Breast revision after mastectomy, whole breast reconstruction, and postmastectomy radiation therapy
Steven J. Kronowitz, John R. Benson, Maurizio B. Nava in Oncoplastic and Reconstructive Management of the Breast, 2020
Patients not uncommonly present with contraction of a breast implant after breast-conservation surgery and radiotherapy performed in the context of prior implant augmentation. This is a particularly challenging reconstructive problem to correct with a high risk of implant loss secondary to attempted capsulectomy and implant exchange. A preferred approach is to consider these cosmetically augmented patients as being small breasted and instead of undertaking breast conservation, nipple-sparing mastectomy can be performed thereby avoiding radiation therapy. Most patients who undergo breast augmentation with implants have A- or B-cup-sized native breast tissue and in terms of breast reconstruction should be assessed accordingly. In addition, many small-breasted patients tend to be relatively thin with limited autologous tissue salvage options in the event that outcomes from breast-conservation therapy are poor.
Complications of Breast Surgery
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
Breast implants obscure some portion of the breast during mammography. One report demonstrated that as much as 44% of the breast can be obstructed by subglandular silicone gel breast implants and as much as 25% can be obstructed by submuscular implants [42]. Capsule contracture also limits the amount of breast tissue that can be seen on postoperative mammograms [43]. Long-term studies have shown that delayed detection of breast cancer does not appear to be a serious problem for patients with breast implants, nor is their prognosis poorer than that of patients without implants [44]. Diagnostic procedures such as needle biopsies and lymphatic mapping may not be recommended for patients with breast implants; open procedures should be used instead. For patients with breast cancer, implants may make lumpectomy impossible and may necessitate mastectomy.
Breast imaging
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha in Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
Patients with breast implants are prone to the same range of diseases as those without implants and the management of those problems is similar. The main differences are that the physical presence of the implant can make mammography more difficult and reduce coverage of the breast parenchyma, and that CBx is more difficult to perform safely even under ultrasound guidance, due to the risk of implant perforation. Alternative mammography projection techniques such as the Eklund/push-back technique [8] can circumvent this to some extent, so that mammography is still attempted as the primary investigation where appropriate, but ultrasound has an enhanced role as the implant will not impede ultrasound examination. FNA and CBx are often possible with careful consideration of the approach, but small lesions on the implant surface may require surgical excision to achieve tissue diagnosis with minimal risk of implant rupture.
Treatment of women with BRCA mutation
Published in Climacteric, 2023
H. Depypere
All options of prophylactic breast removal eventually followed by breast reconstruction should be discussed in length. With the enormous progress in reconstructive surgery, many reconstructive options are now available. The skin and the areola, which is also skin tissue, can be saved. The option not to remove the nipple during breast ablation should be offered [15]. The removed breast tissue can be replaced by a breast implant. The advantage of this surgical option is that this operation is easy to perform, in virtually every clinical setting. A disadvantage is that this implant may need to be replaced when contractions of the capsule occur within the following years after the surgery. Newer techniques using injection of fat and fat stem cells may offer a solution. In this situation, the prosthesis is gradually deflated and replaced by autologous fat through fat injections. After several consecutive procedures the prosthesis may be completely replaced by this injected fat which has started to form viable fat tissue. Pictures of operations may help women to make the decision.
Feasibility and efficacy of ultrasound-guided high-intensity focused ultrasound of breast fibroadenoma
Published in International Journal of Hyperthermia, 2023
Mengdi Liang, Zhizheng Zhang, Cai Zhang, Rui Chen, Yao Xiao, Zi Li, Tao Li, Yuelin Liu, Lijun Ling, Hui Xie, Lin Chen, Xiaoan Liu, Shui Wang, Tiansong Xia
This prospective study has been registered in Clinical-Trials.gov (ChiCTR2100050068) and approved by the institutional ethics committee of the First Affiliated Hospital with Nanjing Medical University (2020-SR-130). A written informed consent was obtained from each patient. From January 2021 to November 2022, a total of 113 patients diagnosed with breast fibroadenoma by core-needle biopsy in our hospital were recruited and underwent USgHIFU at our department. And the clinical outcome of 85 patients with a follow-up time of more than 3 months was analyzed in this study. The inclusion criterion included the following: (a) patients were older than 18 years; (b) the Breast Imaging Recording and Data System (BI-RADS) score ≤3 by ultrasound and mammography in addition for women older than 35 years; (c) breast fibroadenoma proved by core-needle biopsy; (d) the maximum diameter of lesion was between 5 and 40 mm; and (e) fibroadenomas with a safe acoustic pathway and the focus can reach the target. The exclusion criteria were as follows: (a) pathological diagnosis of breast cancer; (b) BI-RADS score ≥4; (c) pregnant or lactating women; (d) patients with evidence of coagulopathy, chronic liver diseases or renal failure; and (e) patients with breast implants.
Technical analysis of US imaging for precise microwave ablation for benign breast tumours
Published in International Journal of Hyperthermia, 2018
Changwen Li, Cuiying Li, Han Ge, Mengdi Liang, Ge Ma, Lijun Ling, Hong Pan, Haiyan Gong, Hui Xie, Qiang Ding, Wenbin Zhou, Shui Wang
Patients clinically diagnosed with benign breast tumours in our department were included in our clinical trial from April 2015. Written informed consent was received from every patient. This clinical trial was approved (No. 2013-NT-138) by the institutional ethics committee of The First Affiliated Hospital with Nanjing Medical University. The inclusion and exclusion criterion of this trial were reported in our previous study [6]: (i) less than three tumours in unilateral breast; (ii) US BI-RADS (the Breast Imaging Recording and Data System) score 3 and mammogram BI-RADS 3 if it was given to patients before biopsy; (iii) the tumour smaller than 3 cm in greatest diameter confirmed by using US and contrast-enhanced US (CEUS); (iv) benign breast disease proved by using core biopsy; and (v) Karnofsky performance status >70%. Patient exclusion criteria were as following: (i) patients with medical contraindications to CEUS; (ii) patients who were pregnant or breastfeeding; (iii) patients with evidence of coagulopathy, chronic liver diseases or renal failure; (iv) US BI-RADS score ≥4; and (v) patients with breast implants. MWA was performed to patients diagnosed with benign breast tumours proved by core biopsy.
Related Knowledge Centers
- Birth Defect
- Breast
- Breast Augmentation
- Elastomer
- Mastectomy
- Prosthesis
- Plastic Surgery
- Breast Pain
- Silicone
- Saline