Surgery for giant tumours of the breast: a 15 year review.

BACKGROUND: Giant tumours of the breast tend to occur in the adolescent age group. Racial predilection has been noted in the literature. The mass often occupies most of the breast, leading to its distortion. Many authors have advocated a mastectomy for benign tumours that severely distort the breast. Giant benign tumours when treated by simple excision risk persistence of asymmetry. To avoid this asymmetry, some authors have resorted to excision and immediate reduction mammaplasty. The aim of this retrospective study was a report on giant tumours of the breast presenting to a plastic surgery unit and to analyse demographic factors, clinical presentations, tumour pathology, management, complications, as well as patient and breast outcomes. METHODS: Medical records of patients with giant tumours were retrospectively analysed for assessing demographic factors, clinical presentation, tumour pathology, the technique of surgery performed and patient and breast outcomes in a single hospital setting. Breast outcomes were rated by panel of 4 experienced plastic surgeons using the 4 Point Likert scale. Their ratings were statistically analysed for inter-rater agreement. RESULTS: Twenty-three subjects were identified to have giant tumours of the breast. Of these South African patients, 19 were black, 3 were Indian and 1 was of mixed ethnicity. The age range was 12-49 years (y) with an average of 19y. All masses were palpable. The final pathological diagnosis was fibrocystic disease in 3, giant fibroadenoma in 14, phyllodes tumour in 4, and hamartoma in 2. The size range was 10-45 cm with a median size of 18 cm. All but one patient had simple excision followed by immediate reduction mammaplasty. Twenty patients were assessed after operation. A minimum of 1 to a maximum of 4 patients per reviewer showed unsatisfactory outcomes and a minimum of 18 to a maximum of 21 patients per reviewer showed satisfactory to excellent outcomes. The overall agreement between assessors for this was 84%. CONCLUSION: Benign giant tumours (> 10 cm) of the breast are suitably managed by excision of the mass and a reduction mammoplasty technique of reconstruction.

Complications of Fat Transfer for Breast Augmentation.

Autologous fat grafting is quite common for breast augmentations as well as for reconstructive breast surgery. Coleman has described the surgical technique of fat grafting. Fat is harvested, and after centrifugation and refinement, blunt infiltration cannulas are used to place the fat through small incisions. The grafted tissue is placed in small aliquots with each withdrawal of the cannula. In order to achieve an aesthetically pleasing contour of the breast, the fat should be layered into different levels from the chest wall to the skin. However, autogenous lipotransfer if not performed lege artis might lead to complications such as fat necrosis, calcification, formation of encapsulated fatty masses (cystic lesions), lymphadenopathy, disfigurement of breast contouring, hypersensitive breasts, itchy nipples. A 36-year old female patient, presented with multiple palpable cystic lesions, disrupted breast contouring, asymmetry, hypersensation and pain during examination, 6 months after autologous fat grafting for breast augmentation elsewhere. The patient had ultrasound and MRI screening, which revealed the multiple bilateral cysts formation in the breast tissue. Surgical removal of the large lesions was performed, and specimens were sent for pathology and cytology consideration and screening. A few months after surgical removal of these lesions and after symptoms subsided, breast augmentation was performed with silicone implants. An aesthetically pleasing result together with relief of the patient's initial symptomatology was achieved. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Augmentation Mammaplasty After Breast Enhancement With Hyaluronic Acid.

BACKGROUND: Macrolane is a stabilized, hyaluronic acid-based gel that has been available since 2007 as a minimally invasive, nonpermanent option for breast enhancement. However, numerous controversies pertaining to its side effects have highlighted the need for studies involving larger groups of patients. OBJECTIVES: The authors sought to determine complications of Macrolane injections for breast enhancement and performed surgical evacuation of cysts comprising collections of hyaluronic acid in patients who previously received Macrolane treatment and presented for augmentation mammaplasty. METHODS: The authors reviewed a case series of 20 patients who were treated elsewhere with intramammary injection of Macrolane for cosmetic purposes and who presented at the authors' medical studio with multiple intramammary and intramuscular cysts. All patients underwent surgical evacuation of the hyaluronic acid-based cysts in association with augmentation mammaplasty. RESULTS: Good aesthetic results were achieved in all patients. Three months after surgery, 15 of 20 (75%) patients rated themselves as very much improved; 4 patients (20%) rated themselves as moderately improved, and 1 patient (5%) rated herself as somewhat improved. CONCLUSIONS: The authors suggest that Macrolane cannot be considered a valid alternative for breast augmentation at this time. LEVEL OF EVIDENCE: 4 Therapeutic.

Triple-Negative or Close-to-Triple-Negative Breast Cancer Presenting as a Thick-Walled Cystic Lesion.

Clinical and pathologic characteristics of the invasive ductal carcinoma (IDC) presenting as a thick-walled breast cyst are little known. Three female patients were included in this report. A palpable, nontender breast lump was found in all cases. While mammography showed a hyperdense mass, ultrasonography demonstrated a thick-walled cystic mass. Magnetic resonance imaging clearly showed the cystic breast lesions with ring-like or irregular rim enhancement. A grade III IDC was confirmed in all cases. All IDCs but one were estrogen receptor negative, progesterone receptor negative, and human epidermal growth factor receptor 2 negative, with merely weak progesterone receptor positivity (5%) in one case. All cases underwent surgical management first and postoperative chemotherapy. Breast malignancy presenting as a thick-walled cystic mass could be a highly aggressive IDC, even triple-negative breast cancer. It is imperative for breast cancer-related practitioners to identify the potentially malignant cystic lesions timely and adopt appropriate management.

Outcome of pure mucocele-like lesions diagnosed on breast core biopsy.

AIM: Current guidelines recommend that mucocele-like lesions (MLL) of the breast diagnosed on needle core biopsy (NCB) should be categorized as a lesion of uncertain malignant potential (B3). However, data on the outcome of MLL diagnosed on NCB remains limited due to the rarity of this lesion. The aim of this study was to assess the outcome of pure MLL without atypia diagnosed on NCB using a large series of cases and a review of the literature to provide evidence that can guide management. METHODS AND RESULTS: Patients who underwent diagnostic excision biopsy after a core biopsy diagnosis of MLL without atypia were identified from several centres. Two of 54 patients (4%) with MLL without atypia on core biopsy had ductal carcinoma in situ in the subsequent excision specimen. This is similar to the rate in previous studies of 4% (four of 106). If there is atypia in the core biopsy, previous studies found that the frequency of malignancy is much higher at 21% (seven of 33). CONCLUSIONS: Our results provide evidence that pure MLL without atypia diagnosed on NCB is usually associated with a benign outcome.

Bilateral galactocele in a male infant with Down syndrome and congenital hypothyroidism.

Galactocele is an uncommon benign breast lesion. Its cause is unknown. Here, we report a male infant with Down syndrome and congenital hypothyroidism during the newborn period. At follow up, when he was 6 months old, bilateral mammillary swelling was detected and diagnosed as galactocele. Although thyroid hormone levels were normal, serum prolactin levels were elevated. Cyst aspiration was performed on the left side and 6 months after the aspiration of the cyst on the left side, both cysts had clinically and sonographically regressed. No recurrence was observed at the end of the 4th year.

[Modern diagnosis-treatment approaches for inflammatory changes of mammary glands].

There were examined 567 women, in whom inflammatory changes of mammary glands (MG), not connected with a child borning, were revealed. There was established, that "nonlactational mastitis" of various structure: the cyst--in 36.5% of observations, periductal mastitis--in 32.1%, abscess--11.3%, purulent galactophoritis--12.9%, mastitis-like mammary gland cancer--7.2%. In the diagnosis of inflammatory changes of MG the ultrasonographic investigation is the main, which permit to determine the disease, to study the abscesses topography, to control miniinvasive diagnostic-treatment interventions, in cluding, for abscess and cyst. Purulent-inflammatory processes in MG while extralactational period demand individual differentiated treatment-diagnostic approach regarding khowledge of ultrasonographic (echographic) semiotics of pathological process.

Polyacrylamide hydrogel injection for augmentation mammaplasty: loss of ability for breastfeeding.

Polyacrylamide hydrogel (PAAG) has been widely used for injection augmentation mammaplasty in Russia, China, and Iran for more than 2 decades. In recent years, it has been advocated as a safe permanent filler for soft-tissue augmentation. However, the complications associated with PAAG injection in soft-tissue augmentation have not been extensively investigated. Augmentation mammaplasty through PAAG injection is associated with some complications. The incidence of infection during breastfeeding was reported to be higher than 50%. Herein, we report 58 cases of infection in breastfeeding women receiving PAAG injection, including 50 with unilateral injection (36 on the right, 14 on the left) and 8 bilateral injection. They experienced large breast autoinflation and some severe symptoms, such as local and systemic fever, breast swelling, nipple bulging, tenderness, and pain, which lead to surgical removal of galactocele or intraprosthetic collection of sterile pus resulting in deformity. Operation and comprehensive measures including removal of the injected material, clearing residual cavity, and pharmacotherapy were carried out to control infection and inflammation for 1 to 2 weeks. In the following 12 months, no relapse or recurrence of residual cavity was noted. Therefore, we do not recommend PAAG injection for augmentation mammaplasty, especially in women intending to breastfeed. Patients undergoing PAAG injection for augmentation mammaplasty should avoid breastfeeding. PAAG injection will cause serious consequences resulting in tissue atrophy and breast resection if inappropriately handled.

Interdisciplinary consensus recommendations for the use of vacuum-assisted breast biopsy under sonographic guidance: first update 2012.

PURPOSE: The vacuum biopsy of the breast under sonographic guidance (VB) was introduced in Germany in the year 2000 and the first consensus recommendations were published by Krainick-Strobel et al. in 2005. Since then, many clinical studies on this technique have been published. The purpose of this publication is to update the consensus recommendations from 2005 regarding the latest literature. MATERIALS AND METHODS: The consensus statements were the result of two preliminary meetings after the review of the latest literature by members of the Minimally Invasive Breast Intervention Study Group from the German Society of Senology. The final consensus text was review by all members of the working group. The statements listed under results obtained complete acceptance (consensus 100 %). RESULTS: The consensus recommendations describe the indications, investigator qualifications, technical requirements, documentation, quality assurance and follow-up intervals regarding the latest literature. CONCLUSION: The VB is a safe method for extracting breast tissue for histological workup. The technique allows the resection of breast tissue up to 8 cm3. Besides the diagnostic indications, the method qualifies for a therapeutic resection of symptomatic benign lesions (e. g. fibroadenomas). The technique should be used in specialized breast centers working in a multidisciplinary setup. This paper is an expert's recommendation for the use of VB under sonographic guidance. It is not formulated as a nationwide guideline.

A rare case of persistent large cystic breast tumor mimicking as malignant cystic breast cancer.

Breast cyst, especially galactocele is usually benign. Needle aspiration or surgical removal are both diagnostic and therapeutic. Mastectomy is not necessary even if the whole breast is affected, but surgeons need to be vigilant. We describe a rare case of persistent and large breast cyst.

Coexistence of pregnancy-like and cystic hypersecretory hyperplasia with invasive lobular carcinoma.

BACKGROUND: Lobular pregnancy-like hyperplasia (PLH) merged with cystic hypersecretory hyperplasia (CHH), designated PLH/CHH, is a rare multicystic breast lesion. A previous report has described the high rate of coexistent ductal carcinoma in situ in PLH/CHH; however, a PLH/CHH study involving a larger number of cases is necessary to unravel the clinical significance of this tumor type. CASE REPORT: We describe a unique case of PLH/CHH that coexisted with multifocal lobular neoplasm. Multifocal invasive lobular carcinoma with lobular carcinoma in situ was observed to be adjacent to the PLH/CHH cystic lesions in the left breast of a 70-year-old woman. CONCLUSIONS: The present case documents the previously unreported coexistence of PLH/CHH accompanied by multifocal lobular carcinoma. Extensive examination, including an excisional biopsy, is prudent if a needle core biopsy reveals a PLH/CHH lesion.

Breast lesion sizing by B-mode imaging and sonoelastography in comparison to histopathological sizing--a prospective study.

PURPOSE: This prospective study evaluates whether sonoelastography can improve B-mode ultrasonographic sizing of breast tumors. Precise measuring is important for effective therapy planning for breast cancer patients. MATERIALS AND METHODS: The size of 100 surgically excised breast lesions (92 patients: 77 malignant, 23 benign) was compared to preoperative measurements. Lesions were imaged with both ultrasonographic techniques in identical planes. The largest sizes measured with each modality were compared to the largest histopathological measurements. The interobserver variability was also computed from measurements made by two examiners assessing identical planes. RESULTS: Both ultrasonographic measuring techniques underestimate lesion size. The sonoelastography measurements were within ± 5 mm of the histological size in 70.1 % of malignant lesions, and the B-mode measurements in 57.1 % of cases. Sonoelastography leads to more accurate measurements of 13.0 % of cases (statistically not significant). A total of 22 lesions were also imaged by a second examiner. Sonoelastography had 27.3 % less interobserver variability (examiners agreed in 36.4 % of sonoelastography and in 9.1 % of B-mode results). CONCLUSION: In this study there is no significant advantage of sonoelastography, although a tendency is apparent. The low interobserver variability also favors sonoelastography for preoperative diagnostics, since it may be less dependent on the observer than conventional B-mode imaging. The results of this prospective study require validation in a prospective multicenter study with larger case numbers.

Large unilateral breast autoinflation after breastfeeding linked to polyacrylamide hydrogel injection augmentation mammaplasty.

Augmentation mammaplasty using polyacrylamide hydrogel (PAAG) injection is associated with myriad complications. A patient treated by the authors had bilateral breast augmentation with PAAG injection and experienced large unilateral right breast autoinflation after breastfeeding, which required surgical clearance of a likely galactocele or sterile pus collection that resulted in deformity. Patients with PAAG filler injection-augmented breasts should avoid breastfeeding. The authors recommend against using PAAG injection for augmentation mammaplasty, especially in women intending to breastfeed. Physicians and patients must be aware of the complications associated with PAAG before gel administration.

Benign cyst of the male breast. An exceedingly rare entity that may pose a diagnostic dilemma. Management and literature review.

Cysts represent the most common cause of a breast mass in women. On the contrary, in men, the presence of a benign apocrine cyst is an exceedingly rare occurrence, with only a few cases reported in the literature. We describe herein a case of benign apocrine breast cyst without concurrent gynecomastia in a 41-year-old male. Diagnostic evaluation and management are discussed, along with a review of the literature. Given the extreme rarity of benign breast cysts in males, a thorough investigation is essential in male patients presenting with cystic breast lesions. Diagnostic breast imaging may be challenging. Surgical resection of the cyst should be considered in the presence of atypical imaging features to exclude underlying malignancy.