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Standard autologous tissue flaps for whole breast reconstruction
Published in Steven J. Kronowitz, John R. Benson, Maurizio B. Nava, Oncoplastic and Reconstructive Management of the Breast, 2020
Steven J. Kronowitz, John R. Benson, Maurizio B. Nava
Women who desire an autologous reconstruction and have small to moderate-sized breasts or larger breasts but a desire for a contralateral reduction are well-suited to ALD reconstruction. This technique is especially useful in the context of postmastectomy radiotherapy where implant reconstruction is often avoided and abdominal tissue transfer procedures delayed. Other indications include patients with non-expansible chest wall skin, breast hypoplasia, and salvage procedures following prior reconstructive failure (Figure 22.2.4). The ALD flap is well-suited to bilateral breast reconstruction because it can be performed as either a synchronous or metachronous procedure in the context of contralateral breast cancer or risk reduction (Figure 22.2.5).
Breastfeeding complications
Published in Amy Brown, Wendy Jones, A Guide to Supporting Breastfeeding for the Medical Profession, 2019
This may sometimes be justified, as will be indicated by weight gain issues or insufficient stooling and urine output. In rare cases, the cause may be breast hypoplasia. Estimates suggest 1–5% of the population may have ‘insufficient glandular tissue’, although the use of this term with mothers is problematic (Neifert et al. 1985). These mothers may have experienced little breast changes in puberty and pregnancy. Breasts may be widely spaced, asymmetrical or tubular in appearance with a bulging proportionately large areola. Attempting to diagnose hypoplasia of the breast based on appearance is unreliable. The mother may have had little sense of postpartum engorgement. Baby may not be audibly swallowing and is likely to require supplementation at an early stage.
Breast disorders in children and adolescents
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Nirupama K. De Silva, Monica Henning
Significant hypomastia may be associated with connective tissue disorders or mitral valve prolapse.6 Breast hypoplasia may also occur after chest wall irradiation, after trauma to the breast bud, in the presence of hypogonadotropic hypogonadism, with an intersex disorder, or with congenital adrenal hyperplasia, or with 17-hydroxylase deficiency.1
Engineering mesenchymal stem cells: a novel therapeutic approach in breast cancer
Published in Journal of Drug Targeting, 2020
Razieh Heidari, Neda Gholamian Dehkordi, Roohollah Mohseni, Mohsen Safaei
Adipose-Derived Mesenchymal Stem Cells (AD-MSCs) were in use as part of the fat grafting technique first defined by Coleman in 1997 long before their characterisation, and it is the most common procedure in post-oncological breast reconstruction [11]. Various studies by Gentile et al. [12,13] demonstrated that the Fat graft enhanced with adipose-derived stem cells (FG-e-ASCs) leads to increased survival of a fat graft in breast hypoplasia patients. FG-e-ASCs may enhance the preservation of fat grafts by increasing vasculature and through secreting growth factors that promote fat survival. AD-MSCs are located in the Stromal Vascular Fraction (SVF) of adipose tissue, which has a heterogeneous collection of mesenchymal cells [14]. AD-MSCs have some benefits as opposed to other MSCs such as higher proliferative ability, slower doubling time, and senescence in vitro. They are harvested by non-invasive methods and can produce a higher cell density than cord-blood MSCs and bone marrow MSCs [11]. In the last few years, in addition to the potential of AD-MSCs in regenerative surgery, their role has been examined in promoting tumour development, metastatic potential, and invasiveness across different pathways. The definition of a ‘double-edged sword’ for MSCs is due to the simultaneous existence of harmful and favourable aspects of this cell in cancer [15].
Validation of the breast evaluation questionnaire for breast hypertrophy and breast reduction
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Richard Lewin, Anna Elander, Jonas Lundberg, Emma Hansson, Andri Thorarinsson, Malin Claudelin, Helena Bladh, Mattias Lidén
Regarding content validity, the questionnaire has previously been validated for breast augmentation. However, breast hypertrophy is an entirely different condition with other physical symptoms than breast hypoplasia and the relevance of the items in the questionnaire therefore had to be re-evaluated for a new target population. Both the plastic surgeons and the operated breast hypertrophy patients evaluated the items in the questionnaire as relevant. This is further strengthened by the fact that the questionnaire measures mainly psychosocial aspects and satisfaction with breasts, which might very well be similar in women with hypertrophy and hypoplasia. In fact, the psychosocial aspects are identical for breast hypertrophy and augmentation in the BREAST-Q (augmentation) and the BREAST-Q (breast reduction) [12,13], which further corroborates the use of the same psychosocial items for the two conditions. The correlation to BREAST-Q is strong but not 100%. This means that BREAST-Q may miss aspects that may be covered by the mBEQ. Nonetheless, the comprehensiveness of the items on the mBEQ for breast hypertrophy was not investigated extensively in the present study. It is possible that additional items should have been explored to cover all the psychosocial aspects of breast hypertrophy. This may explain the presence of floor effects, where 28 and 35%, respectively, of preoperative patients reach the floor threshold in the domains of Breast and Naked (Table 9). In other words, the questionnaire might not be able to distinguish between patients with severe hyperplasia and very severe hyperplasia. This also limits the opportunity to detect which patients experience the greatest improvement postoperatively. In brief, the content validity and responsiveness of the questionnaire could be improved, as some extreme items at the lower end of the scale might be missing. In spite of this, there is a clear difference between patients and controls in all dimensions (Table 6) and the responsiveness is significant in all dimensions (Table 8), which supports the belief that the content validity of the instrument is adequate for its purpose.