Cosmesis with bilateral mammoreduction for conservative breast cancer treatment

Over 7 years, 57 women with breast cancer underwent lumpectomy and bilateral mammoreduction. Physical complaints about large or lax breast shape were the predominate rationale. Two patients were immediately lost to follow-up, 55 patients remained and were followed every 3 months for an average of 1.6 years. This is the largest series traceable by computer and literature search. Chart review and patient examination in this retrospective review were utilized as the basis for data within the article. Collated notes from patients' doctors were assessed, as well as documented patient responses to the procedure. Pictures without head/face for identifiers were taken of the patients. Chart data were collected by clinicians, but were reviewed blindly by a statistician. The overall control and cosmesis rates as well as alleviation of heavy breast problems were noted. Only 6% of women had fair to poor cosmetic results; the majority (82%) had excellent to good results. Women with very large breasts or markedly relaxed breast tissue of concern to the patients proved optimal candidates for lumpectomy of cancer and bilateral mammoreduction in the conservative treatment of these cancers. There was a significant reduction in the physical complaints of the patients as well. For women with very pendulous or extremely large breasts, lumpectomy and bilateral mammoreduction may prove to be the optimal course of action.     

改良真皮帽乳晕埋线法巨乳缩小术的临床应用

目的:探讨在改良真皮帽乳晕"米"字埋线法巨乳缩小术的临床应用,及术后埋线法的悬吊固定作用。方法:通过对17例患者34只乳房行改良真皮帽乳晕埋线法巨乳缩小术以及对患者线结活检标本进行病理学研究。结果:术后随访3～12个月,除1例裂开,1例乳头乳晕感觉丧失(经处理后均恢复),其余均一期愈合。埋线及其周围包膜可持续固定组织,调解组织松紧度,用作提升、牵引、收缩等效果持久理想。结论:改良真皮帽乳晕埋线法巨乳缩小术可简化手术过程、减少创伤、恢复快、疗效持久确实     

Breast reductions: What to do with all the tissue specimens?

In order to find some guidelines for adequate examination of the often very large amount of tissue removed at reduction mammoplasties, a thorough macro- and microscopic study of a total of 400 specimens from 200 consecutive cases of bilateral breast reductions was done. The majority of patients were younger than 30 years of age. In these cases no abnormalities were found and a thorough macroscopic examination performed by an experienced pathologist is believed to be sufficient in this age group. In older women we encountered diverse findings, the most noteworthy being lobular carcinoma in situ in 8% of patients in this series who were over 40 years of age. This indicates the need for generous histological sampling in this age group. The potential value of roentgenological examination is also discussed.     

Breast asymmetry: presentation of a giant fibroadenoma

Patients often present to plastic surgeons with breast asymmetry of unknown etiology. Many patients are females in late adolescence and present complaining of a hypoplastic breast on the smaller side. However, full evaluation may reveal that the larger breast contains the abnormality. Fibroadenomas typically present as firm, mobile, painless, easily palpable breast nodules. However, giant fibroadenomas can present as unilateral macromastia without definable borders or texture differences. Diagnosis is essential since fibroadenomas tend to persist and grow. However, physical examination and standard radiographic evaluations (mammograms and ultrasounds) fail to clarify the diagnosis in many cases. Magnetic resonance imaging (MRI) has improved preoperative diagnosis, but tissue diagnosis is frequently necessary and resection of giant fibroadenomas is essential as they enlarge to the point of causing psychological detriment or mass effects, including venous congestion, glandular distortion, pressure necrosis, and occasionally ulceration. In this article we review nine patients presenting with unilateral macromastia to a tertiary breast care center with a review of the pertinent literature. The differential diagnosis, evaluation modalities, and treatment options of breast asymmetry and unilateral breast masses are presented. Postexcision breast reconstruction is discussed.     

外侧乳腺真皮蒂瓣治疗中-重度巨乳症38例

目的 探讨适合治疗中-重度巨乳症无连接瘢痕新术式.方法采用自行设计外侧乳腺真皮蒂瓣术式治疗中-重度巨乳症38例.结果 术后乳房无乳晕至周边连接瘢痕,随访5年以上乳头乳晕感觉恢复良好,9例患者术后结婚,其中5例生育后哺乳半个月~1年,38例患者中32例对术后乳房形态满意.结论 本术式适合治疗中、度以上巨乳症.     

Benign breast disorders

Benign breast disorders encompass a wide range of presentations and account for approximately 90% of breast outpatient referrals. Although the conditions discussed in this article are labelled ‘benign’, they can cause much anguish for the patient. A specialist breast clinician frequently has the privilege of being able to reassure patients in a single trip to the breast department and unburden them from their worry. One-stop breast clinics were designed to ensure that patients with worrying symptoms are promptly seen to aide early detection of breast cancer and optimize patient outcomes. The diagnostic multidisciplinary team consists of a specialist breast clinician, breast radiologist, pathologist and breast care nurses. Most patients with benign breast disorders can be reassured, with surgery limited to a few to aide definite diagnosis or as a last resort when conservative measures have failed. This is a comprehensive overview of benign breast disorders and covers all that is required for the MRCS examination and serves as a revision aide for FRCS candidates.     

Gestational macromastia: a medical and surgical challenge

Gestational macromastia is a rare and complex disorder. Establishing an optimal medical and surgical management regimen has been challenging. Medical regimens have included tamoxifen, progesterone, bromocriptine, and testosterone. Surgical therapies have included reduction mammaplasty and mastectomy. This report will highlight the successful medical and surgical management in a woman with severe gestational macromastia.     

A case of unilateral gravid macromastia in 23-year-old japanese woman associated with elevated serum CA19-9

We report a rare case of gravid macromastia (GM) treated after delivery. A 23-year-old woman with left breast enlargement was referred to our hospital. Laboratory investigations revealed an elevated serum CA19-9 level of 200.3 U/ml. Gravid macromastia was diagnosed by clinical examination (US, MRI) and 11G mammotome biopsy. Tumorectomy of the left breast and mammoplasty were performed. The mass had proliferated to the exclusion of normal gland. Histological examination revealed abundant proliferation of stromal loose connective tissue and interposed fat cells surrounding normal and lactating lobules. The epithelial cells were positive for CA19-9 on immunohistochemical staining. Serum CA19-9 decreased to normal levels 3 months after operation. GM is exceedingly rare and occurs in less than 0.001-0.003% of all pregnant women. Once established, the condition is likely to continue to successive pregnancies. This benign tumor is sometimes difficult to distinguish from malignant tumors since it shows few histological characteristics and grows rapidly. Attention is necessary to diagnose tumors of the breast during pregnancy.     

Chronic bilateral T1 denervation in women with macromastia

Introduction: The objective of this study was to identify the pattern of neurological deficits and document electrophysiological changes in women with macromastia. Methods: Patients with macromastia and neurological complaints underwent clinical evaluation and electrodiagnostic (EDx) studies of the upper limbs. Results: Findings include low‐amplitude medial antebrachial cutaneous (MACN) sensory nerve action potentials (SNAPs) and median compound muscle action potentials (CMAPs) and chronic denervation changes in the bilateral abductor pollicis brevis (APB) muscles on needle electrode examination (NEE), indicating axonal loss in the bilateral T1 distribution. Conclusions: The EDx data are in keeping with lesions involving bilateral T1 anterior primary rami (APR). Potential sites of compromise of the T1 APR are discussed. Further study of the effect of treatment for macromastia on the clinical and EDx findings is proposed. Muscle Nerve, 2013