COSMESIS FOLLOWING COMPLETE LOCAL EXCISION OF BREAST CANCER

Background : With the establishment of the safety of breast conservation in early breast cancer, cosmesis has become an increasingly important end-point of treatment. The aim of the present study was to establish a model to assess breast cosmesis after complete local excision and to assess cosmesis achieved in patients who had surgery using the seroma technique. Methods : A total of 42 patients were retrospectively reviewed and assessed by independent clinical assessment by a surgeon, structured questionnaire and clinical photography. Results : A total of 86% of patients were rated by surgeon and patient as having a good or excellent cosmetic outcome. There was a high degree of concordance between independent clinical assessment and clinical photographic analysis. Conclusions : A model has been established for the assessment of breast cosmesis; the technique of seroma formation without reconstruction of the defect results in good or excellent cosmesis in the majority of patients.     

Early experience with an anatomical soft cohesive silicone gel prosthesis in cosmetic and reconstructive breast implant surgery

Recently, an anatomic breast implant filled with soft cohesive silicone gel was introduced by Mentor Medical Systems onto the European market. This study reports the early experience of a single surgeon with this implant. All patients who received a Contour Profile Gel (CPG) implant from March 2001 to October 2002 were studied. Patient satisfaction with breast shape and consistency was assessed using linear analogue scales with a maximum score of 10. Thirty-five patients received CPG implants for cosmetic (10 patients, 20 breasts) and reconstructive (25 patients, 31 breasts) surgery purposes. Patients were satisfied with their breast shape (mean score: 8.3). Eighty-five percent of the breasts were rated as soft (score >/=6). No serious esthetic complications such as implant malposition or significant capsular contracture were observed. Anatomic soft cohesive gel implants provide excellent results in selected cases. They are well accepted by patients and not associated with an increased rate of complications.     

Factors influencing cosmetic results after breast conserving management (Turkish experience)

We aimed to determine predictive factors affecting cosmetic results after breast conserving management in breast cancer. Data on 96 patients with 97 breast cancer cases, who had been admitted to Uluda? University M.A. Radiotherapy Center between October 1995 and December 1998 and managed with breast-conserving treatment, were analysed to determine the factors affecting cosmetic outcome. Possible factors affecting cosmesis were grouped as patient-related, tumor-related and treatment-related. Mann-Whitney U test was used in univariate analyses whereas logistic regression was used in multivariate analyses. Median follow-up time was 29.5 months ranging between 11 and 53 months and median age at admission was 50 (range 22-84). Cosmetic results were grouped in five categories; excellent; good; fair; poor and, very poor, using criteria, such as presence of fibrosis, telangiectasia, shape of breast, asymmetry, status of areola, pigmentation. Treated breasts were scored by the patients, three radiation oncologists and a breast surgeon independently. In the analysis performed using scores given by the patients, cases with scores 3 and above (unsatisfactory) were compared with cases with scores below 3 (satisfactory). Eighty-two patients (84%) considered cosmetic result as satisfactory (excellent/good) whereas 15 patients (16%) considered unsatisfactory (fair/poor/very poor). In univariate analysis using Mann-Whitney U test, type of surgery (P=0.0655) was the statistically significant factors affecting cosmetic results. In multivariate analysis using logistic regression, tumor quadrant (P=0.0060) and elapsed radiation therapy days (P=0.0090) were the most significant factors. Median values were taken into consideration for the scores given by the physicians and cases with scores 3 and above (unsatisfactory) were compared with cases with scores below 3 (satisfactory). Eighty-two cases were evaluated as satisfactory (84%) whereas 15 cases were unsatisfactory (16%). In this set of data, patient age (P=0.0144), menopausal status (P=0.0111), institution which surgery was performed (P=0.0045), type of surgery (P=0.0044), placement of metallic clips (P=0.0083) and skin fibrosis (P=0.038) were found to be significant in univariate analysis using Mann-Whitney U test. In multivariate analysis using logistic regression, institution where surgery took place (P=0.0015), menopausal status (P=0.0087) and telangiectasia (P=0.0657) were the most significant factors.     

A Prospective Longitudinal Study of Cosmetic Outcome in Immediate Latissimus Dorsi Breast Reconstruction and the Influence of Radiotherapy

Background Immediate breast reconstruction may result in superior cosmetic outcomes as a result of the preservation of the skin envelope. The impact of implant use and radiotherapy (RT) on the cosmetic outcome of latissimus dorsi (LD) breast reconstruction, however, has never been prospectively evaluated with adequate long-term follow-up. Methods Women undergoing immediate LD breast reconstruction from January 2000 to February 2007 underwent photographic assessment and clinical evaluation for breast retraction analysis (BRA) at 3, 6 and 12 months postoperatively and on the anniversary of their surgery. The resulting photographs were subject to panel cosmetic assessment. A patient-reported cosmetic outcome questionnaire and the body image scale (BIS) were administered to each woman at a single time point to coincide with the anniversary of their surgery. Multilevel linear regression modelling was used to analyse the results. Results Seventy-three women underwent 53 implant-assisted LD breast reconstructions and 20 autologous procedures with a mean follow-up of 2.71 years. The incidence of radiotherapy in this cohort was 43%. RT over time adversely influenced overall cosmetic outcome as assessed by the panel (P = 0.0002), and BRA (P = 0.033), both of which were significantly worse in the implant-assisted group (P = 0.020). Patient reporting of overall cosmetic outcome and BIS, however, did not differ significantly between the LD groups or following RT. Conclusion Radiotherapy may adversely affect the cosmetic outcome of latissimus dorsi breast reconstruction, particularly if an implant is used, but this is not universal. Patient assessment of their cosmetic outcome may, however, differ significantly from the clinician’s view. Financial support: Allergan Medical UK, United Bristol Healthcare Trust Charitable Trustees     

Underdiagnosed and disfiguring - Radiation-induced morphea following breast cancer treatment

ObjectivesRadiation-induced morphea (RIM) is a rare, painful and disfiguring complication in women who receive adjuvant radiotherapy treatment for breast cancer. It is a distinct entity unrelated to radiation-induced fibrosis of the breast.Materials and methodsBetween the years 2005–2016, approximately 12,000 breast cancer cases were treated with surgery and radiation in the central district of Israel. From that population, we have identified and managed the cases of breast RIM by a multidisciplinary team of dermatologists, breast surgeons, and plastic surgeons. Demographic, oncologic, diagnostic and treatment data were collected and reviewed.ResultsThree cases of breast radiation-induced morphea, with an estimated prevalence of 1:3000 cases of post-breast cancer radiation where identified. The first signs of morphea appeared years after the completion of standard RT. Early management leads to superior cosmetic results.ConclusionsUnfortunately, there are no known predictors for RIM. Early recognition by the oncologist, the breast surgeon or the reconstructive surgeon during follow-up enables expeditious provision of patient reassurance and helps guide potential treatment options.     

Breast reconstruction: late cosmetic results of implant reconstruction

The long cosmetic outcome of breast implant reconstruction is unknown. The morbidity and cosmetic outcome of 360 patients who underwent immediate breast reconstruction with various types of implant has been prospectively analysed over a 10-year period. 334 patients who completed their reconstruction were suitable for evaluation of their cosmetic outcome. The early complication rate (<2 months) was 9.1%, with an explantation rate of 1.6%. The late complication rate (>2 months) was 23%, with a pathological capsular contracture rate of 11% at two years and 15% at five years, and an implant removal rate of 7%. The revisional surgery rate was 30.2%. The cosmetic results were prospectively assessed using an objective five point global scale. Every patient was scored at each visit once surgery was completed. The overall cosmetic outcome deteriorates in a linear fashion from an initial acceptable result in 86% of patients two years after completion of their reconstruction to only 54% at five years. This fall off in the cosmetic outcome was not associated with the type of implant used, the volume of the implant, the age of the patient or the type of mastectomy incision employed. Radiotherapy was not a significant factor as only 28 patients were irradiated. However, on Cox model analysis pathological capsular contracture was the only factor which significantly contributed to a poor cosmetic outcome(P<0.0001 (relative risk 6.3). In spite of a high revisional surgery rate, deterioration still occurred, suggesting that other unaccounted for variables were responsible. On photographic retrospective review of those patients without a capsular contracture who demonstrated a deterioration in their cosmetic scores, it became clear that a possible reason for their poor result was late asymmetry produced by the failure of both breasts to undergo symmetrical ptosis as the patients aged.     

Central quadrantectomy with resection of the nipple-areola complex compared with mastectomy in patients with retroareolar breast cancer

Appropriate surgery in women with retroareolar breast cancer should allow resection of the cancer with wide free margins and an acceptable cosmetic result. The aim of this study was to compare breast conservation surgery (BCS) to mastectomy for treatment of retroareolar breast cancer. In a prospective nonrandomized study, 69 women with retroareolar breast cancers underwent either central quadrantectomy (n=33) with complete removal of the nipple-areola complex or mastectomy (n=36). Two of 33 (6%) patients scheduled for BCS had a secondary mastectomy and immediate reconstruction due to involved margins. After a median follow-up of 42 month (range 17-99 months) in the BCS group and 43 months (range 16-118 months) in the mastectomy group local and regional recurrences as well as systemic disease were comparable between both groups. The postoperative cosmetic result after BCS as evaluated by the patients was rated as excellent in 80% and good in 20% with no poor result. BCS followed by radiation therapy is a feasible alternative to mastectomy in patients with retroareolar breast cancer.     

The exposed breast prosthesis at the infra-mammary region: treatment by local flaps

Exposure of a breast implant is a matter of grave concern for every plastic surgeon. Basic surgical principles mandate removal of exposed foreign material. Nevertheless, removal of a breast prosthesis involves a huge psychological distress for the patient. In addition, it often requires subsequent reconstructive interventions, and the final cosmetic result may be compromised. In the literature, only a few strategies, concerning management of an exposed prosthesis, have been reported. We present two cases where a successful salvage procedure was achieved by providing tissue support in the critical area by using local flaps. Between July and August 2009, two patients presented with implant exposure at the infra-mammary scar. There were no signs of systemic or local infection. One patient had previously undergone cosmetic breast augmentation; the other patient suffered implant exposure after breast reconstruction following mastectomy. Both patients refused to have their implants removed. After the patients were thoroughly informed about the options and possible risks, they were prepared for an implant salvage procedure. After rinsing both the pocket and implant, an infra-mammary tissue support was provided by means of a local flap. Three procedures were performed in these two patients. Three different flaps were used: an external oblique muscle flap, an adipofascial flap and a posterior capsular flap. In both patients, we were able to salvage the original implant. During a follow-up period of more than 18 months, both patients remained without recurrence, and no capsular contracture occurred. In case of implant exposure in the infra-mammary region and the absence of severe infection, salvage surgery procedures should be considered and form part of the plastic surgeon's armamentarium.     

Outcome analysis of 541 women undergoing breast conservation therapy

Breast conservation therapy (BCT) has evolved as a favorable approach to the management of early-stage breast cancer. Shortcomings of BCT include the potential need for re-excision in the event of positive tumor margins as well as the untoward sequelae of radiation therapy. Both of those factors have led to a substantial proportion of patients undergoing BCT who ultimately report suboptimal aesthetic outcomes. Application of plastic surgery principles to the management of this patient subset has been shown to be beneficial from both an oncologic and cosmetic perspective.The aim of this study was to identify factors that may predict which patients would benefit most from involvement of a plastic surgeon before BCT. A retrospective analysis was performed on 762 patients undergoing lumpectomy during a 10-year study period at a single institution. Younger women and patients with tumor size approaching 2 cm were noted to have a significantly higher likelihood of oncologic outcomes that ultimately required breast reconstruction. Integration of oncoplastic techniques in the surgical management of patients undergoing BCT would likely contribute to improvement in aesthetic outcomes and overall patient satisfaction.     

BREAST CONSERVATION: LONG-TERM RESULTS FROM WESTMEAD HOSPITAL

Background : Breast conservation has been shown to be a safe and effective alternative to mastectomy in early-stage breast cancer. The present study reviews the long-term outcome and toxicity after treatment of early breast cancer by conservative surgery and radiation. Methods : Between November 1979 and December 1989, 438 patients with Union Internationale Contre le Cancer (UICC) stage I or II breast cancer were treated with conservative surgery and radiation therapy (CS + RT) at Westmead Hospital. Surgery to the breast varied from a local excision to a quadrantectomy, depending on the preference of the referring surgeon. The axilla was surgically dissected in 299 patients (68%). All patients received postoperative breast irradiation. The whole breast was irradiated to 46–54 Gy (median dose, 50 Gy) using 6 Mev photons for 5–6.5 weeks. Boosts were given at the primary tumour site in 336 patients (78%), by electron therapy (88 patients), iridium-192 (247 patients) or photons (one patient). A total of 44 patients (10%) received adjuvant chemotherapy. Results : The median follow-up period for surviving patients was 84 months (range: 56–172 months). The 5-year actuarial rate of local recurrence was 6% (312 patients at risk), and the 10-year rate was 10% (52 patients at risk). Very young patients (aged 34 years at diagnosis) had a 5-year actuarial rate of local recurrence of 13% compared to 5% for older patients (P= 0.04). Neither the total dose to the primary site nor the boost technique influenced local recurrence. The 5-year freedom from distant relapse was 83%. The side effects included rib fractures (2%), symptomatic pneumonitis (3%), fatty necrosis or fibrosis requiring surgery (4%), and moderate-severe oedema of the arm (7%). Conclusions : The long-term data show that CS + RT for UICC stage I or II breast cancer results in low rates of local recurrence which are influenced by age at diagnosis, but not by radiation dose or boost technique. These results confirm those of other international series that CS + RT is a safe alternative to mastectomy for most women with operable breast cancer.     

乳腺癌保留乳房术后影响乳房形态的多因素分析

目的探讨乳腺癌保乳术后影响乳房形态的因素及提高保乳术后乳房美学效果的方法。方法由整形外科医师和患者分别对67例乳腺癌保乳术后的美学效果做出各自独立的评价，单因素分析采用Mann-Whitney U检验，而多因素分析则应用Logistic回归的方法。结果医师对保乳术后乳房形态的满意率为65．7％。单元素分析中，年龄（P=0．003）、体重指数（P=0．002）、绝经状况（P=0．002）、放疗剂量（P=0．022）、肿物位于外上象限时的切口数量（P=0．036）、切除次数（P=0．036）、纤维化（P=0．002）、手术方式（P=0．002）对保乳术后乳房形态具有明显的影响。多元素分析中，纤维化、手术方式、放疗剂量对术后乳房形态具有明显影响（P=0．009、0．001、0．019）。患者对保乳术后乳房形态的满意率为76．1％。单元素分析中，手术方式（P=0．001）和纤维化（P=0．045）对乳房形态影响明显，差异具有统计学意义。多元素分析中，手术方式对术后乳房形态影响明显（P=0．005）。结论患者和医师的满意率具有正相关性（R=0．701，P〈O．01）。在可能影响乳房美学的27项因素中，年龄、体重指数、绝经状况、放疗剂量、肿物位于外上象限时的切口数量、切除次数、纤维化、手术方式对术后乳房形态影响明显。     

Analysis of local complications following explantation of silicone breast implants

A study was undertaken to analyse local complications in patients with breast implants and the total number of implant-related interventions when silicone breast implants were explanted. We studied 53 patients who had received breast implants for cosmetic augmentation or breast reconstruction following surgery for breast cancer at the time of explantation. The clinical records of all these patients were analysed, and clinical information on reason for implantation, implant properties, number and kind of implant-related interventions and reason for explantation was elicited. A complication was defined as a surgical procedure performed for any of the following reasons: capsular contracture, loss of implant integrity, haematoma or seroma, infection of the implant site, extrusion or wound dehiscence, and dissatisfaction with the result. The mean numbers of implant-related operations were 3.1 in patients who had undergone breast reconstruction and 2.3 in patients who had cosmetic augmentation (P < 0.03). We found a total of 35 complications in 28 patients, 21 patients (75%) each had one complication, five patients (18%) had two and two patients (7%) had three complications. A significantly higher incidence of early complications in patients who had undergone breast reconstruction (P < 0.03) marks the difference from complications in the cosmetic group, most of which arose after a longer time (P < 0.02). A complication analysis is presented. At the time of explantation, 78% of the patients decided to have a new implant, while 12% requested permanent removal of the implant without replacement. In the present study we saw no patients with connective tissue or other autoimmune disorders. When breast reconstruction or augmentation with silicone devices is considered, patients must be informed of the possible complications and of the potential choices in later implant-related revision surgery.     

Incidence of major corrective surgery after post-mastectomy breast reconstruction and radiation therapy

Abstract: To evaluate the likelihood of requiring major corrective surgery (MCS) after modified radical mastectomy (MRM), immediate reconstruction and radiation therapy (RT) to the reconstructed breast. The study population consisted of 62 patients who underwent MRM and immediate breast reconstruction between 1990 and 1999, had postoperative radiation and at least one follow-up visit or procedure ≥2 months after radiation. Reconstruction consisted of a pedicled transverse rectus abdominis myocutaneous flap in 42 patients, latissimus dorsi flap in five, latissimus dorsi plus implant in six, and implant alone in nine. Median follow-up time after reconstruction was 13 months (range: 2–58) for non-implant patients and 10 months (range: 4–57) for implant patients. The primary endpoint was the incidence of major complications requiring MCS. Ten patients (16%) underwent MCS between 1 and 28 months after radiation (median in these patients of 8 months). 4/47 non-implant patients (9%) underwent MCS, compared to 6/15 implant patients (40%). Of patients followed ≥6 months after RT, 0/38 non-implant patients underwent MCS within 6 months compared to 3/13 (23%) implant patients (p = 0.01); of patients followed for ≥12 months after RT, the rates of MCS within 12 months were 1/24 (4%) and 2/7 (29%), respectively (p = 0.12). Patients who undergo immediate reconstruction after mastectomy using an implant followed by radiation have a high rate of subsequent MCS. The difference in the rate of MCS between the implant and non-implant groups is significant in early follow-up. Patients considering an implant followed by RT should be apprised of this increased risk. Prospective studies of these risks and the cosmetic outcomes are warranted.     

Hypofractionated radiotherapy in patients with breast conserving therapy; acute and chronic toxicity

Aim-Background

Patients with invasive ductal breast cancer undergoing breast-conserving surgery with lymphectomy, with negative or 3(+) LN (lymph nodes), T<5cm, and excellent expectant survival are submitted to either conformal fractionated irradiation (50Gy in 25 fractions, at 2Gy/fraction) or hypofractionated conformal 3D irradiation (fewer fractions at higher doses per fraction). Patients may or may not undergo chemotherapy, and irradiation commences ≤ 16 weeks after surgery.

Methods

From 2009 to 2010, 11 patients aged between 30 and 50 years, who matched the above criteria and had undergone invasive breast cancer and breast-conserving surgery, received hypofractionated radiotherapy. All patients received 42.5Gy in 16 fractions of 2.66Gy/fraction five times per week. Computed tomography simulation was used to design 3D conformal treatment planning with two tangentional fields and a multileaf collimator linear accelerator.

Results

After completion of radiotherapy, all patients showed Grade 0-1 skin reaction and no cosmetic impairment (oedema, fibrosis, telangiectasia). No side effects were observed in normal tissue structures and at-risk organs, such as the heart and lung. At 3, 6, 12, 18, 24, 30, and 36-month follow-up, none of the patients displayed post-radiation pneumonitis, pericarditis or dermatitis, nor did any patient develop a recurrence or regional distant metastases. Cosmetic assessment of the irradiated breast showed excellent results in terms of skin reaction compared with the healthy breast. Furthermore, the size and shape of the irradiated breast remained unchanged during and after irradiation.

Conclusions

Hypofractionated conformal irradiation in invasive breast cancer achieves optimal disease control and an excellent cosmetic result. Patients can be treated in fewer days with a safe and biological effective dose (BED), as that given by conformal fractionated irradiation. This development results in improved safety and enhanced quality of life for breast cancer patients.     

Partial breast irradiation in breast conserving therapy by way of intersitial brachytherapy

OBJECTIVE: To examine early and late toxicities, evaluate cosmetic results, and determine the need for reoperation or additional diagnostic procedures in patients treated with accelerated partial breast irradiation (APBI) delivered by way of an interstitial implant in breast-conserving therapy. METHODS: A total of 199 patients with stage I or II breast cancer were managed with lumpectomy followed by radiation restricted to the tumor bed using an interstitial implant (APBI). Retrospective analyses were performed for early and late toxicities (infection, fat necrosis, breast pain, edema, erythema, fibrosis, pigmentation changes, and telangiectasias), need for reoperation or additional diagnostic procedures, cosmetic results, and local control. Patient selection criteria by the surgeon for referral to RT for APBI included age, tumor size, histology, nodal status, margin status, and absence of extensive intraductal component. Treatment was delivered with either a low-dose or high-dose rate implant. Median follow-up was 5.7 years, and 54% of the patients were followed-up for >7 years. RESULTS: Infections developed in 22 of 199 (11%) patients: 7% early (1 month after implant removal). Five of the 22 patients (2% of all patients) required operative intervention for the infection, either incision and drainage or debridement. There was a statistically significant difference between infection rates with open (8.5%) versus closed (2.5%) cavity placement of the interstitial needles (P = 0.005). There was no statistically significant difference between low-dose rate (inpatient) and high-dose rate (outpatient) treatment (P = 0.207). Forty-five patients (23%) had an additional diagnostic procedure to evaluate a suspicious or uncertain finding on physical examination or mammogram. Fibrosis and fat necrosis were found in 26 of the 45 patients. The incidence of fat necrosis increased with time. More patients were found to have fat necrosis after 5 years. One patient had fat necrosis diagnosed at <6 months; 8 patients (4% of total) at >/=6 months to <2 years; 10 patients (5% of total) at >/=2 years to <5 years; and 22 patients (11% of total) at >/=5 years. The majority of fat necrosis was detected on mammogram (80%) and was asymptomatic (78%). Cosmesis and toxicities were assessed at 3 defined time points: /=5 years of follow-up. Using Harvard criteria, good to excellent cosmetic results were observed in >90% of patients. Breast pain, edema, and erythema diminished with time. Of the 199 cases, there were only 5 ipsilateral breast failures, yielding a 5-year actuarial local recurrence rate of 1.2%. Of these 5 failures, 2 were true recurrences/marginal misses, yielding a 5-year actuarial true recurrence/marginal miss rate of 0.5%. The 5-year actuarial cause-specific survival rate was 99% for APBI patients. CONCLUSIONS: In selected patients with early-stage breast cancer, APBI with targeted interstitial brachytherapy offers 5-year results comparable with conventional breast-conserving therapy employing whole-breast radiation therapy. Minimal long-term toxicities were noted, most of which demonstrated continued resolution over time. Acceptable acute (7%) and delayed (4%) infection rates were observed. Fat necrosis was identified with increasing frequency with time, but the majority was asymptomatic. Cosmetic results are good to excellent (>90%). Continued follow-up by the surgeon will be required to determine the long-term efficacy of this alternative treatment approach.     

Oncoplastic Breast-Conserving Surgery: Analysis of Quadrantectomy and Immediate Reconstruction with Latissimus Dorsi Flap

Background Oncoplastic breast-conserving surgery satisfies oncologic principles and improves cosmetic outcomes, even when an important breast volume excision is required. Methods We reviewed 28 patients suffering from breast cancer treated with quadrantectomy and immediate myocutaneous latissimus dorsi flap reconstruction. We evaluated the status of the surgical margins, early complications, and cosmetic outcome. Cosmetic assessment was carried out by a panel made up of three women and one man: a female member of an association against breast cancer, a female general practitioner, a female gynecologic resident, and a male breast-specialized surgeon. Results Free margins were obtained in all cases. There were 11 postoperative complications: 9 seromas at the donor site, 1 dehiscence of the back wound, and 1 minor partial flap skin necrosis. Chemotherapy and radiotherapy adjuvant treatment was not compromised. The cosmesis outcome was deemed to be good in 43.75% of the cases and satisfactory in 56.25%. The score for overall cosmesis outcome was 6.92 out of 10. Symmetry and the scar of the reconstructed breast were the most influential criteria in the quantitative assessment of overall cosmetic results. Conclusion Partial mastectomy (quadrantectomy) and immediate reconstruction with a myocutaneous latissimus dorsi flap allows extensive resection, which fits oncologic requirements, without serious morbidity and a good cosmetic outcome.     

Cosmetic results in 242 patients treated by conservative surgery for breast cancer.

The surgery of breast cancer has changed lately in favour of breast conserving treatment, the main purpose of which is to provide good cosmetic results together with radical resection of the tumour. In this paper we describe the cosmetic results obtained in 242 patients treated by conservative surgery (226 quadrantectomies, 93%, and 16 lumpectomies, 7%) for low risk breast cancer. Several of these resections were combined with plastic surgical techniques for residual breast reshaping. The technique chosen depended on the site of tumour, width of resection, and breast volume. The cosmetic assessment was made by the patient and the physician. Our data suggest that better cosmetic results may be obtained when plastic surgical procedures are combined with conservative surgery for breast cancer.     

Conservative treatment for breast cancer. Complications requiring reconstructive surgery

Women who select conservative treatment for carcinoma of the breast (tumor excision followed by supervoltage radiation therapy) place a premium on breast preservation and aesthetics. When local control fails and they require a mastectomy, or when the aesthetic appearance is unacceptable, they may request breast reconstruction. The goal of this study is to evaluate a series of 10 patients who required reconstructive breast surgery after complications of conservative treatment. Patient classification: I. Breast or chest wall necrosis (3). II. Breast fibrosis and gross asymmetry (3). III. Local recurrence of breast cancer (5). IV. Positive margins after the initial lumpectomy (1). The mean age was 34 years. Radiation dosage average was 5252 rads with two patients receiving iridium-192 implant boosts. The reconstructive management was complex and usually required a major musculocutaneous flap because of the radiation effects.     

A feasibility study of magnetic resonance imaging of silicone breast implants in Finland

Cosmetic breast implants have become increasingly popular throughout the world. However, there is insufficient knowledge about the frequency and severity of local complications such as rupture and capsular contracture. A pilot study of 25 Finnish women with 50 cosmetic breast implants was organized to determine the feasibility of conducting a magnetic resonance imaging (MRI)-based study of rupture incidence. The pilot investigation included a clinical examination by a plastic surgeon, MRI scan, and self-administered questionnaire. The participation rate was 100%. Implants in our study represented a cross-section of the different generations of implants in Finland, with implant ages varying from 4 months to 20 years. The average implant size was 215 mL, typical in Finnish cosmetic surgery. MR images were evaluated by two independent readers. The first reader diagnosed six implants with intracapsular rupture, while the other diagnosed all implants as intact. The procedures of the feasibility study proved successful, and the results demonstrate the importance of a rigid image evaluation protocol with employment of well-defined rupture criteria, as well as the benefits of several image readers.     

Breast augmentation with silicone implants: the role of surgical drainage—report on 502 consecutive patients

Breast augmentation is one of the most frequently performed cosmetic surgery procedures worldwide. We report on a series of 502 consecutive cosmetic breast augmentations by a single surgeon, using both the submuscular and submammary approaches. A vacuum drain was placed in the surgical pocket at the end of the procedure. The drain fluid collection was recorded immediately after the surgery and the following day before removal. A tenfold increase in the amount of fluid collection was noted in the drain’s reservoir. Thirteen patients presented with minor wound healing problems at the second postoperative follow-up, which were treated conservatively; two of them had the implant removed and replaced after 2 months. There were only two capsular contractions at 1-year follow-up. We focus our discussion on the drainage in the early postoperative period and conclude that the routine use of a surgical drainage reduces the risk for complications. Based on our findings, we advocate that short-term routine use of a surgical drain is advisable.