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Gan To Kagaku Ryoho ; 48(3): 440-442, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33790181


When the primary breast cancer disappears by neoadjuvant chemotherapy, it is often difficult to detect it during the breast preserving surgery. Before neoadjuvant chemotherapy, preoperative nipple-side HydroMARK-marking, which was made of titanium coil and hydrogel, was a very useful and effective method because of its fine detection by ultrasonography. We report a case of 51-year-old female with the triple negative breast cancer(TNBC). At first, the HydroMARK was inserted between the nipple and the tumor. Its distance was about 10 mm toward the nipple. EC therapy followed by docetaxel was performed for 6 months as neoadjuvant chemotherapy. After that, her left TNBC(T1N0M0, Stage Ⅰ, invasive ductal carcinoma, ER[-], PgR[-], HER2[-])was disappeared in all imagings and resected in August 2018. The HydroMARK was clearly detected by intraoperative ultrasonography and her right breast preserving surgery was completely performed. Its pathological finding was pCR(pathological complete response).

Neoplasias da Mama , Carcinoma Ductal de Mama , Neoplasias de Mama Triplo Negativas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/tratamento farmacológico , Carcinoma Ductal de Mama/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Mamilos/cirurgia , Receptor ErbB-2 , Resultado do Tratamento , Neoplasias de Mama Triplo Negativas/tratamento farmacológico , Neoplasias de Mama Triplo Negativas/cirurgia
Medicine (Baltimore) ; 100(11): e24977, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725968


INTRODUCTION: Breast tubular carcinoma (TC) is a well-differentiated infiltrating ductal carcinoma, common in postmenopausal women. PATIENT CONCERNS: Two patients concerned their abnormality of their breasts, one at deep parasternal higher chest wall in a 74-year-old female and the other behind the nipple in a 39- year-old female. DIAGNOSIS: These masses were detected by mammography, ultrasound and magnetic resonance imaging (MRI) examinations. The parasternal mass identified by mammography showed long spicules along the edges of the mass. Ultrasound examination revealed that these masses had solid irregular hypoechoic nodules. The color Doppler ultrasound of the retro-nipple mass presented with increased blood flow resistance index. The dynamic contrast-enhanced MRI examination of the retro-nipple nodule demonstrated an intensely enhancing mass with a plateau-type time-signal intensity curve. INTERVENTIONS: Two cases were surgically removed by local resection of foci under ultrasound guidance. OUTCOMES: These imaging examinations strongly suggest possible breast tubular carcinoma, which was confirmed by the pathological evaluation of frozen sections from surgically removed masses. CONCLUSION: Although uncommon, breast tubular carcinoma may be considered in the differential diagnosis of small solid masses with long spicules at parasternal breast or behind the nipples in adult women.

Adenocarcinoma/patologia , Neoplasias da Mama/patologia , Adenocarcinoma/diagnóstico , Adulto , Idoso , Neoplasias da Mama/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Mamilos/patologia , Esterno/patologia
Br J Radiol ; 94(1120): 20201013, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33544650


Pathologic nipple discharge (PND) is typically unilateral, spontaneous, involves a single duct, and is serous or bloody in appearance. In patients with PND, breast MRI can be helpful as an additional diagnostic tool when conventional imaging with mammogram and ultrasound are negative. MRI is able to detect the etiology of nipple discharge in 56-61% of cases when initial imaging with mammogram and ultrasound are negative. Advantages to using MRI in evaluation of PND include good visualization of the retroareolar breast and better evaluation of posterior lesions which may not be well evaluated on mammograms and galactograms. It is also less invasive compared to central duct excision. Papillomas and nipple adenomas are benign breast masses that can cause PND and are well visualized on MRI. Ductal ectasia, and infectious etiologies such as mastitis, abscess, and fistulas are additional benign causes of PND that are well evaluated with MRI. MRI is also excellent for evaluation of malignant causes of PND including Paget's disease, ductal carcinoma in-situ and invasive carcinoma. MRI's high negative predictive value of 87-98.2% is helpful in excluding malignant etiologies of PND.

Doenças Mamárias/diagnóstico por imagem , Doenças Mamárias/patologia , Imagem por Ressonância Magnética/métodos , Derrame Papilar/diagnóstico por imagem , Feminino , Humanos , Mamilos/diagnóstico por imagem , Mamilos/patologia
Plast Reconstr Surg ; 147(1): 38-45, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33370047


BACKGROUND: Despite advances in skin envelope reduction techniques and experienced nipple-sparing mastectomy flap procedures, the rate of nipple malposition and secondary revision in these patients remains high and eligible candidates are limited. In this article, the authors present a novel technique combining skin reduction nipple-sparing mastectomy surgery with single-stage skin-only mastopexy and direct-to-implant reconstruction. METHODS: A retrospective review was performed at a single institution from 2015 to 2018. All patients were operated on using this technique consecutively, by a breast and plastic surgeon team (A.F. and A.M.). Surgical technique and outcomes were compared with the currently accepted literature. RESULTS: Twenty-six patients (40 breasts) underwent this technique; all were single-stage direct-to-implant reconstructions. The average body mass index was 31 kg/m2. A Wise pattern was used in 35 breasts (87.5 percent) and prepectoral placement was used in 25 breasts (62.5 percent). Overall complications included seroma [n = 6 (15 percent)], vertical/T-junction dehiscence [n = 4 (10 percent)], skin necrosis [n = 4 (10 percent)], superficial or partial nipple necrosis [n = 4 (10 percent)], with no total nipple-areola complex lost and no reconstructive failures at 18.7 months' average follow-up. CONCLUSIONS: In this article, the authors share a novel reconstructive technique in which the skin envelope is reduced, the nipple-areola complex is repositioned, and a direct-to-implant reconstruction is performed in a single stage at the time of mastectomy. Consideration of pearls and pitfalls accompanies a review of the authors' experienced complication profile, and is discussed in the context of current literature. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Mamoplastia/efeitos adversos , Mastectomia Subcutânea/efeitos adversos , Mamilos/cirurgia , Complicações Pós-Operatórias/epidemiologia , Retalhos Cirúrgicos/efeitos adversos , Tecido Adiposo/transplante , Adulto , Idoso , Implantes de Mama , Neoplasias da Mama/cirurgia , Feminino , Seguimentos , Humanos , Mamoplastia/instrumentação , Mamoplastia/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Retalhos Cirúrgicos/transplante , Resultado do Tratamento
Clin Imaging ; 69: 45-49, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32652457


THE AIM OF THIS WORK: The aim of this work was to estimate the role of diffusion-weighted imaging (DWI) in predicting malignant invasion of the nipple-areolar complex (NAC) by underlying breast cancer. MATERIAL AND METHODS: This prospective study included 70 female patients with breast cancer with a mean age of 45.8 years (range: 28-68). DWI of the breast was done for all patients. Apparent diffusion coefficient (ADC) maps were automatically constructed. The mean ADC values of NAC were independently measured by two observers who are experts in breast imaging and correlated with the results of histopathological examinations. RESULTS: Both observers found a significantly lower ADC value of malignant NAC invasion (n = 18) when compared with free NAC (n = 52), with mean ADC value for malignant NAC invasion was 0.86 ± 0.35 × 10-3 mm2/s and 0.84 ± 0.08 × 10-3 mm2/s for observer one and two respectively versus mean ADC value of 1.34 ± 0.25 × 10-3 mm2/s and 1.4 ± 0.26 × 10-3 mm2/s for free NAC by observer one and two respectively (P-value =0.001). Observer one found that a cutoff ADC value of 1.05 × 0-3 mm2/s can predict malignant NAC invasion with 0.975 AUC, 92.8% accuracy, 94.4% sensitivity, and 92.3% specificity. Observer two found that a cutoff ADC value of 0.95 × 10-3 mm2/s can predict malignant NAC invasion with 0.992 AUC, 95.7% accuracy, 88.9% sensitivity, and 98.1% specificity. CONCLUSION: DWI can predict malignant NAC invasion in patients with breast cancer.

Neoplasias da Mama , Mamilos , Adulto , Idoso , Neoplasias da Mama/diagnóstico por imagem , Difusão , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Pessoa de Meia-Idade , Mamilos/diagnóstico por imagem , Estudos Prospectivos , Reprodutibilidade dos Testes , Papel (figurativo) , Sensibilidade e Especificidade
Zhonghua Wai Ke Za Zhi ; 59(2): 121-126, 2021 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-33378804


Objective: To examine the clinical application value of single-port inflatable endoscopic nipple sparing mastectomy with immediate reconstruction using prosthesis implantation in the treatment of early breast cancer. Methods: From February 2014 to July 2019, the clinic-pathological data of 34 early breast cancer patients received single-port inflatable endoscopic nipple sparing mastectomy with immediate reconstruction using prosthesis implantation at Department of General Surgery, Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed and followed up. All the patients were female, with an age of 46(11) years (M(QR)) (range: 26 to 64 years). The radical cure degree of operation, cosmetic effect after operation were evaluated. The satisfaction to operation and personal quality of life after operation was accessed by BREAST-Q scale. Results: All surgical procedures were successfully completed. The operation time was (313.4±11.7) minutes (range: 200 to 485 minutes). The blooding-liquid was (33.8±3.3) ml (range: 10 to 100 ml). There were 5 cases (14.7%) of nipple areola necrosis after operation, of which 1 patient received taking the prosthesis out because of prosthesis exposure. There was no capsular contracture or postoperative bleeding case. The follow-up time was 35(17) months (range: 12 to 77 months), and there was one case suffering local recurrence and metastasis, and another suffering metastasis. The scores of postoperative breast satisfaction, psychosocial status, chest wall status and sexual health were 78.32±2.57 (range: 55 to 100), 89.12±2.30 (range: 82 to 100), 91.47±1.33 (range: 43 to 100), and 78.50±2.68 (range: 39 to 100). Conclusion: Single-port inflatable endoscopic nipple sparing mastectomy with immediate reconstruction using prosthesis implantation in the treatment of early breast cancer can achieve provided curative and cosmetic effect on patients with breast cancer, with good patients' postoperative quality of life and satisfaction.

Neoplasias da Mama , Mamoplastia , Mastectomia/métodos , Adulto , Neoplasias da Mama/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Mamilos , Implantação de Prótese , Qualidade de Vida , Estudos Retrospectivos
Clín. investig. ginecol. obstet. (Ed. impr.) ; 47(4): 161-163, oct.-dic. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-197644


Los neurofibromas son crecimientos exuberantes del tejido nervioso periférico que aparecen en pacientes afectos de neurofibromatosis tipo 1. Los neurofibromas a nivel mamario son raros, y cuando aparecen suelen localizarse a nivel areolar. Presentamos el caso de una paciente de 31 años en la que se llevó a cabo la extirpación de un neurofibroma areolar

Neurofibromas are exuberant growths of peripheral nervous tissue that appear in patients with neurofibromatosis type 1. Neurofibromas of the breast are rare, but they are usually located in the nipple-areola complex. We present the case of a 31-year-old patient who underwent excision of a neurofibroma of the areola

Humanos , Feminino , Adulto , Neurofibroma/diagnóstico , Neurofibroma/cirurgia , Neoplasias da Mama/patologia , Neurofibroma/patologia , Mamilos/patologia , Imuno-Histoquímica/métodos
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3949-3952, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018864


The objective of this study was to elucidate the dynamic mechanism of infant tongue movement during sucking. We developed an integrated device with sensors for three-dimensional force measurements applied by the tongue to an artificial nipple. Three mini-size built-in cantilever sensors were installed in each of three sides of the regular hexagonal prism (nine sensors in total) inside the artificial nipple. Signals from the force sensors were amplified and displayed on a PC monitor via USB in real time. We conducted measurements using the system and confirmed that signals were outputted from all nine sensors. The output waveforms and force distributions showed that the force applied was larger at the nipple tip than at the nipple root and moved from the nipple root to the nipple tip.

Mamilos , Comportamento de Sucção , Ingestão de Alimentos , Humanos , Lactente , Monitorização Fisiológica , Língua
Rev. cir. (Impr.) ; 72(5): 418-426, oct. 2020. tab, graf, ilus
Artigo em Espanhol | LILACS | ID: biblio-1138733


Resumen Objetivo: Se presenta experiencia realizada en Servicio de Salud Talcahuano, de masculinización mamaria en el proceso de reasignación sexual, de transexuales masculinos. En Chile se estima que habrían 754 mujeres transexuales. Materiales y Método: Estudio de 47 individuos, intervenidos en Hospital Las Higueras de Talcahuano, entre 2006 y 2019, sometidos a masculinización mamaria mediante mastectomía subcutánea y reconstrucción del complejo areolomamilar. Resultados: Se intervinieron pacientes de todo el país; 59% corresponde a octava región; 42,5% operados entre los años 2017 y 2018. Un 36% rango de edad de 18 a 22 años. Un 68% IMC entre 24 y 30. Según el tamaño de las mamas, 57% copa B, 31% C, 12% D y 12% de gigantomastía. Un 29%, peso promedio de la mastectomía fue de 600 g; un 29% de 300 gramos y en 9% más de 800 g por lado. En 68% se utilizó abordaje submamario e injerto de piel total del complejo aréola pezón (CAP); otras tecnicas fueron periareolar, incisión en T y liposucción. La complicación más frecuente fue la colección. Biopsia normal en un 100%. Discusión: Experiencia pionera en Chile, realizada en un Hospital Público, en el difícil proceso de reasignación de género, en la población transexual de Chile. Individuos muy estigmatizados de parte de la comunidad, que encontraron en el Servicio de Salud de Talcahuano, una mano amiga, que les extendió su apoyo desinteresado y calificado, logrando excelentes resultados finales.

Aim: Describe the experience in Talcahuano Helath Service, of mammary masculinization in the sexual reassignment process, of male transsexuals. In Chile it is estimated that there will be 754 transsexual women. Materials and Method: Study of 47 individuals, operated at Las Higueras Hospital in Talcahuano, between 2006 and 2019, subjected to breast masculinization by subcutaneous mastectomy and reconstruction of the areolomamilar complex. Results: Patients from all over the country were operated; 59% corresponds to the Bio-Bio province; 42.5% operated between 2017 and 2018. A 36% range of ages from 18 to 22 years. 68% BMI between 24 and 30. According to the size of the breasts, 57% B cup, 31% C, 12% D and 12% gigantomasty. At 29%, the average weight of the mastectomy was 600 grams; 29% of 300 grams and 9% more than 800 grams per side. In 68%, the submammary approach and total skin graft of the CAP were used; Other techniques were periareolar, incision in T and liposuction. The most frequent complication was the collection. 100% normal biopsy. Discussion: Pioneering experience in Chile, carried out in a public hospital, in the difficult process of gender reassignment, in the transsexual population of Chile. Individuals very stigmatized by the community, who found in the Health Service of Talcahuano, a helping hand, which extended their selfless and qualified support, achieving excellent final results.

Humanos , Masculino , Feminino , Mastectomia Subcutânea/métodos , Pessoas Transgênero , Mamilos/cirurgia , Distribuição por Idade , Procedimentos Cirúrgicos Reconstrutivos
Niger J Clin Pract ; 23(9): 1324-1327, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32913175


Infiltrating syringomatous adenoma of the nipple (SAN) is a rare benign neoplasm of the breast that is often misdiagnosed. SAN may present with a subareolar lesion and clinical, mammographic, and ultrasonographic findings associated with malignancy. We present the case of a 60-year-old woman with a painful, firm, solid tumor in her left breast and deformation of the left nipple-areolar complex (NAC). Histopathological test results were conflicting. The tumor, including the NAC were locally excised. Postsurgical immuno-histochemical tests revealed squamous histology, whereas myoepithelial cells were present in the resected specimen, a feature consistent with SAN. The pathologist noted microscopically positive surgical margins. Three months after surgery, tumor recurrence occurred. The patient underwent revision surgery with wide excision of the skin and gland around the lesion, followed by immediate breast reconstruction, using a pedicled myocutaneous latissimus dorsi (pLD) flap. Extreme care should be taken when diagnosing SAN to ensure proper treatment and prevent recurrence.

Adenoma/cirurgia , Erros de Diagnóstico/efeitos adversos , Recidiva Local de Neoplasia/cirurgia , Mamilos/cirurgia , Siringoma/cirurgia , Adenoma/patologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mamoplastia , Mamografia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Mamilos/patologia , Papiloma/patologia , Papiloma/cirurgia , Siringoma/diagnóstico , Siringoma/patologia , Resultado do Tratamento
Cir. plást. ibero-latinoam ; 46(3): 259-269, jul.-sept. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-196912


INTRODUCCIÓN Y OBJETIVO: Después de recorrer las diferentes técnicas para la reparación de la mama tuberosa desde los años 70 hasta ahora, concluimos que no existe un procedimiento fácil y sin complicaciones tanto por la técnica en sí como por el uso de implantes aloplásticos. Comparamos las desventajas y ventajas, indicaciones y complicaciones, del trasplante de grasa frente al implante aloplástico, con el fin de que el cirujano plástico tenga en consideración la técnica de transferencia grasa a la hora de llevar a cabo el procedimiento de reconstrucción de una mama tuberosa, puesto que se trata de una técnica que puede reportar mejores resultados que la mera utilización de implantes. MATERIAL Y MÉTODO: Estudio retrospectivo sobre 40 pacientes con mamas tuberosas corregidas mediante autoinjerto graso y con seguimiento postoperatorio medio de 23.4 meses. RESULTADOS: El total de pacientes operadas fue de 40, cada una en 2 tiempos. La técnica habitual fue la de Coleman para la infiltración del injerto graso. Presentamos 8 casos, 2 por cada grado de tuberosidad según la clasificación de Von-Heigburg, y su resolución. CONCLUSIONES: En nuestra experiencia en el tratamiento de la mama tuberosa con este método, el implante graso es la técnica de elección porque produce cicatrices mínimas, proporciona una forma más natural al seno y excluye las complicaciones del material aloplástico. Es un procedimiento sencillo, con una curva de aprendizaje rápida. Además, la lipoescultura asociada es un valor importante, la atención postoperatoria es simple y las complicaciones son poco frecuentes

BACKGROUND AND OBJECTIVE: After touring the different techniques for the repair of the tuberous breast from the 70`s until now, we conclude that there is no easy procedure and free of complications both by the technique itself and by the use of alloplastic implants. We compare the disadvantages and advantages, indications and complications of fat transplantation versus alloplastic implants in order for the plastic surgeon to take into consideration the fat transfer technique when carrying out the reconstruction procedure of a tuberous breast, since this technique can yield better results than the sole use of implants. METHODS: A retrospective study was carried out on 40 patients with tuberous breasts corrected by using a fat autograft and with a postoperative follow-up of 23.4 months. RESULTS: Total number of operated patients was 40, each one operated on in 2 stages. The usual technique was that of Coleman for infiltration of the fat graft. We present 8 cases, 2 for each degree in relation to the Von-Heigburg classification, and its resolution. CONCLUSIONS: In our experience, fat implant is the technique of choice in this process because the scars are minimal, the breast shape is more natural, excludes complications of alloplastic material and it's a simple procedure with a quick learning curve. Besides, associated liposculpture is an important value, postoperative care is simple, and complications are uncommon

Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Mama/anormalidades , Mama/cirurgia , Autoenxertos/cirurgia , Mamoplastia/métodos , Doenças Mamárias/diagnóstico , Implantes de Mama , Tecido Adiposo/transplante , Estudos Retrospectivos , Cuidados Pós-Operatórios , Mamoplastia/instrumentação , Doenças Mamárias/cirurgia , Transplante Autólogo/métodos , Mamilos/patologia , Mamilos/cirurgia , Antibacterianos/administração & dosagem
Rev. senol. patol. mamar. (Ed. impr.) ; 33(3): 121-124, jul.-sept. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-197297


INTRODUCCIÓN: El cáncer de mama masculino representa <1% de todas las neoplasias malignas en hombres, y aunque comparte muchas similitudes con el cáncer de mama en las mujeres, tiene diferencias importantes. CASO CLÍNICO: Paciente masculino de 68años, de raza mestiza, que acude con cuadro clínico de 5meses de evolución caracterizado por lesión nodular en la región areolar de la mama izquierda acompañada de dolor ocasional y crecimiento progresivo. El ultrasonido evidenció lesión heterogénea de bordes irregulares con calcificaciones, BIRADSV. Se decidió hacer mastectomía más biopsia de ganglio centinela, con positividad en el transoperatorio, por lo que se completó la linfadenectomía axilar. El reporte de histopatología confirmó carcinoma ductal infiltrante, ganglio centinela y satélite positivo para carcinoma metastásico. CONCLUSIÓN: Varias incógnitas permanecen sobre el cáncer de mama en hombres. Es de importancia comprender mejor la biología de la enfermedad para lograr identificar las diferencias entre ambos géneros y así determinar si estas tienen implicaciones terapéuticas

INTRODUCTION: Male breast cancer accounts for <1% of all malignancies in men, and although it shares many similarities with breast cancer in women, it has important differences. CASE REPORT: A 68-year-old male patient presented with a 5-month history of a nodular lesion in the areolar region of the left breast accompanied by occasional pain and progressive growth. An ultrasound scan showed a heterogeneous lesion with irregular edges and calcifications, BIRADSV. It was decided to perform a mastectomy and sentinel lymph node biopsy, with positivity in the transoperative period, and axillary lymphadenectomy was completed. The histopathology report confirmed infiltrating ductal carcinoma, sentinel lymph node- and satellite-positive for metastatic carcinoma. CONCLUSION: Several questions remain unanswered about breast cancer in men. It is important to enhance understanding of the biology of the disease to identify the differences between the two sexes and thus determine if they have therapeutic implications

Humanos , Masculino , Idoso , Neoplasias da Mama Masculina/patologia , Biópsia de Linfonodo Sentinela/métodos , Excisão de Linfonodo/métodos , Mamilos/patologia , Carcinoma Ductal de Mama/patologia , Metástase Linfática/patologia , Fatores de Risco