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1.
BMJ Open ; 12(5): e047866, 2022 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-35501091

RESUMO

INTRODUCTION: Breast cancer is the most prevalent cancer and the leading cause of cancer-related death in women. Conventional open mastectomy (C-OM) is one of the most common procedures for breast cancer, which involves the removal of the nipple-areola complex and a large proportion of the breast skin, leading to poor cosmetic effect and restriction of upper extremity function. Single-port insufflation endoscopic nipple-sparing mastectomy (SIE-NSM) could conceal the incision along the wrinkles in the axilla, preserve all the breast skin and nipple-areola complex and provide a better cosmetic outcome and quality of life. This trial aims to investigate the oncological safety between SIE-NSM and C-OM in early breast cancer patients. METHODS AND ANALYSIS: This is a single centre, non-blinded, randomised controlled trial (RCT) and will be conducted at Beijing Friendship Hospital. Patients will be enrolled in the inpatient ward. Breast surgeons will notify patients who meet the inclusion and exclusion criteria with the instruction of this RCT. Patients will be randomly assigned to C-OM or SIE-NSM with a 3:1 allocation as per a computer-generated randomisation schedule. Patients will be followed-up for 12 months for analysing surgical outcomes. The primary outcome is the local recurrence rate at a 12-month follow-up. The secondary outcome is the distant metastasis rate, cosmetic satisfaction score and psychosocial well-being score after a 12-month follow-up. To ensure the accuracy of the cosmetic satisfaction score and psychosocial well-being score, the standard scale, Breast-Q score, will be applied. ETHICS AND DISSEMINATION: This study will be conducted according to the medical ethics committee of the Beijing Friendship Hospital and according to the principles of the Declaration of Helsinki. All patients will receive clear instruction of their disease and treatment plan. Informed consent will be obtained from all patients when they agree to comply with our research plan. The results will be disseminated at academic presentations and publications in peer-reviewed journals. The raw data will be confidentially stored in our electronic data capture database. Data will not be shared unless an appropriate data request is submitted after the trial completion and peer-review journal publication. TRIAL REGISTRATION NUMBER: NCT04461847.


Assuntos
Neoplasias da Mama , Insuflação , Neoplasias da Mama/cirurgia , Endoscopia , Feminino , Humanos , Mastectomia/métodos , Mamilos/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
Ann Plast Surg ; 88(3 Suppl 3): S302-S308, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35513336

RESUMO

BACKGROUND: Nipple reconstruction is widely regarded as the final step in postmastectomy breast reconstruction. While grafts, local flaps, or combination approaches have been used in nipple reconstruction, none has been able to achieve reliable long-term projection preservation. In response, we have sought to bioengineer neonipples in situ via the implantation of processed, decellularized cartilage xenografts placed within 3-dimensional-printed polylactic acid (PLA) scaffolds. MATERIALS AND METHODS: External nipple scaffolds were designed in-house and 3-dimensional-printed with PLA filament. Decellularized ovine xenograft infill was prepared and processed by mincing or zesting. All nipple scaffolds were placed subcutaneously on the dorsa of Sprague-Dawley rats and explanted after 1, 3, and 6 months for analysis. RESULTS: Explanted nipple scaffolds demonstrated gross maintenance of scaffold shape, diameter, and projection with accompanying increases in tissue volume. Histologic analyses revealed preservation of native cartilage architecture after 6 months without evidence of degradation. Analysis of formed tissue within the scaffolds revealed a progressive invasion of fibrovascular tissue with identifiable vascular channels and adipose tissue after 6 months in vivo. Confined compression testing revealed equilibrium moduli of both minced and zested samples that were within the expected range of previously reported human nipple tissue, while these data revealed no differences in the mechanical properties of the neotissue between time points or processing techniques. CONCLUSIONS: These preliminary data support potential use of decellularized allograft to foster healthy tissue ingrowth within a PLA scaffold, thereby offering a novel solution to current limitations in nipple reconstruction.


Assuntos
Neoplasias da Mama , Mamilos , Animais , Neoplasias da Mama/cirurgia , Feminino , Xenoenxertos , Humanos , Mastectomia , Mamilos/cirurgia , Poliésteres , Ratos , Ratos Sprague-Dawley , Ovinos , Engenharia Tecidual/métodos , Tecidos Suporte
4.
Clin Plast Surg ; 49(2): 293-305, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35367036

RESUMO

Contemporary management of gynecomastia includes transareolar excision of gland, disruption of inframammary fold, ultrasonic-assisted lipoplasty with muscular definition, bipolar radiofrequency tightening, pedicled NAC mastopexy with boomerang pattern excision and J torsoplasty, NAC grafts with hockey stick excision pattern, and pectoralis muscle lipoaugmentation. Therapeutic options are arranged across a modified Simon classification. The aesthetic goal is near total glandular reduction, with proper position and shape of the nipple areolar complexes, and masculinity with skin adherence reflecting musculoskeleton. Clinical cases demonstrate these multiple approaches, successes, and pitfalls. Complications relate to delayed healing caused by excessive closure tension or inadequate or inappropriate treatment.


Assuntos
Ginecomastia , Lipectomia , Mamoplastia , Ginecomastia/cirurgia , Humanos , Masculino , Mamilos/cirurgia , Resultado do Tratamento
5.
Acta Chir Plast ; 64(1): 18-22, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35397776

RESUMO

BACKGROUND: Breast ptosis is characterized by severe volumetric deficiency of the upper pole, excess of skin in the lower pole and descent of the nipple-areola complex (NAC). Mastopexy, also known as breast lifting, is the surgical operation aimed to reshape the ptotic breast. Recurrence of breast ptosis after mastopexy is common but to the best of our knowledge no study before has measured it. PURPOSE: The aim of this study was to measure the recurrence of breast ptosis after mastopexy in a prospective study. MATERIALS AND METHODS: Female patients affected by unilateral or bilateral moderate or severe breast ptosis were enrolled in the study. All the patients underwent mastopexy performed only with the removal of skin excess following a Wise pattern. The jugular notch-nipple distance was measured before surgery, immediately after surgery and after 1, 3, 6 and 12 months. RESULTS: Ten patients were included in the study, four underwent unilateral mastopexy and six underwent bilateral mastopexy. The lifting of the NAC, measured in the immediate post-operative period, ranged from 3 to 8.5 cm, with an average value of 6.3 cm. This lifting, one year after surgery, ranged from 2 to 7 cm, with an average value of 4.6 cm. The percentage loss of the NAC lifting one year after surgery compared to the immediate post-operative time ranged from 12.5 to 41.7%, with an average value of 27.5%. CONCLUSION: In our case series, the lifting of the NAC obtained immediately after surgery showed an average loss of 27.5% one year after surgery. Even if limited by the low number of patients included, this pilot study is eye-opening on a very common phenomenon that occurs after mastopexy. The patients should be informed about the possible recurrence of the breast ptosis.


Assuntos
Blefaroptose , Mamoplastia , Blefaroptose/cirurgia , Mama/cirurgia , Feminino , Seguimentos , Humanos , Mamoplastia/efeitos adversos , Mamilos/cirurgia , Projetos Piloto , Estudos Prospectivos
6.
J Surg Oncol ; 125(8): 1202-1210, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35298037

RESUMO

BACKGROUND: This study investigated the outcomes of nipple-sparing mastectomy (NSM) with a deep inferior epigastric perforator (DIEP) flap using delayed primary retention suture (DPRS) to achieve superior breast esthetics. METHODS: Between December 2010 and March 2021, patients who underwent NSM with DIEP flap were inset with or without a skin paddle (using DPRS) as Group A or B, respectively. Demographics, operative findings, complications, BREAST-Q questionnaire, and Manchester scar scale were compared between two groups. RESULTS: Twelve patients underwent 12 unilateral reconstructions in Group A, while 12 patients underwent 13 DIEP flaps in Group B. There was no significant difference in demographics, ischemia time, flap-used weight and percentage, complications of hematoma, infection, re-exploration, partial flap loss, and total flap loss (All p > 0.05, respectively). At a mean 9 months of follow-up, the Breast-Q "Satisfaction with surgeon" domain was significant in Group B (p = 0.04). At a mean 12 months of follow-up, the overall Manchester scar scale of 10.3 in Group B was statistically superior to 12.6 in Group A (p = 0.04). CONCLUSIONS: The NSM with a DIEP flap using DPRS is a reliable and straightforward technique. It can provide greater cosmesis of the reconstructed breast mound in a single-stage procedure.


Assuntos
Neoplasias da Mama , Mamoplastia , Retalho Perfurante , Neoplasias da Mama/cirurgia , Cicatriz/cirurgia , Artérias Epigástricas/cirurgia , Feminino , Humanos , Mamoplastia/métodos , Mastectomia/métodos , Mamilos/cirurgia , Satisfação do Paciente , Retalho Perfurante/cirurgia , Estudos Retrospectivos , Suturas
7.
Acta Biomater ; 143: 333-343, 2022 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-35240316

RESUMO

Nearly all autologous tissue techniques and engineered tissue substitutes utilized for nipple reconstruction are hindered by scar contracture and loss of projection of the reconstructed nipple. The use of unprocessed costal cartilage (CC) as an internal support for the reconstructed nipple has not been widely adopted because of the excessively firm resultant construct. Herein we use a 3D-printed Poly-4-Hydroxybutyrate (P4HB) bioabsorbable scaffold filled with mechanically processed patient-derived CC to foster ingrowth of tissue in vivo to protect the regenerated tissue from contractile forces as it matures. After 6 months in vivo, newly formed spongy fibrovascular cartilaginous tissue was noted in processed CC filled 3D-printed scaffolds, which maintained significantly greater projection than reconstructions without scaffolds. Interestingly, 3D-printed P4HB scaffolds designed with an internal 3D lattice of P4HB filaments (without CC) displayed the fastest material absorption and vascularized adipose-fibrous tissue as demonstrated by SEM and histological analysis, respectively. Using 3D-printed P4HB scaffolds filled with either processed CC, a 3D P4HB lattice or no fills, we have engineered neo-nipples that maintain projection over time, while approximating the biomechanical properties of the native human nipple. We believe that this innovative 3D-printed P4HB nipple reconstruction scaffold will be readily translatable to the clinic. STATEMENT OF SIGNIFICANCE: Nearly all autologous tissue techniques and engineered tissue substitutes utilized for nipple reconstruction are hindered by scar contracture and substantial loss of projection of the reconstructed nipple, leading to significant patient dissatisfaction. Using 3D-printed P4HB scaffolds filled with either processed costal cartilage or 3D P4HB lattices, we have engineered neo-nipples that resist the forces induced by scar contracture, resulting in maintenance of neo-nipple projection over time and biomechanically approximating human nipples after 6 months in vivo implantation. This novel 3D-printed bioabsorbable P4HB scaffold will be readily translatable to the clinic to reconstruct nipples with patient-specific dimensions and long-lasting projection.


Assuntos
Contratura , Mamoplastia , Implantes Absorvíveis , Cicatriz , Contratura/cirurgia , Humanos , Mamoplastia/métodos , Mamilos/cirurgia , Impressão Tridimensional , Tecidos Suporte
8.
Rev Med Liege ; 77(2): 118-123, 2022 Feb.
Artigo em Francês | MEDLINE | ID: mdl-35143132

RESUMO

In our society, the number of gender affirming surgeries is increasing. Mastectomy is usually the initial surgical procedure performed for the treatment of gender dysphoria in transgender men. It has been shown to improve quality of life and to promote assimilation into the new genre. Creating an aesthetic male chest requires adjustment of the breast tissue volume, proper placement of nipple areola complex, and removal of the inframammary fold. Although many papers have been published on this topic, there is still no consensus as to which surgical technique should be preferred. This article deals with the procedures performed in our plastic surgery department at CHU in Liège and reviews the literature relating to the various surgical techniques, postoperative complications as well as patient satisfaction.


Dans notre société, le nombre de chirurgies d'affirmation de genre est en augmentation. La mastectomie est généralement la procédure chirurgicale initiale réalisée dans le traitement de la dysphorie de genre chez l'homme transgenre. Il a été démontré qu'elle améliore la qualité de vie et favorise l'assimilation au nouveau genre. La création d'une poitrine masculine esthétique nécessite un ajustement du volume du tissu mammaire, un placement approprié de la plaque aréolo-mamelonnaire et la suppression du pli infra-mammaire. Bien que de nombreux articles aient été publiés sur le sujet, il n'y a pas encore de réel consensus quant à la technique chirurgicale à privilégier. Cet article fait le bilan des interventions réalisées au sein du Service de Chirurgie plastique au CHU de Liège et revoit la littérature relative aux différentes techniques chirurgicales utilisées, aux complications postopératoires ainsi qu'à la satisfaction des patients.


Assuntos
Neoplasias da Mama , Pessoas Transgênero , Humanos , Masculino , Mastectomia , Mamilos/cirurgia , Qualidade de Vida
9.
World J Surg Oncol ; 20(1): 42, 2022 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-35189907

RESUMO

BACKGROUND: Lateral excess tissue after mastectomy is a frequent problem, which should be included into preoperative planning. Women with lateral tissue abundance are frequently impaired cosmetically and functionally. We suggest a novel oncoplastic mastectomy technique to eliminate the above mentioned. METHODS: Surgical technique Two small horizontal lines are drawn, one line above and one line below the Nipple Areola Complex. These lines should represent the possible skin excision and allow tight skin closure. Consecutively, two ending points of the incision are planned, one close to the xyphoid area and the other one in the anterior axillary line. These points are then interconnected in an s-shaped manner to form a double s-shaped skin excision. RESULTS: The double S-shaped technique is an easy reproducible technique which not only allows good access to the lateral side of the mastectomy, but also and mainly the reduction of lateral fat and skin. CONCLUSION: The double S mastectomy allows for simultaneous removal of access in the axillary region, eliminating skin, and fat as needed and preventing the lateral dog ear.


Assuntos
Neoplasias da Mama , Mamoplastia , Neoplasias da Mama/cirurgia , Estética , Feminino , Humanos , Mamoplastia/métodos , Mastectomia/métodos , Mamilos/cirurgia
10.
BMC Surg ; 22(1): 40, 2022 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-35120473

RESUMO

BACKGROUND: Periductal mastitis (PM) is a rare disease characterized by chronic inflammation of the terminal mammary ducts. Complete removal of terminal lactiferous ducts with Hadfield procedure is a previously defined technique in treatment but carries various complications risks. This study aims to evaluate the effectiveness of modified techniques in the treatment of PM. METHODS: Twenty women who underwent surgery due to PM between January 2012 and December 2019 were retrospectively analyzed. Types of PM were determined. All patients were operated on with three different incisions [Hadfield's operation with periareolar incision (n:11), periareolar combined radial incision (n:7), and round block incision (n:2)]. RESULTS: The mean age was 37.5 ± 6.5 years (range: 24-49). Sixty percent of patients had type 3 PM. In Hadfield's procedure, NAC retraction (n:2), seroma (n:1), and hematoma (n:1) were seen. In the periareolar incision combined radial incision group only one patient had complications (seroma) and none in the round block method. Follow-up was 12 ± 1.5 months and disease relapse occurred in two patients in the Hadfield group. Patients who underwent round block were more satisfied with the appearance of the nipple. CONCLUSIONS: In the treatment of PM, the main principle of surgical treatment is the excision of the affected canal with a clear margin. Apart from the classical Hadfield procedure, the round block method and periareolar combined radial incision techniques can be performed in the treatment of PM.


Assuntos
Mamoplastia , Mastite , Ferida Cirúrgica , Adulto , Feminino , Humanos , Mastite/cirurgia , Mamilos/cirurgia , Estudos Retrospectivos
11.
Radiographics ; 42(2): 321-339, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35179983

RESUMO

Nipple-sparing mastectomy (NSM) is increasingly offered to patients undergoing treatment of breast cancer and prophylaxis treatment for reduction of breast cancer risk. NSM is considered oncologically safe for appropriately selected patients and is associated with improved cosmetic outcomes and quality of life. Accepted indications for NSM have expanded in recent years, and currently only inflammatory breast cancer or malignancy involving the nipple is considered an absolute contraindication. Neoplasms close to and involving the nipple areolar complex are common, and cancer of the lactiferous ducts can spread to the nipple. Therefore, accurate determination of nipple involvement at imaging examinations is critical to identifying appropriate candidates for NSM and preventing local recurrence. Multiple imaging features have been described as predictors of nipple involvement, with tumor to nipple distance, enhancement between the index malignancy and the nipple, and nipple retraction demonstrating the highest predictive values. These features can be assessed at multimodality breast imaging, particularly at breast MRI, which demonstrates high specificity and negative predictive value for determining nipple involvement in malignancy. Online supplemental material is available for this article. ©RSNA, 2022.


Assuntos
Neoplasias da Mama , Mamoplastia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia/métodos , Mamilos/diagnóstico por imagem , Mamilos/patologia , Mamilos/cirurgia , Qualidade de Vida , Radiologistas , Estudos Retrospectivos
12.
Zhonghua Wai Ke Za Zhi ; 60(3): 244-248, 2022 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-35078300

RESUMO

Objective: To examine the outcome of different incision selection for nipple-sparing mastectomy (NSM) with implant-based breast reconstruction (IBBR). Methods: Ninety-Two cases accepted NSM and IBBR from totally 1 002 cases of breast cancer admitted to Beijing Tongren Hospital Affiliated to Capital Medical University from June 2013 to December 2020 were analyzed retrospectively. All the patients were female, aging (42.0±7.5) years (range: 27 to 64 years). There were 12 patients at stage 0, 47 patients at stage Ⅰ, 17 patients at stage Ⅱ, and 16 patients at stage Ⅲ. The patients were divided in three groups by the incision: peri-areolar group (n=23), inframammary group (n=33) and lateral group (n=36). The age, tumor size, lymph node status, hormone receptor, operation method and postoperative complications were followed-up of three groups and compared by one-way ANOVA, χ2 test or Fisher's exact test and expansion to comparied. Results: There was no significant difference in operation time ((180.7±54.0) minutes vs. (176.9±48.1) minutes vs. (194.6±37.5) minutes, F=1.401, P=0.252), postoperative drainage volume ((497.5±226.0) ml vs. (495.4±182.5) ml vs. (519.8±172.0) ml, F=0.167, P=0.846) and drainage time ((8.8±3.8) days vs. (8.0±2.5) days vs. (8.3±2.9) days, F=0.542, P=0.583) among the peri-areolar, inframammary, and lateral groups. The cumulative postoperative complications were relatively higher in the peri-areola group (26.1%(6/23) vs. 0 vs.8.3%(3/36), χ²=9.675, P=0.004). All female patients were followed up for (49.0±25.6) months(range: 12 to 112 months). Breast cancer related death rate was 2.2% (2/92), local recurrence was 1.1% (1/92), regional recurrence was 4.3% (4/92), distant metastasis was 6.5% (6/92), and the disease-free survival rate was 88.0% (81/92). Conclusion: The surgical effects of the peri-areolar, inframammary and lateral incisions for NSM and IBBR are approximate, the total complication rate of the peri-areolar incision is slightly higher.


Assuntos
Neoplasias da Mama , Mamoplastia , Neoplasias da Mama/patologia , Feminino , Humanos , Mamoplastia/métodos , Mastectomia/métodos , Mamilos/cirurgia , Estudos Retrospectivos
13.
Isr Med Assoc J ; 24(1): 20-24, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35077041

RESUMO

BACKGROUND: The purpose of mastectomy for the transgender patient is to produce a masculine appearance of the chest. A number of algorithms have been proposed for selecting the surgical technique. A holistic and surgical approach to transgender men includes our experience-based classification system for selecting the correct surgical technique. OBJECTIVES: To present and discuss the Transgender Standard of Care and our personal experience. METHODS: Data were collected from the files of female-to-male transgender persons who underwent surgery during 2003-2019. Pictures of the patients were also analyzed. RESULTS: Until May 2021, 342 mastectomies were performed by the senior author on 171 patients. The 220 mastectomies performed on 110 patients until November 2019 were included in our cohort. Patient age was 13.5 to 50 years (mean 22.5 ± 6.1). The excision averaged 443 grams per breast (range 85-2550). A periareolar approach was performed in 14 (12.7%), omega-shaped resection (nipple-areola complex on scar) in 2 (1.8%), spindle-shaped mastectomy with a dermal nipple-areola complex flap approach in 38 (34.5%), and a complete mastectomy with a free nipple-areola complex graft in 56 (50.9%). Complications included two hypertrophic scars, six hematomas requiring revision surgery, three wound dehiscences, and three cases of partial nipple necrosis. CONCLUSIONS: A holistic approach to transgender healthcare is presented based on the World Professional Association for Transgender Health standard of care. Analysis of the data led to Wolf's classification for female-to-male transgender mastectomy based on skin excess and the distance between the original and the planned position of the nipple-areola complex.


Assuntos
Cicatriz , Hematoma , Mastectomia , Complicações Pós-Operatórias , Procedimentos de Readequação Sexual , Deiscência da Ferida Operatória , Pessoas Transgênero , Adulto , Contorno Corporal/métodos , Contorno Corporal/psicologia , Imagem Corporal/psicologia , Cicatriz/etiologia , Cicatriz/psicologia , Feminino , Hematoma/diagnóstico , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Masculino , Mastectomia/efeitos adversos , Mastectomia/métodos , Mamilos/patologia , Mamilos/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Satisfação do Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Reoperação/estatística & dados numéricos , Procedimentos de Readequação Sexual/efeitos adversos , Procedimentos de Readequação Sexual/métodos , Procedimentos de Readequação Sexual/psicologia , Deiscência da Ferida Operatória/diagnóstico , Deiscência da Ferida Operatória/cirurgia , Pessoas Transgênero/psicologia , Pessoas Transgênero/estatística & dados numéricos
14.
Curr Oncol ; 29(1): 350-359, 2022 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-35049705

RESUMO

Nipple-areolar complex (NAC)-related complications are common during nipple-sparing mastectomy (NSM), with obesity as a risk factor. Although the incidence of NAC-related complications after robotic NSM (RNSM) with immediate breast reconstruction (IBR) is lower than that after conventional NSM, it remains one of the most unwanted complications. We aimed to evaluate body composition-based risk factors for NAC-related complications after RNSM with IBR. Data of 92 patients with breast cancer who underwent RNSM with IBR using direct-to-implant or tissue expander from November 2017 to September 2020 were analyzed retrospectively. Risk factors for NAC-related complications were identified with a focus on body composition using preoperative transverse computed tomography at the third lumbar vertebra level. Postoperative complications were assessed for 6 months. The most common complication was NAC ischemia, occurring in 15 patients (16%). Multivariate analysis revealed a low skeletal muscle index/total adipose tissue index (SMI/TATI) ratio as an independent NAC ischemia risk factor. An increase in the SMI/TATI ratio by one decreased the incidence of NAC ischemia by 0.940-fold (p = 0.030). A low SMI/TATI ratio is a risk factor for postoperative NAC ischemia in patients undergoing RNSM with IBR for breast cancer. Preoperative body composition-focused evaluation is more valuable than simple body mass index assessment.


Assuntos
Neoplasias da Mama , Mamoplastia , Procedimentos Cirúrgicos Robóticos , Composição Corporal , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mamoplastia/métodos , Mastectomia/métodos , Mamilos/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos
17.
Clin Breast Cancer ; 22(2): 136-142, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34481753

RESUMO

BACKGROUND: Skin-sparing (SSM) and nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR) have significantly increased. There is limited information on complications of IBR in patients with prior cosmetic breast surgery (CBS). We compare IBR outcomes in patients undergoing SSM and/or NSM with and without prior CBS. MATERIALS AND METHODS: Patients undergoing mastectomy from January 1, 2017 to December 31, 2019 were selected. Patient characteristics, surgical approach, and complications were compared between mastectomy and IBR cases for breasts with and without prior CBS. Binary logistic regression analysis was performed to identify predictors of complications and reconstruction loss. RESULTS: 956 mastectomies were performed in 697 patients, with IBR performed for 545 mastectomies in 356 patients. Median age was 51 (range 19-83), 45.8% of patients were age < 50, 62.6% of mastectomies were performed for breast cancer. 95 mastectomies (17.4%) were performed in breasts with prior CBS and 450 (82.6%) without. NSM was more frequently utilized for breasts with prior CBS (P < .001). Complications occurred in 80 mastectomies (14.7%); reconstruction loss in 30 (5.5%). On multivariable analysis, age ≥ 50 (OR 1.76, 95%CI 1.01-3.09, P = .047) and NSM (OR 2.11, 95%CI 1.17-3.79, P = .013) were associated with an increased risk of any complication. Prior CBS was not associated with an increased risk of complications (OR 1.11, 95%CI 0.58-2.14, P = .743) or reconstruction loss (OR 1.32, 95%CI 0.51-3.38, P = .567). CONCLUSION: In this analysis of mastectomy and IBR, prior CBS was not associated with an increased risk of complications or reconstruction loss. In patients with prior CBS undergoing mastectomy, IBR may be safely performed.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/psicologia , Mastectomia Subcutânea/psicologia , Mamilos/cirurgia , Tratamentos com Preservação do Órgão/psicologia , Adulto , Idoso de 80 Anos ou mais , Neoplasias da Mama/psicologia , Feminino , Humanos , Mamoplastia/métodos , Mastectomia Subcutânea/métodos , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão/métodos , Satisfação do Paciente , Estudos Retrospectivos , Adulto Jovem
18.
Ann Surg Oncol ; 29(2): 1033-1040, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34498158

RESUMO

BACKGROUND: Nipple-sparing mastectomy (NSM) is an oncologically safe alternative to skin-sparing mastectomy (SSM). This study evaluated whether NSM patients were more satisfied than SSM patients in short- and long-term follow-up. METHODS: Women who underwent NSM or SSM between 2009 and 2019 completed a postoperative BREAST-Q survey at least 1 year after surgery and patient characteristics were compared. Patient satisfaction at 1-5 years and 6-10 years after NSM and SSM were analyzed. RESULTS: Overall, 431 patients were included; 247 had NSM and 184 had SSM 1-10 years prior to BREAST-Q survey completion. SSM patients were older, had higher body mass index (BMI), larger breast weight, and more hypertension than NSM patients, but oncologic treatments were similar between groups. BREAST-Q Psychosocial Well-Being and Sexual Well-Being scores were significantly higher in NSM patients compared with SSM patients in the 1-5 years cohort; however, scores attenuated in the 6-10 years cohort. Satisfaction with breasts was nearly significantly higher in NSM patients compared with SSM patients in the 1-5 years cohort (p = 0.056), but no different in the 6-10 years cohort. Receipt of adjuvant chemotherapy, receipt of postmastectomy radiation therapy, and BMI ≥30 were independent risk factors for dissatisfaction with breasts. CONCLUSIONS: Women who are not candidates for NSM should be reassured that long-term qualify of life is not significantly different between SSM and NSM. Dissatisfaction with reconstructed breasts is linked with other factors (besides the nipple), which patients should be made aware of at the time of surgical decision making.


Assuntos
Neoplasias da Mama , Mamoplastia , Mastectomia Subcutânea , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia , Mamilos/cirurgia , Satisfação do Paciente , Estudos Retrospectivos
19.
Ann Plast Surg ; 88(5): 555-559, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-34611089

RESUMO

BACKGROUND: Breast reconstruction using autologous tissue has been widely performed, and its safety and usefulness have been reported. However, there are few reports on the long-term morphological evaluation of autologous breast reconstruction cases. We evaluated long-term change of breast shape using Vectra, a 3-dimensional imaging device, for breast reconstruction cases with more than 10 years of follow-up. METHODS: The subjects had undergone autologous tissue breast reconstruction between 2007 and 2009. Sixteen deep inferior epigastric perforator flap cases were included in this study. For each patient, 4 items were measured as indicators: breast width, distance from the sternal notch to the nipple, distance from the nipple to the inframammary fold, and breast volume. The ratio of reconstructed breast to healthy breast was calculated for these 4 items. RESULTS: The long-term average ratio of breast width was 0.99, that of distance from the sternal notch to the nipple was 0.98, that of distance from the nipple to the inframammary fold was 0.94, and that of breast volume was 1.13. We evaluated the influence of body mass index and age at the time of the primary reconstructive surgery, but there was no significant difference in 2 body mass index groups (obese and nonobese groups) and 2 age groups (less than and more than 50 years old). CONCLUSION: We assumed that the balance between the reconstructed breast and the contralateral native breast would become worse over time because of breast sagging and changes in breast elasticity. According to our study, the shape balance of left and right breasts was maintained over time. Limitation of this study is the fact that more than half of the cases included in this study had undergone small to moderate revision surgery during the course of follow-up.


Assuntos
Neoplasias da Mama , Retalhos de Tecido Biológico , Mamoplastia , Retalho Perfurante , Neoplasias da Mama/cirurgia , Feminino , Seguimentos , Humanos , Mamoplastia/métodos , Pessoa de Meia-Idade , Mamilos/cirurgia , Retalho Perfurante/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
20.
J Plast Reconstr Aesthet Surg ; 75(2): 544-549, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34728157

RESUMO

Breast reconstruction aims to achieve a natural look and can involve manipulation or removal of the nipple-areola complex (NAC) as well. One of the final steps of the breast reconstruction process involves creation of the appearance of a new NAC, either via surgical intervention or medical tattooing. Medical tattooing involves little to no surgical intervention while still resulting in aesthetically pleasing results. This specific type of tattooing can be performed by a member of the plastic surgeon team, or a medical tattoo specialist. Integration of this method into plastic surgery practice can prove beneficial to the patient as a viable solution for aesthetically pleasing NAC recreation.


Assuntos
Neoplasias da Mama , Mamoplastia , Cirurgia Plástica , Tatuagem , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mamoplastia/métodos , Mamilos/cirurgia , Estudos Retrospectivos
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