro/economia , Mamoplastia/métodos , Estudos Retrospectivos , Estados Unidos
10.
Plast Reconstr Surg ; 146(2): 137e-146e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740570

RESUMO

BACKGROUND: Abdominally based free tissue transfer (FTT) and latissimus dorsi and immediate fat transfer (LIFT) procedures are both fully autologous options for breast reconstruction. The former is specialized and requires comfort with microsurgical technique, whereas LIFT combines a common set of techniques familiar to all plastic surgeons. Comparing the two methods for clinical effectiveness and complications for equivalency in outcomes may help elucidate and enhance patient decision-making. METHODS: A retrospective review of a prospectively maintained database between March of 2017 and July of 2018 was performed to compare the LIFTs and FTTs performed by the senior surgeon. Outcomes of interest included postoperative complications, flap success, and follow-up revision and fat-grafting procedures. RESULTS: Sixty-five breasts were reconstructed by FTT; and 31 breasts were reconstructed with LIFT. Demographics were similar (p > 0.05). LIFT had a shorter length of operation time (343 ± 128 minutes versus 49 ± 137 minutes) (p < 0.0001) and a shorter length of stay (1.65 ± 0.85 days versus 3.83 ± 1.65 days) (p < 0.001). FTTs had a shorter time until drain removal (13.3 ± 4.3 days versus 24.0 ± 11.2 days) (p < 0.0001). The number of major (requiring operation) and minor complications were not statistically different (i.e., FTTs, 20.0 percent major and 27.7 percent minor; LIFT, 12.9 percent major and 19.35 percent minor) (p > 0.05). The need for revisions (FTTs, 0.80 ± 0.71; LIFT, 0.87 ± 0.71) and fat grafting (FTTs, 41.54 percent; LIFT, 58.8 percent) was not statistically different (p > 0.05). CONCLUSIONS: Both the LIFT and abdominally based FTT have similar outcomes and complication rates. However, LIFT may be preferred in patients who require shorter operation times. The LIFT may be the fully autologous breast reconstruction of choice for nonmicrosurgeons. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Gordura Abdominal/transplante , Neoplasias da Mama/cirurgia , Mama/cirurgia , Retalhos de Tecido Biológico , Mamoplastia/métodos , Microcirurgia/métodos , Músculos Superficiais do Dorso/transplante , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
11.
Medicine (Baltimore) ; 99(30): e20797, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791669

RESUMO

To evaluate the value of a breast computed tomography (CT) (B-CT) in assessing breast density, pathologies and implant integrity in women with breast implants.This retrospective study was approved by the local ethics committee. B-CT images of 21 women with implants (silicone/saline; 20 bilateral, 1 unilateral) who underwent opportunistic screening or diagnostic bilateral B-CT were included. Breast density, implant integrity, extensive capsular fibrosis, soft tissue lesions and micro-/macrocalcifications were rated. In 18 of the 21 women, an additional ultrasound and in two patients breast magnetic resonance imaging was available for comparison. The average dose was calculated for each breast using verified Monte Carlo simulations on 3D image data sets.Breast density was nearly completely fatty (ACR a) in two patients, scattered fibroglandular (ACR b) in five, heterogeneously dense (ACR c) in ten and very dense (ACR d) in four women. In three women showed a unilateral positive Linguine sign indicative of an inner capsule rupture. Extensive capsular fibrosis was found in three women. In three women, soft tissue lesions were depicted, which revealed to be cysts (n = 2) and lymph nodes (n = 1) on subsequent sonography. Diffuse, non-clustered microcalcifications were found in nine women. Eleven women showed cutaneous or intramammary macrocalcifications. Average dose was 6.45 mGy (range 5.81-7.28 mGy).In women with implants, B-CT presents a promising modality for evaluating breast density, implant integrity, extensive capsular fibrosis, soft tissue lesions and micro-/macrocalcifications without the need of breast compression utilizing a lower dose compared to doses reported for conventional four-view mammography.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Implantes de Mama , Mama/diagnóstico por imagem , Tomografia Computadorizada Espiral , Adulto , Idoso , Mama/patologia , Feminino , Fibrose , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
Adv Exp Med Biol ; 1252: 3-7, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816256

RESUMO

The mature breast is located within the anterior thoracic wall, lying atop the pectoralis major muscle. Pubertal changes lead to incomplete development of the breast , a process which is only completed during pregnancy . The incomplete breast consists mostly of adipose tissue but also lactiferous units called lobes. These eventually drain into the lactiferous ducts and then into the lactiferous sinus and then to the nipple-areolar complex. During pregnancy , the breast undergoes both anatomic and physiologic changes to prepare for lactation. During the first trimester, the ductal system expands and branches out into the adipose tissue in response to the increase of estrogen. Elevated levels of estrogen also cause a decrease in adipose tissue and ductal proliferation and elongation. Estrogen also stimulates the pituitary gland which leads to elevated levels of prolactin. By the twentieth week of gestation, mammary glands are sufficiently developed to produce components of milk due to prolactin stimulation. Milk production is inhibited by high estrogen and progesterone levels and colostrum is produced during this time. In the third trimester and then rapidly after birth, these levels decrease, allowing for milk production and eventual let-down to allow for breastfeeding. Most pregnancies cause the areola to darken, the breast to increase in size, and the Montgomery glands to become more prominent. Post-lactational involution occurs at the cessation of milk production caused by a decline in prolactin.


Assuntos
Mama/anatomia & histologia , Mama/fisiologia , Lactação/fisiologia , Gravidez/fisiologia , Estrogênios , Feminino , Humanos , Leite Humano , Parto , Prolactina
13.
Adv Exp Med Biol ; 1252: 9-16, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816257

RESUMO

Physical exam of the breast is a very important part of breast assessment both for breast cancer screening, and when approaching breast lesions. Examination during pregnancy and breastfeeding follows exactly the same method as non-pregnancy periods. However, physical changes that occur in the breast during these times due to hormonal effects cause alterations that can on one hand conceal some pathologic disorders, and may on the other hand appear as pathologic findings while being purely physiologic. This chapter focuses first on some key points for an accurate breast examination, and then reviews some challenging controversial findings that may be noticed during breast exam in a pregnant or lactating woman.


Assuntos
Doenças Mamárias/diagnóstico , Mama/anatomia & histologia , Mama/patologia , Lactação/fisiologia , Exame Físico , Mama/fisiologia , Doenças Mamárias/patologia , Aleitamento Materno , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Feminino , Humanos , Gravidez
14.
Adv Exp Med Biol ; 1252: 17-25, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816258

RESUMO

All breast disorders found during pregnancy and lactation should be carefully evaluated. Most of them are benign, but it is essential to exclude pregnancy-associated breast cancer (PABC), which is too often diagnosed late. The first-line imaging technique is ultrasound (US), which must be completed by mammography if there is any clinical or US suspicious sign . In lactating patients with PABC , breast magnetic resonance imaging (MRI) can be useful for local assessment.Management depends on the precise analysis and BI-RADS classification of the lesion. During pregnancy and lactation, there is an overlap in imaging: many benign lesions can grow, infarct, become heterogeneous and thus suspicious, and on the other hand, PABC does not always present with typical malignant features. That is why biopsy must be performed if after the clinical and radiological evaluation the doubt persists, i.e. for all BI-RADS 4 and 5 lesions, and for some BI-RADS 3 lesions.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Mama/diagnóstico por imagem , Lactação , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Mamografia , Gravidez
15.
Adv Exp Med Biol ; 1252: 27-32, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816259

RESUMO

Breast tissue reveals some physiologic changes during pregnancy and lactation due to hormonal alterations. Whole range of breast diseases including inflammatory, benign and malignant neoplasms can be seen in pregnancy but due to concurrent physiologic changes, may lead to diagnostic challenges. This chapter reviews sampling methods and histologic features of common benign breast lesions in pregnancy and lactation periods.


Assuntos
Doenças Mamárias/patologia , Mama/citologia , Mama/patologia , Lactação/fisiologia , Complicações na Gravidez , Gravidez/fisiologia , Neoplasias da Mama/patologia , Feminino , Humanos
16.
Adv Exp Med Biol ; 1252: 33-39, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816260

RESUMO

The breast tissue undergoes significant physiological change during pregnancy and lactation. These changes can give rise to some unique disorders during pregnancy , puerperium and lactation or exaggerate pre-existing conditions. Clinical examination becomes less reliable due to textural change and density of breast tissue as a result of hormonal changes. The main symptoms during pregnancy and lactation are breast pain, mastitis, lactational abscess, breast lump, and blood- stained nipple discharge.Lactational mastitis/ abscess must be treated without delay. Open incision and drainage of lactational abscess is rarely required, any lactational abscess should be treated with appropriate antibiotics and ultrasound guided aspiration of the pus.Any breast lump during pregnancy and lactation should be investigated with triple assessment. Pregnancy associated breast cancer (PABC ) must be ruled out. The choice of investigations and treatment needs careful consideration. While ultrasound is the investigation of choice, mammography can be performed with abdominal shielding if malignancy is suspected. Core biopsy is necessary for evaluation of any breast pathology but it comes with risk of infection, bleeding, hematoma and even milk fistula.The treating clinical specialist must be aware of certain unusual unique clinical conditions in pregnancy and lactation including accessory axillary breast tissue, gigantomastia and Raynaud's phenomenon.


Assuntos
Doenças Mamárias/diagnóstico , Doenças Mamárias/fisiopatologia , Lactação , Complicações na Gravidez , Abscesso , Mama , Doenças Mamárias/patologia , Aleitamento Materno , Feminino , Humanos , Mastite , Gravidez
17.
Adv Exp Med Biol ; 1252: 43-51, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816261

RESUMO

Benign cystic or solid lumps frequently occur in the breasts of young women, and consequently can also be seen during pregnancy and lactation. Simple cysts do not increase the risk of malignancy. The current management is routine follow-up. Complex cysts are thick walled or contain a mass, and should be followed by a US-guided biopsy and then treated similar to any non-gravid, non-lactating patient.Galactoceles can be detected during the last trimester of pregnancy and during or after stopping lactation. Aspiration can be done to confirm the content. Co-existence of galactocele and malignancy is extremely rare, and the key is to follow up until it resolves.Fibroadenoma is the most frequent lesion found during pregnancy and lactation. Management is usually conservative after triple assessment. Surgery is usually not recommended in pregnant and lactating women unless rapid increase in size occurs or there is discordance in the triple assessment.Lactating adenomas are sometimes interpreted as a variant of fibroadenoma . They can naturally disappear at the end of pregnancy or lactation. Management is usually conservative, and an excisional biopsy is only mandated if it is rapidly enlarging or if there is discordance in the triple assessment.Gestational gigantomastia is a rare condition consisting of diffuse severe hypertrophy of both breasts during pregnancy . Mastectomy and reconstruction may rarely be required in such cases.


Assuntos
Doenças Mamárias , Lactação , Complicações na Gravidez , Mama , Cisto Mamário , Feminino , Fibroadenoma , Humanos , Mastectomia , Gravidez
18.
Adv Exp Med Biol ; 1252: 63-72, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816263

RESUMO

Papillomas, atypical hyperplasias, and lobular carcinoma in situ of the breast are not malignant tumors, but present serious management challenges when they are diagnosed in a breast biopsy . Upgrading after excision and increased possibility of future cancer are risks that accompany these lesions. While some features have been defined as high-risk for upgrading, many practitioners now recommend conservative non-surgical treatment and vacuum-assisted biopsy . However, the challenge gets worse when the patient is pregnant or breastfeeding because of the limitations in imaging and treatment in relation to the fetus. This chapter deals with these problems, although the best management strategy cannot be defined because of lack of evidence at present.


Assuntos
Aleitamento Materno , Lactação , Lesões Pré-Cancerosas , Complicações na Gravidez , Mama , Neoplasias da Mama , Feminino , Humanos , Hiperplasia , Gravidez
19.
Adv Exp Med Biol ; 1252: 81-86, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816265

RESUMO

Breasts are one of the most common sites of neoplastic lesions in women during pregnancy and lactation. This chapter reviews carcinomas of the breast during pregnancy and lactation while focusing on histologic features, biomarker profiles and some involved molecular pathways. Also, a brief review of previous studies on this field is performed.


Assuntos
Neoplasias da Mama , Carcinoma , Complicações Neoplásicas na Gravidez , Mama , Feminino , Humanos , Lactação , Gravidez
20.
Adv Exp Med Biol ; 1252: 95-99, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32816267

RESUMO

Surgery in the form of both mastectomy and breast conservation is the main step in the treatment of breast cancer. Numerous studies have shown an equivalent long-term survival for breast conserving surgery (BCS) and mastectomy . Patients desire and tumor characteristics, especially size and multicentricity, are the key factors that affect the decision between these two types of surgery . Patients with any contraindication for radiotherapy or previous history of radiation to the breast field are not suitable for BCS . There are few absolute contraindications for BCS , and early pregnancy is listed among them; mastectomy is preferred in the first trimester of pregnancy to avoid the impact of delaying radiation therapy on outcome of the cancer.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia , Complicações Neoplásicas na Gravidez/cirurgia , Mama/cirurgia , Neoplasias da Mama/radioterapia , Feminino , Humanos , Mastectomia Segmentar , Gravidez , Complicações Neoplásicas na Gravidez/radioterapia , Resultado do Tratamento
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