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1.
Medicine (Baltimore) ; 99(10): e19442, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150097

RESUMO

INTRODUCTION: Giant juvenile breast fibroadenoma can cause deformity and should be excised. Cosmesis is an important consideration in young patients. PATIENT CONCERNS: The patient was admitted to our hospital for a mass of 6 × 6 cm in her left breast. DIAGNOSE: A giant juvenile fibroadenoma. INTERVENTIONS: With the help of Mammotome, we translated the larger mass to smaller one and removed it via a small circumareolar incision with no residual tumor. OUTCOMES: There was no recurrence of disease after 2 years. CONCLUSION: Mammotome-combined resection is a new approach that can be used to excise giant fibroadenomas with a minimal incision, and provides a favorable contour to the breast.


Assuntos
Neoplasias da Mama/cirurgia , Fibroadenoma/cirurgia , Neoplasias da Mama/diagnóstico por imagem , Feminino , Fibroadenoma/diagnóstico por imagem , Humanos , Mamoplastia , Procedimentos Cirúrgicos Minimamente Invasivos , Monitorização Intraoperatória , Satisfação do Paciente , Ultrassonografia Doppler , Adulto Jovem
2.
Am Surg ; 86(2): 134-139, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32167044

RESUMO

Postmastectomy reconstruction has been shown to be oncologically safe, but few studies have investigated factors influencing the type of reconstruction chosen, if at all. Records of female patients with stages 0 to 3 breast cancer undergoing mastectomy at a large academic institution between January 2010 and March 2018 were reviewed. Nine hundred sixty patients were included in this cohort; 784 patients had reconstruction. Younger age, earlier disease stage, private insurance, no history of diabetes, and bilateral mastectomy (BM) were associated with reconstruction. On multivariate analysis, younger age, BM, private insurance, and earlier disease stage predicted reconstruction. Of reconstruction patients, 453 had implants. Race, BMI, and later disease stage influenced the type of reconstruction; on multivariate analysis, higher BMI and later disease stage predicted flap reconstruction. Younger age, BM, private insurance, and earlier disease stage were associated with reconstruction, but the type of reconstruction was affected primarily by BMI and disease stage.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Mastectomia/métodos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Implantes de Mama/estatística & dados numéricos , Neoplasias da Mama/patologia , Feminino , Humanos , Cobertura do Seguro , Mamoplastia/estatística & dados numéricos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Adulto Jovem
3.
Zhonghua Wai Ke Za Zhi ; 58(2): 105-109, 2020 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-32074808

RESUMO

Objective: To summarize the status of immediate breast reconstruction (IBR) after mastectomy in Beijing City, Tianjin City and Hebei Province. Methods: A retrospective analysis was made on the data of 382 cases with breast cancer who were treated and followed up successfully with immediate breast reconstruction after mastectomy from January 2012 to December 2016 in Beijing City, Tianjin City and Hebei Province. Clinic data of the followed-up 382 cases (all female, age (38.5±4.2) years (range: 24 to 70 years)), including general information, tumor information, sugery methods, and treatments after surgery were collected. The survival status, metastasis,complications and prognosis were followed up. Cosmetic effcet was evalated by Harris method, and life quality by Functional Assessment of Cancer Therapy-Breast scale (FACT-B). χ(2) test was used to compare the difference between year 2012 and year 2013 to 2016. Bonferroni method was used to correct the inspection level, which was 0.05/10=0.005. The trend of IBR rate (ratio of IBR to modified radical mastectomy) from 2013 to 2016 was analyzed by trend χ(2) test. Results: There was 46 cases in stage 0, 152 cases in stage Ⅰ, 165 cases in stage Ⅱ, 19 cases in stage Ⅲ. Twenty-five cases was treated by neoadjuvant chemotherapy, 231 by chemotherapy and 35 by radiotherapy. The proportion of implant reconstruction was 48.7% (186/382), more than expanded of 21.5% (82/382), with latissimus dorsi of 12.0% (46/382), TRAM of 8.9% (34/382), DIEP of 2.1% (8/382), and latissimus plus implant of 6.8% (26/382). According to the Harris standard, the excellent and good rate of the cosmetic effect of the reconstructed breast was 93.7%. The score of FACT-B was 108.20±16.9 (range: 67 to 144) 1 year postoperatively. Compared with 2012, the IBR rate was significant increased, till 2015, the IBR rate was 153/10 000 cases (χ(2)=47.028, P=0.000). Conclusions: There is a significant increase on IBR rate in Beijing City, Tianjin City and Hebei province by year. Most of cases received IBR is stage Ⅰ to Ⅱ. Implant reconstruction is the main reconstructive method. Postoperative cosmetic effects and quality of life are both meet patients' demon.


Assuntos
Neoplasias da Mama , Mamoplastia , Mastectomia , Adulto , Pequim , Neoplasias da Mama/cirurgia , Feminino , Humanos , Qualidade de Vida , Estudos Retrospectivos
4.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(1): 169-176, 2020 Feb 18.
Artigo em Chinês | MEDLINE | ID: mdl-32071482

RESUMO

OBJECTIVE: To investigate the outcomes of breast reconstruction with employing improved techniques throughout the tissue expander/implant two-stage breast reconstructed process, which involved the tissue expander placement, the saline filling intraoperatively and postoperatively, the implant selection, and the permanent implant replacement. METHODS: In this study, 68 patients who had been provided immediate or delayed tissue expander/implant two-stage breast reconstruction with autologous fat injection post-mastectomy in Peking University Third Hospital from April 2014 to September 2018 were involved, and the relevant information was analyzed retrospectively. The enhancements of the techniques, involving the incision selection, the expander placement, the principle of expansion, the management of capsule, the prosthesis selection, and the assisted reconstruction method were summarized, and the reconstruction outcomes were evaluated objectively through three-dimensional surface imaging. RESULTS: Among the 68 patients in this study, immediate reconstruction was conducted in 25 patients and 43 patients underwent delayed reconstruction. The median time of tissue expansion was 7.0 (3.0, 20.0) months, and the average volume of expansion was (372.8±87.2) mL. The median size of breast implant was 215 (100, 395) mL. The median number of injections for fat grafting was 1 (1, 3), and the average volume of fat grafting was (119.3±34.1) mL. The median follow-up time was 7.0 (4.0, 24.0) months. During the process of breast reconstruction, the tissue expander leakage was observed in two patients, and one of them underwent expander replacement due to the secondary infection. In the immediate reconstruction cases, the volume symmetry of bilateral breasts after reconstruction got even better than that before mastectomy (t=4.465, P<0.01). And in the delayed reconstruction cases, the volume between bilateral breasts also achieved good symmetry after reconstruction (t=0.867, P>0.1). CONCLUSION: Good results of tissue expander/implant two-stage breast reconstruction could be achieved through the techniques enhancement, which involved the preferred transverse incision, the downward placement of expander, the rapid expansion of chest soft tissue, the release of capsule tension, the application of sizer in prosthesis selection, and the assisted autologous fat grafting.


Assuntos
Mamoplastia , Dispositivos para Expansão de Tecidos , Neoplasias da Mama , Humanos , Mastectomia , Estudos Retrospectivos , Resultado do Tratamento
5.
Plast Reconstr Surg ; 145(2): 333-339, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985616

RESUMO

BACKGROUND: Rates of autologous breast reconstruction are stagnant compared with prosthetic techniques. Insufficient physician payment for microsurgical autologous breast reconstruction is one possible explanation. The payment difference between governmental and commercial payers creates a natural experiment to evaluate its impact on method of reconstruction. This study assessed the influence of physician payment differences for microsurgical autologous breast reconstruction and implants by insurance type on the likelihood of undergoing microsurgical reconstruction. METHODS: The Massachusetts All-Payer Claims Database was queried for women undergoing immediate autologous or implant breast reconstruction from 2010 to 2014. Univariate analyses compared demographic and clinical characteristics between different reconstructive approaches. Logistic regression explored the relative impact of insurance type and physician payments on breast reconstruction modality. RESULTS: Of the women in this study, 82.7 percent had commercial and 17.3 percent had governmental insurance. Implants were performed in 80 percent of women, whereas 20 percent underwent microsurgical autologous reconstruction. Women with Medicaid versus commercial insurance were less likely to undergo microsurgical reconstruction (16.4 percent versus 20.3 percent; p = 0.063). Commercial insurance, older age, and obesity independently increased the odds of microsurgical reconstruction (p < 0.01). When comparing median physician payments, governmental payers reimbursed 78 percent and 63 percent less than commercial payers for microsurgical reconstruction ($1831 versus $8435) and implants ($1249 versus $3359, respectively). Stratified analysis demonstrated that as physician payment increased, the likelihood of undergoing microsurgical reconstruction increased, independent of insurance type (p < 0.001). CONCLUSIONS: Women with governmental insurance had lower odds of undergoing microsurgical autologous breast reconstruction compared with commercial payers. Regardless of payer, greater reimbursement for microsurgical reconstruction increased the likelihood of microsurgical reconstruction. Current microsurgical autologous breast reconstruction reimbursements may not be commensurate with physician effort when compared to prosthetic techniques. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Reembolso de Seguro de Saúde/economia , Mamoplastia/economia , Microcirurgia/economia , Adulto , Implante Mamário/economia , Implante Mamário/estatística & dados numéricos , Implantes de Mama/economia , Implantes de Mama/estatística & dados numéricos , Neoplasias da Mama/economia , Neoplasias da Mama/cirurgia , Feminino , Retalhos de Tecido Biológico/economia , Humanos , Mamoplastia/estatística & dados numéricos , Massachusetts , Mastectomia/economia , Mastectomia/métodos , Medicaid/economia , Medicaid/estatística & dados numéricos , Microcirurgia/estatística & dados numéricos , Microvasos , Pessoa de Meia-Idade , Reoperação/economia , Reoperação/estatística & dados numéricos , Transplante Autólogo/economia , Estados Unidos
6.
Plast Reconstr Surg ; 145(2): 317-327, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985612

RESUMO

BACKGROUND: This study investigated the risk of reconstruction failure after mastectomy, immediate breast reconstruction, and radiotherapy to either a temporary tissue expander or permanent implant. METHODS: Records of women treated at a single institution between June of 1997 and December of 2011 were reviewed. Two patient groups were identified based on type of immediate breast reconstruction: tissue expander followed by exchange with a permanent implant and permanent implant. The study endpoint was rate of reconstruction failure, defined as a replacement, loss of the implant, or conversion to flap. RESULTS: The tissue expander/permanent implant and the permanent implant groups consisted of 63 and 75 patients, respectively. The groups were well balanced for clinical and treatment characteristics. With a median follow-up of 116 months, eight implant losses, 50 implant replacements, and four flap conversions were recorded. Reconstruction failure occurred in 22 of 63 patients in the expander/implant group and in 40 of 75 patients in the permanent implant group. A traditional proportional hazards model showed a higher risk of reconstruction failure for the expander/implant group (hazard ratio, 2.01) and a significantly shorter time to reconstruction failure compared with the permanent implant group (109.2 months versus 157.7 months; p = 0.03); however, according to a competing risk model, the between-groups cumulative incidences were not significantly different (hazard ratio, 1.09). CONCLUSIONS: Radiotherapy to either a tissue expander or a permanent implant presented a fairly large risk of reconstruction failure over time. The expander/implant group was not more likely to develop reconstruction failure compared to permanent implant group, but the timing of onset was shorter. More complex techniques should be investigated to lower the risk of reconstruction failure. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia/métodos , Expansão de Tecido/métodos , Adolescente , Adulto , Idoso , Antibacterianos/administração & dosagem , Implante Mamário/instrumentação , Implante Mamário/métodos , Neoplasias da Mama/radioterapia , Implantes de Medicamento , Feminino , Humanos , Mamoplastia/métodos , Pessoa de Meia-Idade , Polimetil Metacrilato/uso terapêutico , Cuidados Pós-Operatórios/métodos , Infecções Relacionadas à Prótese/prevenção & controle , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Terapia de Salvação/instrumentação , Terapia de Salvação/métodos , Expansão de Tecido/instrumentação , Dispositivos para Expansão de Tecidos , Resultado do Tratamento , Adulto Jovem
7.
Plast Reconstr Surg ; 145(2): 330-332, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985615

RESUMO

Dual-plane breast augmentation offers the advantages of a subpectoral implant location with the ability to expand its use to glandular ptotic and constricted lower pole breasts. Alas, high implant position or very loose breast tissue can lead to a notorious breast shape known as the "waterfall deformity." To prevent many of these undesired deformities, the authors introduce a novel pectoralis major median myotomy they call the "median cut." From all of the dual-plane breast augmentations that were performed by the two authors between the years 2011 and 2017, a total of 605 included a median cut to resolve an apparent waterfall deformity. Without this procedure, a shift to subglandular augmentation would have been performed. The authors strongly believe that the median cut is a powerful and effective way to avoid intraoperative waterfall deformities and to have more women benefit from a submuscular approach. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Assuntos
Mamoplastia/métodos , Músculos Peitorais/transplante , Adulto , Implante Mamário/métodos , Implantes de Mama , Feminino , Humanos , Miotomia/métodos , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento
8.
Plast Reconstr Surg ; 145(2): 340-343, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985617

RESUMO

The history of autologous breast reconstruction has been characterized by the desire for progressively increasing reliability with decreasing donor-site morbidity. The robotic deep inferior epigastric artery perforator flap permits the longest possible pedicle harvest through the smallest possible fascial incision and, for this reason, may be the next stage in the evolution of minimally invasive, autologous breast reconstruction.


Assuntos
Mamoplastia/métodos , Retalho Perfurante , Procedimentos Cirúrgicos Robóticos/métodos , Feminino , Humanos , Pneumoperitônio Artificial/métodos , Reto do Abdome/transplante , Coleta de Tecidos e Órgãos/métodos , Sítio Doador de Transplante , Transplante Autólogo
19.
Cancer Treat Rev ; 84: 101963, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31958739

RESUMO

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a recently recognized non-Hodgkin lymphoma of T-cell origin. Despite the low incidence of this new disease, the increasing use of breast implants for cosmetic or post-mastectomy reconstruction purposes places BIA-ALC as an emerging and compelling medical challenge. The real BIA-ALCL pathogenesis has not been fully uncovered so far, while different putative causal factors have been proposed. Breast implants with textured surfaces seem to be associated with nearly all cases of BIA-ALCL, while the real the risk of disease development has not been well estimated so far. Late onset, persistent seroma around breast implant represents the classical clinical presentation. Most of the BIA-ALCL patients presents with localized disease, which confers an excellent prognosis. Unlike other non-Hodgkin lymphomas, surgical excision of the mass has a key role in the treatment. For patients with advanced and disseminated diseases, the treatment did not differ from other types of T-cell lymphoma. For these reasons, BIA-ALCL represents an emerging disease which requires multidisciplinary team approach to well define diagnostic workup and treatment for each patient. This review article aims to summarize available data on BIA-ALCL. First, we will outline available data on BIA-ALCL epidemiology, pathogenesis, diagnostic work-up, and treatment. Second, we will point out the potential psychological implications as well as the risk of perception distortion for women with breast implants, especially for those with previous breast cancer. Lastly, we will summarize the current national recommendations regarding textured breast implants and discuss the diagnostic-therapeutic algorithm for BIA-ALCL management.


Assuntos
Implante Mamário , Implantes de Mama , Neoplasias da Mama/epidemiologia , Linfoma Anaplásico de Células Grandes/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Neoplasias da Mama/imunologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Remoção de Dispositivo , Feminino , Humanos , Incidência , Linfoma Anaplásico de Células Grandes/imunologia , Linfoma Anaplásico de Células Grandes/patologia , Linfoma Anaplásico de Células Grandes/cirurgia , Mamoplastia , Mastectomia , Estadiamento de Neoplasias , Complicações Pós-Operatórias/imunologia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/cirurgia , Prognóstico , Seroma , Taxa de Sobrevida
20.
J Surg Oncol ; 121(3): 441-446, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31907948

RESUMO

BACKGROUND AND OBJECTIVES: Giant juvenile fibroadenoma (GJF) is a rare benign tumor that disfiguring affects the breast shape and quality of life of patients. This study aimed to report the experience of GJF management. METHODS: A Wise-pattern skin reducing tumor resection followed by immediate breast reconstruction with a dermal flap pocket was used. The long-term outcomes were assessed retrospectively by BREAST-Q questionnaire from 2008 to 2018. RESULTS: The study included eight patients with GJF. All patients achieved satisfactory results without severe complications. The BREAST-Q revealed that postoperative scores for satisfaction with breasts (69.3 ± 17.6) and sexual wellbeing (62.3 ± 27.6) were higher than the normative scores. The psychosocial wellbeing (69.7 ± 14.6) and physical wellbeing-chest (86.8 ± 13.0) scores were slightly lower than the normative scores. CONCLUSION: Although GJF is a benign tumor, it should be surgically removed. And the Wise-pattern skin reducing tumor resection with immediate breast reconstruction is a proper way to improve patients' satisfaction with breast size and shape and quality of life.


Assuntos
Fibroadenoma/cirurgia , Mamoplastia/métodos , Qualidade de Vida , Transplante de Pele , Retalhos Cirúrgicos/transplante , Adolescente , Criança , Gerenciamento Clínico , Feminino , Fibroadenoma/patologia , Seguimentos , Humanos , Prognóstico , Estudos Retrospectivos
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