Giant fibroadenoma of one breast: Immediate bilateral reconstruction.

A rare case of giant fibroadenoma of the left breast is presented. We performed a nipple sparing subcutaneous mastectomy of the left breast. Since the patient desired larger breasts, a contralateral augmentation mammaplasty was carried out in a single stage operation. A satisfactory result was achieved.     

Immediate autologous latissimus breast reconstruction after skin sparing mastectomy

A technique of immediate breast reconstruction, combining skin sparing mastectomy and autologous latissimus breast reconstruction, is presented. In this study, 50 patients underwent this procedure between May 1993 and May 1997. The most frequent indication (62%) was ductal carcinoma in situ (multifocal, high grade or larger than 3 cm). In 38% of cases, the patients had a contraindication to the TRAM flap; in the other cases (62%) the patients preferred the dorsal donor site to the abdominal site. Reduction of the contralateral breast was done in 20% of cases of unilateral reconstruction. The aesthetic results, evaluated by two others surgeons, were rated as very good in 88% of cases, good in 8% and poor in 4%. Study of patient satisfaction showed 84% of patients to be pleased, 12% satisfied and 4% poorly satisfied. Dorsal sequelae were rated as slight in 96% of cases, intermediate in 4% and marked in none. The main disadvantage was dorsal seroma which occurred in 62% of cases but was easily managed by repeated aspiration. No patient developed a local recurrence or distant metastases. This technique represents a significant advance in breast reconstruction, giving a breast of natural shape and consistency with no transverse scar or patch effect due to the flap. Received: 13 October 1997 / Accepted: 16 November 1998     

Immediate bilateral breast reconstruction with implants and inferolateral AlloDerm slings

To shorten the reconstructive process, improve results, and provide additional options for women seeking mastectomy, we used an acellular cryopreserved dermal matrix (AlloDerm) sling to reestablish the lower pole of the pectoralis major muscle. This technique creates a subpectoral-sub-AlloDerm pocket that completely encloses the breast implant. By tailoring the width of the AlloDerm, we can precisely control the degree of lower-pole fullness. This technique shortens or eliminates the need for tissue expansion and provides an additional option for single-stage breast reconstruction with implants. We have selectively used this technique as a reconstructive option for 10 women undergoing bilateral mastectomy (20 breasts).     

Immediate breast reconstruction for phyllodes tumors

Phyllodes tumors are rare breast tumors. Surgery is the mainstay of treatment and mastectomy has been the traditional procedure adopted for these tumors. Although wide excision with adequate margins gives equivalent results, mastectomy may still be required if the tumors are very large. There are very few reports on the use of breast reconstruction after mastectomy for phyllodes tumors. We present a series of 7 patients with phyllodes tumors who were treated with mastectomy and immediate breast reconstruction. Mastectomy was conventional in 4 patients and skin sparing in 3. Reconstruction was performed with latissimus dorsi (LD) musculocutaneous flap in 4 patients and transverse rectus abdominis musculocutaneous (TRAM) flap in 3 patients. The mean follow-up was 40.1 months. One patient developed recurrence, 1 year after the surgery, which was treated with excision and radiotherapy. The cosmetic results were acceptable to all patients. Skin sparing mastectomy was associated with better cosmetic results.     

背阔肌肌瓣在双侧乳腺皮下切除后即时隆乳六例

目的：探讨双侧乳腺重度增生时,既能彻底切除,防止癌变,又能保持乳房外形的术式。方法：经腋下沿腋后线切口,行双侧乳腺皮下切除术,用带神经血管蒂的背阔肌肌瓣移转即时行隆乳。结果：1995－1998年治疗6例,术后双侧乳房对称,外形美观,手感良好。结论：该术式操作简便易行,切口隐蔽,组织瓣量大,血供好,外形美观,供区无明显后遗畸形,不影响功能。     

Immediate breast reconstruction after mastectomy for cancer

BACKGROUND: Immediate breast reconstruction after mastectomy has increased over the past decade following the unequivocal demonstration of its oncological safety and the availability of reliable methods of reconstruction. Broadly, it is undertaken in the treatment of breast cancer, after prophylactic mastectomy in high-risk patients, and in the management of treatment failure after breast-conserving surgery and radiotherapy. Immediate breast reconstruction can be achieved reliably with a variety of autogenous tissue techniques or prosthetic devices. Careful discussion and evaluation remain vital in choosing the correct technique for the individual patient. METHODS: This review is based primarily on an English language Medline search with secondary references obtained from key articles. RESULTS AND CONCLUSION: Immediate breast reconstruction is a safe and acceptable procedure after mastectomy for cancer; there is no evidence that it has untoward oncological consequences. In the appropriate patient it can be achieved effectively with either prosthetic or autogenous tissue reconstruction. Patient selection is important in order to optimize results, minimize complications and improve quality of life, while simultaneously treating the malignancy. Close cooperation and collaboration between the oncological breast and reconstructive surgeons is desirable in order to achieve these objectives.     

Pure fat grafting for breast reconstruction: An alternative autologous breast reconstruction

Plastic surgeons offer various options for breast reconstruction based on patient preference, underlying disease, and comorbidities. An alternative form of breast reconstruction exists, which includes tissue expansion with tissue expander and subsequent fat grafting without the use of implant or flap. We retrospectively reviewed the breast cancer patients who underwent breast reconstruction at our institution to identify those with pure fat grafting. Demographic information, complications, operative details, and BREAST‐Q scores were abstracted. From 2010‐2015, 10 patients were identified. Patients with unilateral or bilateral mastectomy followed by pure fat grafting had a median of 3.5 or 4 sessions and a total median fat grafting volume of 380 or 974.5 cc, respectively. Patients were followed for 12 months, and no complications or breast cancer recurrences were noted. Finally, BREAST‐Q scores at the 12‐month follow‐up were comparable to the preoperative values.     

Immediate breast reconstruction and high-dose chemotherapy

BACKGROUND: Immediate breast reconstruction (IBR) is considered as a safe procedure nowadays, and it can be proposed in the majority of patients requiring a mastectomy. In fact, recent studies have demonstrated that immediate breast reconstruction is not detrimental also to patients with locally advanced breast cancers. However, IBR should be reevaluated in case of locally advanced breast cancer requiring high-dose chemotherapy (HDCT). The aim of this study is to evaluate both the risk of chemotherapy delay due to surgical complications and the risk of late surgical complications related to the association with HDCT. We considered 3 series of 23, 67, and 15 patients requiring a mastectomy at the European Institute of Oncology in Milan. After mastectomy, these groups respectively received an IBR and HDCT, an IBR and conventional chemotherapy, and only HDCT with no IBR. METHODS: Files of 105 patients who were admitted to our department from October 1999 to January 2002 were reviewed. Twenty-three patients underwent a mastectomy, followed by IBR and HDCT; 67 underwent a mastectomy plus IBR plus conventional CT; and, finally, 15 underwent a mastectomy alone followed by HDCT. The reconstructive techniques performed were 72 permanent prosthesis and 18 temporary expanders. We excluded all patients with IBR by flap (latissimus dorsi or pedicled rectus abdominis) to improve the homogeneity of the sample. RESULTS: All patients who underwent IBR started high-dose chemotherapy without any delay; the time elapsed between surgery and HDCT is not significantly different for patients with and without IBR (54 versus 60 days, P = 0.13). The early complication rate (before CT) was 2.9% (2 patients with infection). The late complication rate (after CT) was higher for the group that underwent IBR followed by HDCT (39% versus 20%). CONCLUSION: We did not observe any delay for the administration of high-dose chemotherapy after mastectomy with IBR surgery. The complication rate before HDCT is similar to the complication rates published in the literature. On the contrary, we observed a higher rate of infections (13% versus 0%, P = 0,014) after HDCT than after conventional CT, which can be related to the association with high-dose chemotherapy, inducing a decrease of the immune defenses. These results seems to demonstrate that the association of IBR with HDCT is not detrimental to patients from the oncological point of view, but the impact of HDCT on the reconstruction is more negative. Further studies are needed to verify if this risk exists, although lower, in the association with conventional CT. However, a careful evaluation of the risk of infections should be considered preoperatively, and perioperative contaminations should be carefully prevented.     

Immediate breast reconstruction with tissue expanders

Primary breast reconstruction with expander devices provides a safe, simple, and rapid method that is most cost-effective and should usually be the method of choice in these cases.     

Immediate breast reconstruction after modified mastectomy for carcinoma of the breast

With the increased knowledge of breast cancer and its implications, many women are unwilling to accept the deformity that results from the surgical treatment of this disease. The acceptance of modified mastectomy as the procedure of choice in carcinoma of the breast has resulted in selected patients being offered rehabilitation by restoration of the breast contour at the time of definitive surgery or 6 months later. We believe that an immediate breast prosthesis after modified mastectomy for carcinoma of the breast is an acceptable procedure in selected patients. The two-team approach to this procedure as advocated by Halsted will provide the patient with a maximal cancer preventive operation with a minimum of mental and emotional anxiety.     

DIEAP flap for safe definitive autologous breast reconstruction

BackgroundBreast cancer is the commonest form of cancer in women affecting almost a quarter of a million patients in the US annually. 30 percent of these patients and patients with genetic mutations undergo removal of the breast, as highlighted in a high profile celebrity patient. Although breast reconstruction with free microvascular transfer of a DIEAP flap from the abdomen is an ideal form of reconstruction, there have been misgivings about the complexity and potential complications. This study was aimed at clearing these misunderstandings and establishing the value of this form of breast reconstruction.Methods1036 DIEAP flap breast reconstructions carried out at the University Hospital, Gent (five year period) and at the Sana Kliniken, Düsseldorf (three year period) were included prospectively. Comorbid factors like chemotherapy, radiotherapy, patient age >65 years, BMI >30 and smoking were recorded. Outcomes were evaluated over a mean follow up of 2 years.ResultsOverall complication rate related to the reconstructed breast and donor abdominal area was 6.8 percent. Total flap loss was seen in only 0.8 percent. The mean operating time was less than five hours. Older age, higher BMI, chemotherapy and radiotherapy did not have a significant influence on complication rates, however smoking resulted in significant delay in wound healing in the breast (p = 0.025) and abdominal wounds (p = 0.019).ConclusionThe DIEAP flap is an excellent option for breast reconstruction, with a low level of donor site morbidity and complications. It is an autologous reconstruction that provides a stable long term result.     

Polyurethane-covered silicone gel mammary prosthesis for successful breast reconstruction

A polyurethane-covered silicone gel implant has been used by the author in 150 breast reconstructions and augmentations in the past 9 years. The results have been most gratifying with regard to breast softness, breast compressibility, and esthetics. Only 4 patients have developed a unilateral capsule contracture and firm breast. The reasons are postulated for these satisfying results. Complications have been few and very minor.