Occurrence of Breast Mucinous Carcinoma After Autologous Fat Grating for Breast Augmentation.

UNLABELLED: Autologous fat grafting is commonly performed in reconstructive breast surgery as well as in aesthetic breast augmentation surgery. Nevertheless, little is known about the interaction between fat grafts and cancer. A 36-year-old patient had undergone bilateral breast augmentation with autologous fat grafting. Two months after surgery, she perceived two small palpable indurations in the right breast. Nine months after the procedure, the lumps grew bigger and lumpectomy was performed. Histologic examination of the specimens showed mucinous carcinoma of the breast. This case raises once again the question about the possible links between breast cancer and fat grafts. The level of evidence is level V. NO LEVEL ASSIGNED: 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.

Breast augmentation with autologous fat injection: a report of 105 cases.

INTRODUCTION: Autologous fat transplantation has attracted great interest in breast augmentation for cosmetic purpose. In the present study, we reported our experience in fat grafting in breast in 105 cases, and some detailed procedure concerning efficacy and safety of grafting was evaluated. METHODS: Fat was harvested using 20-mL syringe attached to a 3-hole blunt cannula in a diameter not beyond 3 mm. After washing with cool normal saline to remove blood, the fat was managed with open method using cotton towel as a platform for concentration fat tissue and separating them from fluids, oil, and debris. A 14-gauge, 1-hole blunt cannula was used to place the fat through 3-mm incision on inframammary fold. The fat was infiltrated into the breast from deep to superficial subcutaneous plane. RESULTS: Between July 2002 and August 2010, 105 patients have undergone this procedure. The age distribution of the patients ranged from 18 to 45 years, with a mean of 31.3 years. Grafted fat volume has ranged from 120 to 250 mL (average, 205 mL) per breast per session. All women had a significant improvement in their breast size and shape postoperatively, and the breasts were soft and natural in appearance. CONCLUSIONS: Liposuction and autologous fat transplantation is a suitable approach for augmentation mammaplasty.

[Comparison of therapeutic effects of immediate implanting breast reconstruction after skin sparing mastectomy and modified radical mastectomy on breast cancer].

OBJECTIVE: To compare the therapy efficiency of immediate implanting breast reconstruction after skin sparing mastectomy and modified radical mastectomy in breast cancer. METHODS: This study retrospectively analyzed 530 female patients with early breast cancer operated in the department of General Surgery, Beijing Chaoyang Hospital, from Jan. 2004 to Dec. 2008, including 91 patients operated with skin sparing mastectomy and immediate implanting breast reconstruction and 439 patients with modified radical mastectomy. The follow up ended in Mar. 2010. By comparing complications, local recurrence, distant metastases and mortality rates between the two groups, the research was done to evaluate the therapy efficiency. RESULTS: In the group of immediate implanting reconstruction, 84 patients completed follow up with the median follow-up time of 35 months (14 - 72 months) while the local recurring rate was 2.4%, distant metastasis rate was 8.3% and mortality rate was 6.0%. In the group of modified radical mastectomy, 398 patients completed follow up with the median follow-up time of 36 months (12 - 74 months) while the local recurring rate was 3.3%, distant metastasis rate was 9.5% and mortality rate was 6.5%. Therefore there was no obvious statistic difference between the two groups in local recurring rate, distant metastasis rate and mortality rate (P > 0.05). Evaluation of aesthetic results was done in the 84 patients after immediate implanting reconstruction for 12 months which was 93% as good or excellent by surgeons while 87% by patients. Surgeons and patients were both satisfied with the breast appearance. CONCLUSION: For patients with early stage breast cancer, combining standard postoperative therapy, skin sparing mastectomy and immediate implanting reconstruction could achieve the same effect as the traditional modified radical mastectomy, while reconstruction would bring about better appearance and higher quality of life.

Immediate breast reconstruction with implants after skin-sparing mastectomy: a report of 96 cases.

BACKGROUND: Skin-sparing mastectomy (SSM) with immediate breast reconstruction (IBR) has become increasingly popular as an effective treatment for patients with early-stage breast cancer requiring mastectomy. This study aimed to evaluate the clinical outcomes of IBR using permanent gel breast implants and Becker expandable breast implants after SSM. METHODS: A review of 96 patients undergoing IBR with Beck expandable or permanent gel breast implants after SSM from July 2002 to December 2006 was performed. Of the 96 patients, 30 had IBR after SSM with conservation of the nipple-areola complex (NAC). The mean patient age was 42 years (range, 29-57 years). Aesthetic outcomes were assessed according to the breast volume, shape, and symmetry with the opposite breasts after a mean follow-up period of 44 months. RESULTS: The aesthetic outcomes were graded as excellent for 29 patients, good for 47 patients, fair for 12 patients, and poor for 8 patients. The overall complication rate was 11.5% (11/96). The complications included prosthesis loss after skin flap necrosis subsequent to hematoma formation (n = 1), skin necrosis (n = 2), partial necrosis of preserved NAC (n = 1), capsular contracture (Baker 4, n = 2), wound infection not involving the prosthesis (n = 2), inversion of the injection port (n = 2), and seroma (n = 2). CONCLUSION: This study demonstrates that prosthetic breast reconstruction is a safe, reliable method with minimal complications and good to excellent aesthetic results for the majority of patients with early-stage breast cancer. For selected patients, NAC-sparing mastectomy can be performed without increasing the risk of local recurrences. Success depends on patient selection, proper incision for SSM, total coverage of the prostheses with muscles, and careful intra- and postoperative management.

[A selection of methods for immediate and delayed breast reconstruction].

OBJECTIVE: To investigate the surgical methods, indications and effects of postmastectomy breast reconstruction in 67 consecutive patients. METHODS: From July 2002 to October 2005, 67 patients received postmastectomy breast reconstructions. Immediate breast reconstructions were performed using full-size implants in 38 cases, Becker expandable implants in 16 cases, unilateral pedicled transverse rectus of abdominis musculocutaneous (TRAM) in 2 cases. Delayed breast reconstruction were carried out in 6 cases with unilateral pedicled TRAM flaps, 4 cases with extended latissimus dorsi musculocutaneous flap (ELDF), one case with Becker expandable implant. RESULTS: Of the patients, more than 90% were satisfied with the results. Minor complications were recorded in 5 patients, including small local skin necrosis, partial necrosis of nipple-areola complex preserved and seroma formation. CONCLUSIONS: Full-size implant breast reconstruction is ideal for slender, small-breast women undergoing immediate breast reconstruction after skin-sparing mastectomy, but not suitable for delayed breast reconstruction. Expandable implants can be used for immediate breast reconstruction in patients with large breast or those who received modified mastectomy and also can be used for delayed breast reconstruction in patients with well-preserved skin and muscle. TRAM or ELDF flap for breast reconstruction is a useful procedure with advantages of autologous tissue and excellent results, both are suitable for immediate and delayed breast reconstruction.

Effect of adenovirus-mediated gene transfection of vascular endothelial growth factor on survival of random flaps in rats.

OBJECTIVE: To evaluate the effect of local application of vascular endothelial growth factor (VEGF) via adenovirus-mediated gene transfer on survival of full thickness flaps selected randomly in rats. METHODS: Thirty Sprague-Dawley rats weighing 480-520 g were used in this study. A dorsal flap (8 cm x 2 cm) in full thickness with the pedicle located at the level of the iliac crest was designed. Then the rats received 1,012 pfu replication-deficient recombinant adenovirus carrying VEGF (AdCMV-VEGF group, n=10), 1,012 pfu recombinant beta-galactosidase adenovirus (AdCMV-Gal group, n=10) and 1 ml saline (saline group, n=10), respectively, in the distal two thirds of the proposed flap by means of subdermal injection at 8 different locations. Three days after treatment, the flaps were elevated as originally designed and sutured back in situ. The survival rate of the flaps was evaluated on day 7 after operation. RESULTS: The survival rate of the flaps in the AdCMV-VEGF group increased significantly as compared with those of the AdCMV-Gal group (P<0.01) and the saline group (P<0.01). Immunohistochemical staining showed that VEGF was expressed in the survival flaps injected with AdCMV-VEGF. Histological analysis showed that more granulation tissues and angiogenesis were observed in the AdCMV-VEGF group than those in the AdCMV-Gal and the saline groups. CONCLUSIONS: Local application of adenovirus-mediated VEGF165 cDNA may efficiently improve the survival of ischemic skin flaps.

[Expandable implants in immediate breast reconstruction].

OBJECTIVE: To investigate the indications, surgical methods and esthetic results in patients undergoing immediate breast reconstruction with expandable implants. METHODS: From January 2002 to March 2006, immediate breast reconstructions were carried out with expandable implants following mastectomy in 30 breast cancer patients. Nipple-areola were preserved in 5 patients. RESULTS: Very satisfactory results were achieved. Minor complications were recorded in 3 patients, two with local skin necrosis, and another with partial necrosis of nipple-areola complex. CONCLUSIONS: The techniques provide better results for the patient who is not a candidate for simple implant reconstruction. These techniques also eliminate the need for a second major surgery to replace a temporary expander with a permanent implant in those patients needing soft tissue expansion. It is a simple procedure with advantages of no additional scarring, short time for convalescence.

[Intra-uterine model of cleft lip and scarless wound healing of fetal rats].

OBJECTIVE: To properly evaluate the benefits of in utero repair of cleft lip, an animal model of cleft lip was developed and the fetal scarless wound healing was observed in SD rat fetus. METHODS: Through a maternal celiotomy and hysterotomy, twenty excisional cleft was created in the upper lip of rat fetus. Another group of 20 rat fetus were given full-thickness incisional wounds in the upper lips. The fetus with cleft lip were returned into utero for further development till birth.Wound specimens from the incisional wounds in the other group were removed successively 12, 24, 48, 72h postwounding for histological examination. RESULTS: The fetus with excisional wound demonstrated a complete cleft lip after birth. In contrast, the wound in the fetus with incisional wounds regenerated with normal architecture histologically, indistinguishable from the surrounding normal skin. CONCLUSION: The results of this preliminary study indicates that the fetal rat cleft lip is technically feasible with an excellent survival rate. Healing occurs without scar formation. This model will be used to document facial growth following in utero repair of a cleft lip.

[Effects of hVEGF cDNA on random skin flap via a replication-deficient adenovirus vector].

OBJECTIVE: The purpose of this study was to determine the effects of local delivery of vascular endothelial growth factor( VEGF) transferred with adenovirus-mediated gene on the survival of ischemic random skin flap in rats. METHODS: The animals were divided into three groups randomly (n = 10) . A 2 cm x 8 cm dorsal skin flap was designed with the pedicle at the level of the iliac crest. In group A (AdCMV-VEGF), each animal received 10(12) PR replication-deficient recombinant adenovirus (AdCMV-VEGF) in the distal two-thirds of the proposed flap by means of the subdermal injection at ten different locations. In group B (AdCMV-GaI), each received 1012 PR AdCMV-Gal. In Group C (Saline), each received 1 ml saline. Three days after the treatment, the flap was elevated as planed way and re-sutured back to its donor site. All the animals were evaluated 7 days after the operation. RESULTS: The mean percentage of surviving flap area was (85.91 +/- 2.54)% in group A, (59.56 +/- l.18)% in group B, and (61.48 +/- l.09)% in group C. There was a significant increase in the percentage of the survival area in the flaps of the group A, compared with the group B and group C (Group B vs. Group A, P < 0.01; Group C vs.Group A, P < 0.01, Group B vs. Group C, P >0.05). Hybridization in the situ, the immunohistochemical stain showed that the VEGF was expressed in the survival tissue of the flap treated with the AdCMV-VEGF, but it was not found in the control groups. Histological analysis demonstrated qualitatively greater amount of granulation tissue and angiogenesis was found in the group treated with the AdCMV-VEGF than the controls. CONCLUSIONS: The results may indicate that Ad vector carrying VEGF cDNA could be useful in enhancing the survival of the skin flap due to the effect of the local delivery of the VEGF.