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Contralateral prophylactic mastectomy rate stable at major Canadian breast cancer center

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World Journal of Clinical Oncology 2016年第3期7卷 302-307页

作者： Amanda Roberts Lakhbir Sandhu Tulin D Cil Stefan O P Hofer Toni Zhong Department of Surgery University of Toronto Division of General Surgery University Health Network and Women’s College Hospital Division of Plastic and Reconstructive Surgery University Health Network Toronto General Hospital

AIM: To examine trends of contralateral prophylactic mastectomy(CPM) rates at a Canadian academic breast cancer ***: A single-institution retrospective cohort study was completed. Women of any age who underwent at least a unilateral mastectomy(UM) for primary unilateral breast carcinoma between January 1, 2004 and December 31, 2010 were included. Patients who underwent CPM on the same day as UM were isolated to create two distinct cohorts. Patient and procedure characteristics were compared across groups using R software(version 3.1.0). The percentage of CPMs per year was determined. The Cochrane-Armitage test was used to assess the trend of CPMs over time. A P value of mastectomy volume. Annual CPM rates did not increase over time(P = 0.7) and varied between 2.6% to 10.7%. Family history of breast cancer [OR 3.6(1.8-7.3)] and immediate reconstruction [10.0(5.2-19.3)] were both significantly associated with CPM. Women who underwent CPM were younger(median age CPM 49 years vs UM 52 years, P < 0.0001) but age less than 50 years was not statistically associated with increased rates of CPM. CONCLUSION: CPM rates from 2004 to 2010 at a high-volume Canadian breast cancer center did not increase over time, in contrast to trends observed in the United States.

关键词： Breast Oncology Prophylactic mastectomy Surgery

Immediate nipple-areola-sparing mastectomy reconstruction: An update on oncological and reconstruction techniques

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World Journal of Clinical Oncology 2014年第3期5卷 478-494页

作者： Alexandre Mendon?a Munhoz Eduardo Montag José Roberto Filassi Rolf Gemperli Division of Plastic Surgery Hospital Sírio-LibanêsS?o PauloSP 01239-040Brazil Cancer Institute of S?o Paulo University of S?o Paulo School of Medicine S?o PauloSP01246-903Brazil Plastic Surgery Division University of S?o Paulo School of MedicineS?o PauloSP 01246-903Brazil

Nipple-sparing mastectomy(NSM) is a safe technique in patients who are candidates for conservation breast surgery. However, there is worry concerning its oncological safety and surgical outcome in terms of postoperative complications. The authors reviewed the literature to evaluate the oncological safety, patient selection, surgical techniques, and also to identify the factors influencing postoperative outcome and complication rates. Patient selection and safety related to NSM are based on oncological and anatomical parameters. Among the main criteria, the oncological aspects include the clinical stage of breast cancer, tumor characteristics and location including small, peripherally located tumors, without multicentricity, or for prophylactic mastectomy. Surgical success depends on coordinated planning with the oncological surgeon andcareful preoperative and intraoperative management. In general, the NSM reconstruction is related to autologous and alloplastic techniques and sometimes include contra-lateral breast surgery. Choice of reconstructive technique following NSM requires accurate consideration of various patient related factors, including: breast volume, degree of ptosis, areola size, clinical factors, and surgeon's experience. In addition, tumor related factors include dimension, location and proximity to the nipple-areola complex. Regardless of the fact that there is no unanimity concerning the appropriate technique, the criteria are determined by the surgeon's experience and the anatomical aspects of the breast. The positive aspects of the technique utilized should include low interference with the oncological treatment, reproducibility, and long-term results. Selected patients can have safe outcomes and therefore this may be a feasible option for early breast cancer management. However, available data demonstrates that NSM can be safely performed for breast cancer treatment in selected cases. Additional studies and longer follow-up are necessary to defi

关键词： Breast reconstruction Skin-sparing mastectomy Nipple-sparing mastectomy Outcome Complications Silicone breast implants Tissue expanders Oncoplastic surgery

Patients with Shoulder Dysfunction After mastectomy Can Benefit from Nurse-Assisted Home-Based Range of Motion Exercises

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Journal of Clinical and Nursing Research 2022年第6期6卷 37-41页

作者： Waqas Ahmed Farjad Afzal Department of Allied Health Sciences University of SargodhaSargodha 40100PunjabPakistan

Background:Shoulder dysfunction is very common after mastectomy,and there is also less follow-up for physiotherapy services among patients with ***:A study was conducted to determine the role of nurse-assisted home-based range of motion(ROM)exercises in patients with shoulder dysfunction after ***:A pre-and post-interventional study design was used to collect data from 30 post-mastectomy *** subjects were selected on a voluntary *** consent was obtained from post-mastectomy patients who were discharged from different oncology hospitals in Pakistan prior to their inclusion in this *** obtaining a baseline measurement,the patients were supervised with nurse-assisted ROM exercises at *** nurse-assisted home-based ROM exercise program was designed for such patients,and the patients were followed-up for up to 1 *** total duration of the study was 1 year from August 2015 to August ***-intervention measurement was performed at the patients’*** difference in terms of pain reduction and ROM improvement at the shoulder joint was recorded using goniometric measurements and the 100 mm visual analogue scale(VAS).Results:The mean age of the 30 subjects was 39.83±*** mean ROM of shoulder flexion before the exercise program was 106.03°,which improved to 133.93°after 1 month of the exercise *** mean ROM of shoulder abduction before treatment was 94.83°,which improved to 127.13°after 1 month of supervised exercise *** mean ROM of shoulder rotation before the exercise program was 127.53°,which improved to 152.03°after 1 month of the exercise ***:The nurse-assisted home-based shoulder ROM exercise program is effective in terms of improving the range of motion and reducing pain at the shoulder joint in post-mastectomy patients.

关键词： mastectomy Shoulder Dysfunction Adhesive capsulitis ROM Exercises

Regional Block Anesthesia in Breast Surgery: What Do We Know So Far?

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Open Journal of Anesthesiology 2024年第9期14卷 185-195页

作者： Hao Wang Sharat Chopra Prit Anand Singh Department of Anesthesia & Surgical Intensive Care Changi General Hospital Simei Singapore Department of Surgery Aneurin Bevan University Health Board Newport UK

Breast cancer is the most prevalent cancer in women worldwide, and pain following mastectomy is a major post-surgical complication. This paper highlights the risk factors for chronic pain in breast surgery and evaluates various regional block techniques used to reduce post-operative pain, and minimize hospital stays in high-risk patients. Further research is needed to evaluate the effectiveness of novel regional anaesthesia techniques in an enhanced recovery context, and to assess their role in preventing or reducing chronic pain.

关键词： Chronic Pain Breast Surgery mastectomy Regional Anesthesia Nerve Blocks Ultrasound-Guided

Expanding the Use of Nipple-Sparing Mastectomies in Obese Patients Undergoing Staged Implant-Based Reconstruction

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Modern Plastic Surgery 2024年第3期14卷 23-35页

作者： Mallory A. Rowley Prashant K. Upadhyaya College of Medicine SUNY Upstate Medical University Syracuse USA Department of Surgery SUNY Upstate Medical University Syracuse USA

Background: Advantages of various mastectomy techniques include skin reduction and favorable aesthetics in Wise-pattern closures, and less visible scars in nipple-sparing mastectomies (NSM). This study compares postoperative complication profiles between Wise-pattern and nipple-sparing mastectomies in the obese population. Methods: A retrospective chart review of obese patients (BMI ≥ 30) who underwent staged breast reconstruction following Wise-pattern and nipple-sparing mastectomies at our institution between February 2016 and January 2020 was conducted. Complications between cohorts were analyzed using the independent samples t-test (2-sided) and the χ2 test. Results: A total of 232 breasts (163 Wise-pattern, 69 NSM) were re-constructed in 123 obese female patients (85 Wise-pattern, 38 NSM). Complication rates in both the Wise-pattern and NSM patient cohorts were similar following stage 1 (Wise-pattern: 30.7%, NSM: 39.1%, p = 0.212) and stage 2 (Wise-pattern: 16.6%, NSM: 15.9%, p = 0.907) of reconstruction. No statistically significant differences in rates of infection, dehiscence, seroma, hematoma or malposition of tissue expander (TE)/implant following stage 1 or stage 2 were found between cohorts. Conclusions: There were no significant differences in postoperative complication rates between the Wise-pattern and NSM cohorts of obese patients. NSM can be a viable surgical option in carefully selected obese patients and offer the advantage of concealed scarring.

关键词： mastectomy Breast Reconstruction Nipple-Sparing

Postmastectomy Pain： A Cross-sectional Study of Prevalence, Pain Characteristics, and Effects on Quality of Life

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Chinese Medical Journal 2016年第1期129卷 66-71页

作者： Serbiuenl Gokhan Beyaz Jalan Serbetcigil Erganenc Tolga Ergonenc Ozlem Uysal Sonmez Unal Erkorkmaz Fatih Allintoprak Department of Anesthesiology and Pain Medicine Faculty of Medicine Sakarya University Sakarya Republic of Turkey Department of Anesthesiology Sakarya University Training and Research Hospital Sakarya Republic of Turkey Department of Oncology Yeditepe University Medical School Istanbul Republic of Turkey Department of Biostatistics Faculty of Medicine Sakarya University Sakarya Republic of Turkey Department of General Surgery Faculty of Medicine Sakarya University Sakarya Republic of Turkey

Background： Postmastectomy pain syndrome （PM PS） is defined as a chronic （continuing for 3 or more months） neuropathic pain affecting the axilla, medial arm, breast, and chest wall after breast cancer surgery. The prevalence of PMPS has been reported to range from 20% to 68%. In this study, we aimed to determine the prevalence of PMPS among mastectomy patients, the severity of neuropathic pain in these patients, risk factors that contribute to pain becoming chronic, and the effect of PMPS on life quality. Methods： This cross-sectional study was approved by the Sakarya University, Medical Faculty Ethical Council and included 146 patients ranging in age from 18 to 85 years who visited the pain clinic, general surgery clinic, and oncology clinic and had breast surgery between 2012 and 2014. Patients were divided into two groups according to whether they met PMPS criteria： pain at axilla, arm, shoulder, chest wall, scar tissue, or breast at least 3 months after breast surgery. All patients gave informed consent prior to entry into the study. Patient medical records were collected, and pain and quality of life were evaluated by the visual analog scale （VAS） for pain, a short form of the McGill Pain Questiomlaire （SF-MPQ）, douleur neuropathique-4 （DN-4）, and SF-36. Results： Patient mean age was 55.2 ± 11.8 years （33.0-83.0 years）. PMPS prevalence was 36%. Mean scores on the VAS, SF-MPQ, and DN-4 in PMPS patients were 1.76 ±2.38 （0-10）, 1.73 ± 1.54 （0-5）, and 1.64 ± 2.31 （0-8）, respectively. Of these patients, 31 （23.7%） had neuropathic pain characteristics, and 12 （9.2%） had phantom pain according to the DN-4 survey. Patients who had modified radical mastectomy were significantly more likely to develop PMPS than patients who had breast-protective surgery （P = 0.028）. Only 2 （2.4%） of PMPS patients had received proper treatment （anticonvulsants or opioids）. Conclusions： PMPS seriously impacts patients＇ emotional situation, daily activities, and social relationships and is

关键词： Breast Cancer mastectomy Neuropathic Pain Postrnastectomy Pain Surgery

Trillium Flap for Postmastectomy Neo-Nipple Reconstruction (A Novel Technique)

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Modern Plastic Surgery 2020年第1期10卷 9-16页

作者： Ahmed Abdelmoez Alsayed Independent Researcher Al-Hokail Khobar Saudi Arabia

Introduction: Breast cancer cases, mastectomy and following reconstruction procedures are growing in numbers. Despite being lifesaving, mastectomies have a destructive psychological impact on the patients. On the other hand, breast reconstruction improves psychological damages within the same population. Various techniques for nipple reconstruction were described in literature. Trillium flap is an innovative technique to reconstruct neo-nipple with several advantages that make it superior to other popular flaps. Objectives: To come up with an innovative design for reconstructing a neo-nipple post mastectomy, that is superior to other popular flaps. Results: The Trillium flap design has less visible and easily camouflaged scars, is geometry-based, specific, well-detailed and flexible to produce a tailored nipple with any desired height and diameter and ensures the flaps good vascularity and the neo-nipple projection sustainability. Conclusion: Trillium flap is an innovative technique to reconstruct neo-nipple with several advantages that make it superior to other popular flaps. The results shown in the study are for experimental procedures done on human tissue samples of excised flaps from abdominoplasties and brachioplasties. Further application on actual cases is needed with monitoring of neo-nipple projection sustainability on the long term.

关键词： Trillium Flap Breast Nipple NAC Reconstruction Neo-Nipple mastectomy

Primary leiomyosarcoma of the nipple-areola complex:Report of a case and review of literature

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2008年第2期9卷 109-113页

作者： Lai-ching WONG Po-chi HUANG Shi-ping LUH Chiun-sheng HUANG Department of Pathology Taichung Hospital Executive Yuan Department of Health Taichung 401 Taiwan China Department of Surgery Chung-Shan Medical University and Hospital Taichung 402 Taiwan China Department of Surgery National Taiwan University Hospital Taipei 100 Taiwan China

Primary leiomyosarcoma of the nipple-areola complex is extremely rare. Less than ten such cases have been reported in English literature so far. Herein we describe a 52-year-old female presenting with a 1.5 cm×1.1 cm×0.7 cm nodular lesion over her left nipple, and leiomyosarcoma was proved by pathological examination of the excised specimen. Positron emitted tomogram (PET) revealed no abnormal signal other than the primary site. Microscopically, this poorly circumscribed tumor was composed of interlacing bundles of smooth muscle cells with bizarre and pleomorphic nuclei, as well as prominent nucleoli. Its mitotic count was up to 7 mitoses per 10 high power fields (HPF). Immunohistochemical study of tumor cells revealed positive stain for α-smooth muscle actin and vimentin; and negative for cytokeratin, CD34 and S-100. Left simple mastectomy was undertaken and no residual mass lesion was noted on the resected specimen. Related literatures about the diagnosis and treatment for breast leiomyosarcoma will be presented here.

关键词： Breast Leiomyosarcoma mastectomy

Titanium-coated polypropylene mesh as innovative bioactive material in conservatives mastectomies and pre-pectoral breast reconstruction

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Bioactive Materials 2021年第12期6卷 4640-4653页

作者： Pietro Gentile Marco Bernini Lorenzo Orzalesi Silvia Sordi Icro Meattini Francesca Lessi Ashutosh Kothari Claudio Calabrese Department of Surgical Science University of Rome“Tor Vergata”Rome00133Italy Breast Surgery Breast UnitOncology DepartmentCareggi University Hospital50134FlorenceItaly Department of Experimental and Clinical Biomedical Sciences“M.Serio” University of Florence Radiation Oncology Unit-OncologyCareggi University HospitalFlorenceItaly Fondazione Pisana per la Scienza onlus Pisa 56122Italy Breast Surgery Unit Guy’s HospitalGuy’s and St.Thomas’NHS Foundation TrustLondonUnited Kingdom San Rossore Breast Unit Pisa 56122Italy

Breast reconstruction is rapidly evolving,thanks to the growing acceptance of synthetic meshes as innovative biomaterials.276 patients undergoing mastectomy(total of 328 mastectomies)were analyzed in a retrospective observational study to evaluate the pre-pectoral immediate breast reconstruction(IBR)using an implant wrapped with Titanium-Coated Polypropylene Mesh(TCPM)*** treated with tissue expander(TE),equally placed pre-pectorally(and wrapped with the same TCPM in 74.3%of the control group’breasts).163 patients,of the study group(SG),underwent mastectomy and pre-pectoral IBR with implant wrapped with TCPM,in a one-step surgery,called direct-to-implant technique(DTI),while 113 patients control group(CG)underwent mastectomy and *** technique has been performed in 192 breasts of the SG while TE procedure in 136 breasts of the *** BREAST-Q questionnaire has been provided before the treatment and 2 years *** scale has been used to evaluate capsular ***,surgical,and aesthetic outcomes along with BREAST-Q scores were ***,a histologic evaluation was conducted in 11 capsules’samples randomly chosen(6 derived from SG patients and 5 derived from CG).Complications were recorded in 43 cases(29SG-14CG):8 skin-nipple necrosis(5SG-3CG),8 wound dehiscence(6SG-2CG),3 hematomas(1SG-2CG),and 24 infections(8SG-16CG).Grade IV capsular contracture was detected in 9 breasts(1SG-8CG),whereas 254 breasts were grade I(110SG-144CG),33(10SG-23CG)grade II,and 32(4SG-28CG)grade *** wrinkling was detected in 18 cases(10SG-8CG)after 30 *** local tumor recurrence rate was 5.8%.Three recurrences were on the nipple-areola complex(1.9%).SG patients showed significantly higher rates in the BREAST-Q overall Satisfaction with Outcome(74.1),overall Satisfaction with Breasts(69.1),Psychosocial Well-being(81.9),and Sexual Well-being(63.1),versus CG’s patients(p<0.05).Histological analysis showed a process of normal tissue repair with

关键词： mastectomy Pre-pectoral breast reconstruction Titanium-coated polypropylene mesh Immediate breast reconstruction