immediate breast reconstruction with prostheses after conservative treatment plus intraoperative radiotherapy long term esthetic and oncological outcomes

Abstract Electron intraoperative radiotherapy (ELIOT) has been introduced for breast conservative treatment (BCT) with promising oncological outcome. Thus, immediate breast reconstruction with prosthesis after BCT became possible due to minimal radiation effect on local tissue from ELIOT. We reported oncological and esthetical results of 29 BCT patients who had immediate implant reconstruction plus 21 Gy-ELIOT as the sole radiation treatment. All patients had prosthesis in ipsilateral breast and had simultaneous contralateral augmentation for symmetrical procedure. The average age was 52.3 years. There were stage Ia thirteen cases, stage Ib seven cases, stage IIa six cases and stage IIIb one case and two cases of intraepithelial neoplasia. From 54.2 (36–88) months follow up, the capsular contracture grading in the reconstructed breast from ELIOT-side is comparable with non-irradiated contralateral side. There was one patient who developed local recurrence (LR) and later on dead with breast related event (LR = 0.76% per year). There was no primary ipsilateral carcinomas and distant metastasis

The value of latissimus dorsi flap with implant reconstruction for total mastectomy after conservative breast cancer surgery recurrence

The presence of previous RT following breast cancer conservative treatment and actual recurrence does not contraindicate breast reconstruction with implant. The use of latissimus dorsi flap together with breast implant provides a large muscle cover to the implant and ideally a low capsular contraction rate. The authors describe a large study in order to have a long follow-up in this group of patients demonstrating the very low capsular contraction rate despite the previous RT

Shoulder function after breast reconstruction with the latissimus dorsi flap: A prospective cohort study - Combining DASH score and objective evaluation.

Abstract Objectives The latissimus dorsi (LD) flap is well-known in breast reconstruction especially in previously-irradiated patients, in order to have a low capsular contraction rate whenever an implant is associated. The aim of this study is to closely evaluate the effect of LD flap harvesting on shoulder function as well as specific movements related to the LD, both objectively and subjectively. Materials and methods We retrospectively collected data on 86 patients who underwent pedicled LD muscle flap for breast reconstruction at the European Institute of Oncology between September 1995 until March 2011. Results The majority of patients showed a joint recovery superior to 80% in all joint movements examined. Disabilities of the Arm, Shoulder and Hand questionnaire revealed minimal disability similar to normal range and furthermore it appears to decrease in all sports and in particular in those who practice with LD involvement. Conclusion Focusing this data, a growing, "disability-free" percentage changes depending on whether or not the patients have practiced sport could be appreciate

A single centre experience of local perforator flaps in oncoplastic breast surgery: A cross-sectional study

Background & objectives: Various oncoplastic techniques have emerged over the years to preserve breast cosmesis and symmetry without compromising the principles of tumor excision. One of the newer techniques for breast volume replacement to achieve symmetry and cosmesis is the use of fasciocutaneous pedicled chest wall perforator flaps or local perforator flaps (LPF). The objectives of this study were to document the details of the surgical procedure as well as patient-reported satisfaction and well-being following the procedure using a validated BREAST-Q tool among Pakistani women.Materials & methods: This cross-sectional study was conducted from March 2019 to February 2021 enrolling 25 female patients who underwent breast conservative surgery using LPF for breast tumors at The Aga Khan University Hospital, Karachi. Data related to the procedure was collected on a pre-designed proforma. Cosmetic outcomes and patient satisfaction were evaluated using 2 scales from BREAST-Q BCT domain version 2.0. The questionnaire was self-administered by the patients during their routine follow-up in the clinic. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 23. Mean (SD)/median (IQR) were computed for quantitative variables and frequency and percentages were calculated for qualitative variables. 2 sample t-test was applied. P-value ≤0.05 was considered significant.Results: 25 patients underwent LPF with a mean age of 47 ± 13.1 years. 8 LICAP, 7 AICAP, and 10 LTAP flaps were performed. Two postoperative complications of wound site erythema were encountered. 23 women were eligible for the BREAST-Q survey. Median (IQR) postoperative satisfaction with breasts and physical well-being chest (equivalent Rasch transformed score) was 100 (41) and 76 [18] respectively. We found high satisfaction with breasts and comparable physical well-being among Pakistani women after LPF surgeries.Conclusion: Local perforator flaps in oncoplastic breast-conserving surgery are a good option showing high satisfaction with breasts and physical well-being in Pakistani women

Lembi perforanti sul modello animale vivente. CAPITOLO 03.

La tecnica operatoria che permette di alle- stire i lembi perforanti richiede delicatezza e precisione. Questo tipo di dissezione deve essere ap- preso ed af nato prima di arrivare alla esperienza clinica sull\u2019 umano ed il metodo migliore per otte- nere questa esperienza \ue8 l\u2019esercizio assiduo. In generale i modelli per l\u2019esercizio chirurgico di tecniche ni come la microchirurgia sono quel- li sintetici e i piccoli animali (ratti, conigli). Ove l\u2019esercizio da apprendere non sia di pura micro- chirurgia (con le anastomosi microvascolari) ma di preparazione di lembi perforanti, siano essi pe- duncolati o microchirurgici, i metodi migliori per fare esperienza sembrerebbero essere la pratica su cadavere e la pratica su modello vivente ani- male.1 L\u2019esercizio su cadavere \ue8 molto utile soprattutto per l\u2019apprendimento della reale dimensione e di- stribuzione dei vasi perforanti e in generale delle strutture anatomiche nell\u2019essere umano. Gli svan- taggi della dissezione su cadavere sono quello della impossibilit\ue0 di simulare le reali dif colt\ue0 che si incontrano in clinica. In particolare la mancanza di una circolazione sanguigna attiva, fa s\uec che il campo operatorio sia sempre pulito e che possa- no essere trascurati alcuni aspetti fondamentali come la precisa e dettagliata emostasi di tutti i vasi minori che non sia necessario preservare. \uc8 questa la ragione per cui riteniamo molto utile la pratica chirurgica dei lembi perforanti sul model- lo animale vivente che ha l\u2019enorme vantaggio di riprodurre fedelmente tutte le possibili dif colt\ue0 chirurgiche incontrate in clinica. I tessuti inoltre hanno la consistenza e la malleabilit\ue0 che han- no i tessuti umani. Alla ne della dissezione del lembo, \ue8 possibile veri care la vitalit\ue0 del lembo, sia per la perfusione arteriosa che per il drenag- gio venoso e quindi in conclusione la correttezza dell\u2019esercizio chirurgico

Evaluation of Lipofilling Safety in Elderly Patients with Breast Cancer

South facade with ironwork balcony, overlooking walled garden; The brick Andrew Low House combines Grecian details with elements of the Italian Villa style and boasts one of Savannah's most stunning ironwork balconies. A shuttered sleeping porch (in the style of the Charleston 'piazza' type) overlooks a beautiful brick-walled garden in the rear of the home. The front garden remains much as it did when first planted, with two hourglass-shaped flowerbeds. Andrew Low was a wealthy cotton factor (broker). Andrew Low’s son, William Mackay Low, married Juliette Gordon in 1886. Juliette Gordon Low was the founder of the Girl Scouts of America. The Andrew Low House is open for tours. Source: Visit Historic Savannah [website]; http://www.visit-historic-savannah.com (accessed 4/30/2011

Nipple Sparing Mastectomy: Does Breast Morphological Factor Related to Necrotic Complications?

Background: Nipple sparing mastectomy (NSM) can be performed for prophylactic mastectomy and the treatment of selected breast cancer with oncologic safety. The risk of skin and nipple necrosis is a frequent complication of NSM procedure, and it is usually related to surgical technique. However, the role of the breast morphology should be also investigated. Method: We prospectively performed an analysis of 124 NSM from September 2012 to January 2013 at the European Institute of Oncology, Milan, Italy, focusing on necrotic complications. We analyzed the association between the risks of skin necrosis and the breast morphology of the patients. Results: Among 124 NSM in 113 patients, NSM procedures were associated with necrosis in 22 mastectomies (17.7%) among which included partial necrosis of nipple-areolar complex (NAC) in 15 of 124 NSM (12.1%) and total necrosis in 4 cases (3.5%). The NAC was removed in 5 NSM cases (4%). The volume of breast removed was the only significant factor increasing the risk of skin necrosis. The degree of ptosis was not significantly related to the necrosis risk. Conclusions: Large glandular specimen increases the risk of NAC necrosis. The degree of ptosis and the distance between the sternal notch and the NAC have no significant impact on necrotic complications in NSM. To reduce the necrotic complications in large breast after NSM, reconstruction should better be performed with autologous flap or slow skin expansion using the expander technique