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Breast Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Gaural Patel, Lucy Kate Satherley, Animesh JK Patel, Georgina SA Phillips
Describe implant-based reconstruction in the immediate and delayed settings.Implant-based reconstructions may be one (if adequate skin/muscle cover for desired size is achieved e.g. with a skin-sparing mastectomy) or two stages (gradual expansion and exchange for fixed-volume implant).The implant may be placed in the submuscular (pectoral muscle + partial serratus anterior lifted), subpectoral using synthetic mesh/ADM/dermal sling (if adequate ptosis) for lower pole coverage, or pre-pectoral (using complete implant coverage with mesh/ADM +/- dermal sling) plane.The benefits of implant-based reconstruction include short hospital stay and quicker return to daily living (compared to autologous reconstruction). However, implant-based reconstructions look and feel less natural than an autologous reconstruction and do not move or age like natural tissue.Implant-associated risks/complications include infection, capsular contracture, implant loss (∼10%), ‘animation’ with submuscular techniques, anaplastic large cell lymphoma, need for replacement in future, not advisable if post-mastectomy radiotherapy required due to higher rate of complications.
Breast cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Simple mastectomy involves complete removal of the disease-involved breast. The pectoral muscles are preserved. The procedure is often combined with a breast reconstruction using either a tissue expander (Becker implant) or an autologous flap, e.g. latissimus dorsi (LD) muscle or TRAM flap. If reconstruction is not undertaken, the physical appearance of the chest wall will be far superior to that after a more radical mastectomy.
The breasts
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Some DCIS lesions are believed to rapidly transit to invasive carcinomas, while others remain unchanged for many decades. Because of the potential for progression, management of DCIS is typically surgical at present, the aim being to completely excise the abnormality with a margin of uninvolved tissue. If the DCIS is identified when sufficiently small, breast-conserving therapy (complete local excision), with postoperative radiotherapy for most, is recommended. If the disease is more extensive, mastectomy may be undertaken. Of note, however, the prognosis of DCIS is excellent, with a 10-year survival rate of >95%. Because of this, and because of the long time to progression seen in series of low grade DCIS, ongoing clinical trials are assessing the identification of low risk disease that can be safely managed by surveillance.
An external validation of a novel predictive algorithm for male nipple areolar positioning: an improvement to current practice through a multicenter endeavor
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Floyd W. Timmermans, Laure Ruyssinck, Sterre E. Mokken, Marlon Buncamper, Kevin M. Veen, Margriet G. Mullender, Karel E. Y. Claes, Mark-Bram Bouman, Stanislas Monstrey, Timotheus C. van de Grift
To evaluate the outcomes of the current practice in the UZG in Belgium and the Amsterdam UMC in the Netherlands, we performed a comparative analysis. All transgender men had undergone a double incision mastectomy with free nipples grafts. A double incision mastectomy is a mastectomy technique during which the whole breasts, including skin, glandular tissue and nipples are removed. The outcomes are presented in Table 5. Both groups were statistically similar in age, weight, CC and AUX-AUX. In both centers, a significant difference was seen between the measured and predicted NN. Whereas the difference in the Belgian center suggested a too wide placement (+0.8 cm ± 1.7), the results from the Dutch center suggested a too narrow placement of the NACs (-0.9 cm ±1.7). Similarly, a significant mismatch between measured and predicted outcomes for SNN was established in both centers (p= <0.001). Whereas the Belgian center showed a mean difference of 1.6 cm (±1.1), the Dutch center showed a mean difference of 2.3 cm (±1.8, p = 0.067). These mean differences indicated that in both centers the NACs are being placed too cranially on the chest.
Patient experience of implant loss after immediate breast reconstruction: An interpretative phenomenological analysis
Published in Health Care for Women International, 2023
Linn Weick, Alice Ericson, Lars Sandman, Petra Boström, Emma Hansson
Furthermore, the informants had not realized how important their breasts were to their identities and their womanhood until they were gone, finding that breast loss resulted in a temporary “loss of womanhood.” This is similar to what researchers have found in a previous study, where women were surprised by the emotional impact of mastectomy and the extent to which it actually affected their body image (Hill & White, 2008). In our study, most informants expressed dissatisfaction with their bodies being flat/asymmetrical and subsequently developed avoidance coping. It did not appear that the informants experienced actual negative reactions from others but rather feared they would. This is similar to previous findings, where patients have been described by researches to have fears of reactions from other people to their mastectomised bodies (Cromvoets, 2003; Piot-Ziegler et al., 2010).
Ultrasound-guided serratus anterior block versus instillation of local anaesthetic through surgical drain in modified radical mastectomy: A randomized controlled study
Published in Egyptian Journal of Anaesthesia, 2022
Rabab S. S. Mahrous, Haytham Awad Fayed, Abdelrahman Mohamed Kamal
Mastectomy is a widely accepted and common procedure for breast cancer management worldwide. Many patients are complaining of side effects from such surgical intervention. Postmastectomy pain is one of the most common complaints during the postoperative time and can be complicated by postmastectomy pain syndrome in an insignificant number of patients if not adequately controlled. The primary objective of our study was to compare the duration of analgesia between both techniques. In the SAPB group, the duration lasted for 1370 min (around 22 hr) while in the local instillation group lasted for 450 min (around 7.5 hr) that could be explained by using ultrasound allows delivery of the precise amount of LA in the exact plan without escaping into the undesired site and also explained by a higher dose of bupivacaine 0.5% used which has a longer duration of action than other types of LA used in other studies. On the other hand, escape of local anesthetic by the effect of gravity and drain malposition may add to the shorter duration of analgesia.