This activity is designed for primary care physicians. GOAL: To appreciate the significant advances and current techniques in breast reconstruction after mastectomy and realize the positive physical and emotional benefits to the patient. OBJECTIVES: 1. Understand basic and anatomic principles of breast reconstruction. 2. Discuss the options for breast reconstruction: a) immediate versus delayed; b) autologous tissue versus implant; and c) stages of reconstruction and ancillary procedures. 3. Provide a comprehensive overview of the risks and benefits of, as well as the alternatives to, each approach so primary care physicians can counsel patients effectively. (+info)
Effect of infiltration with ropivacaine on blood loss during reduction mammoplasty.
Ropivacaine is a new aminoamide local anaesthetic agent. Unlike other agents in its class, such as bupivacaine, it has been found to be vasoconstrictive. We have sought to investigate if this property is clinically useful and may reduce surgical blood loss. Reduction mammoplasty is a procedure in which considerable blood loss may occur. We have compared pre-incision infiltration of ropivacaine 75 mg in 0.9% saline 60 ml with the current practice of infiltration with bupivacaine 75 mg in 0.9% saline 60 ml and epinephrine (adrenaline) 5 micrograms ml-1. We studied five subjects; each received both solutions by infiltration, one to each breast, in random order and both the operating surgeon and anaesthetist were blind to the solution given. For data analysis, blood loss was expressed in ml/kg of tissue excised. There was no significant difference between the two regimens for duration of surgery or amount of tissue excised; however, ropivacaine was associated with markedly greater intraoperative blood loss than bupivacaine (median 696 (range 305-1366) ml kg-1 vs 300 (169-608) ml kg-1; P = 0.04, Wilcoxon rank sum test). Postoperative blood loss was not significantly different between groups (116 (14-173) ml kg-1 vs 98 (13-332) ml kg-1; P = 0.69, Wilcoxon rank sum test). We conclude that the vasoconstrictive properties of ropivacaine were not sufficiently great to merit its use as a sole agent for infiltration before reduction mammoplasty. (+info)
Low-intensity laser therapy for benign fibrotic lumps in the breast following reduction mammaplasty.
BACKGROUND AND PURPOSE: Fibrotic masses in the breast secondary to fat necrosis or hematoma are a complication of breast reduction mammaplasty. The treatment commonly recommended for this condition is early surgical debridement of necrotic tissue from the entire area, which causes scarring. This case report describes the use of low-intensity laser therapy for fibrotic lumps following reduction mammaplasty. CASE DESCRIPTION: The patient was a 46-year-old woman who had breast reduction surgery 80 days prior to referral for physical therapy. At the time of referral, the largest mass was 8.0 cm in diameter. The patient reported pain and said she was distressed about the breast disfigurement. Laser irradiation was initiated at an energy density (ED) of 20 J/cm2 and a pulse repetition rate of 5,000 pulses per second. The laser settings were adjusted during the 8-month treatment period. The final ED was 50 J/cm2. OUTCOMES: The mass was 33% of its original size after 3 treatments over the initial 11-day period. Pain relief was immediate. The rate of resolution decreased after the initial period. The patient had some tissue thickening at the time of discharge after 6 months of treatment. DISCUSSION: This case demonstrates the potential use of laser therapy as a treatment for benign breast lumps following mammaplasty. (+info)
Unilateral gestational macromastia--an unusual presentation of a rare disorder.
Macromastia (mammary gigantism) is an uncommon clinical entity. Macromastia occurring during pregnancy (gestational macromastia) is rare. A case of unilateral gestational macromastia is reported which required reduction mammoplasty. We documented hyperprolactinaemia in the patient. This case report is particularly interesting because, to our knowledge, no such case has previously been reported. (+info)
Initial experience with breast reconstruction using the transverse rectus abdominis myocutaneous flap: a study of 45 patients.
Breast conserving surgery for breast cancer has led to an increased interest in reconstruction following mastectomy. The transverse rectus abdominis myocutaneous flap has been proven to give good results in terms of restoration of body symmetry with near normal contour and consistency. Furthermore, immediate reconstruction has the advantage of a single procedure with less psychological morbidity, and reduction in hospital stay and overall complication rate. The aim of this study was to review our experience with the transverse rectus abdominis myocutaneous flap procedure an initial series of 45 patients. The overall complication rate of 27% is similar to that reported in the literature, with no total flap loss and nine patients with partial flap loss. There was no delay in commencement of adjuvant chemotherapy or radiotherapy and we believe our ability to detect local recurrence has not been compromised. We consider that immediate breast reconstruction is now an integral part of the surgical treatment of breast cancer. (+info)
Elevated expression of the CC chemokine regulated on activation, normal T cell expressed and secreted (RANTES) in advanced breast carcinoma.
Breast carcinoma is the most common malignant disease among women and the second most lethal one. In search for a better understanding of the role of cellular mediators in the progression of this disease, we investigated the potential involvement of the CC chemokine Regulated on Activation, Normal T Cell Expressed and Secreted (RANTES) in breast carcinoma progression. To this end, RANTES expression was determined in breast tumor cell lines and in sections of breast carcinomas, followed by analysis of the incidence and intensity of its expression in different stages of the disease. Our study reveals that high and physiologically relevant levels of RANTES are constitutively produced by T47D and MCF-7 breast tumor cell lines. Analysis of RANTES expression in sections of breast carcinomas demonstrates a high incidence of RANTES expression in epithelial tumor cells; the chemokine was expressed in 74% of the sections. RANTES expression was rarely detected in normal duct epithelial cells or in epithelial cells that constitute benign breast lumps, which were located in proximity to tumor cells. High incidence and intensity of RANTES expression were detected in sections of most of the patients with stage II and stage III of the disease (expression was detected in 83 and 83.3%, respectively), whereas RANTES was expressed at a lower incidence and intensity in sections of patients with stage I of breast carcinoma (55% of the cases). Most importantly, the expression of RANTES was minimally detected in sections of patients diagnosed with benign breast disorders and of women that underwent reduction mammoplasty (15.4% of the cases). These results indicate that the expression of RANTES is directly correlated with a more advanced stage of disease, suggesting that RANTES may be involved in breast cancer progression. Moreover, it is possible that in patients diagnosed with benign breast disorders, RANTES expression may be indicative of an ongoing, but as yet undetectable, malignant process. (+info)
Proteomic definition of normal human luminal and myoepithelial breast cells purified from reduction mammoplasties.
Normal human luminal and myoepithelial breast cells separately purified from a set of 10 reduction mammoplasties by using a double antibody magnetic affinity cell sorting and Dynabead immunomagnetic technique were used in two-dimensional gel proteome studies. A total of 43,302 proteins were detected across the 20 samples, and a master image for each cell type comprising a total of 1,738 unique proteins was derived. Differential analysis identified 170 proteins that were elevated 2-fold or more between the two breast cell types, and 51 of these were annotated by tandem mass spectrometry. Muscle-specific enzyme isoforms and contractile intermediate filaments including tropomyosin and smooth muscle (SM22) alpha protein were detected in the myoepithelial cells, and a large number of cytokeratin subclasses and isoforms characteristic of luminal cells were detected in this cell type. A further 134 nondifferentially regulated proteins were also annotated from the two breast cell types, making this the most extensive study to date of the protein expression map of the normal human breast and the basis for future studies of purified breast cancer cells. (+info)
Utilisation of prophylactic mastectomy in 10 European centres.
Increasingly women at high risk of breast cancer are opting for prophylactic surgery to reduce their risks. Data from 10 European centres that offer a risk counselling and screening service to women at risk show different approaches to the option of preventive surgery, although most centres adhere to a protocol including at least two risk counselling sessions and a psychological assessment. Thus far the combined centres have data on 174 women who have undergone prophylactic mastectomy with in excess of 400 women years of follow up. Operations were carried out on women with lifetime risks of 25-80%, with an average annual expected incidence rate of 1% per women. No breast cancers have occurred in this cohort. Long term follow up on an extended group of women will be necessary to truly address the risk of subsequent breast cancer and the psychological sequelae. (+info)