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Kijima Y, Hirata M, Higo N, Nakazawa Y, Shinmura K. Nipple reconstruction using spiral-peeling technique during oncoplastic breast-conserving surgery for a patient with small breasts. Surg Today 2024:10.1007/s00595-024-02892-0. [PMID: 38969868 DOI: 10.1007/s00595-024-02892-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 06/18/2024] [Indexed: 07/07/2024]
Abstract
Treatment of early breast cancer using breast-conserving surgery (BCS) commonly leads to local control and acceptable cosmetic results. We report a useful technique to achieve symmetry of the breast shape and nipple-areola, with excellent results. A Japanese patient with early breast cancer located in the inner central area of the breast was enrolled in this study. Intraductal spread of breast cancer to the nipple was suspected; however, no invasion was observed outside the nipple wall. We preserved the cylindrical surface, but resected the inner tissue with the top surface of the nipple. After coring the nipple, the remnant cylindrical surface was cut into a spiral shape. Nipple reconstruction using the spiral-peeling technique during oncoplastic breast-conserving surgery (OPBCS) may be useful for patients who desire nipple preservation.
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Affiliation(s)
- Yuko Kijima
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Munetsugu Hirata
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Naotomo Higo
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yumika Nakazawa
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Kazuya Shinmura
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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2
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Oncoplastic breast surgery combining partial mastectomy with resection of double equilateral triangular skin flaps. Surg Today 2021; 52:514-518. [PMID: 34398273 PMCID: PMC8873059 DOI: 10.1007/s00595-021-02355-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/12/2021] [Indexed: 11/26/2022]
Abstract
The treatment of early breast cancer using oncoplastic breast surgery (OBS) has been gradually increasing in popularity and is recognized for its efficacy in local control and excellent cosmetic results. We herein report a useful technique for obtaining symmetry of the breast shape for an early breast lesion located in an outer area, close to the nipple-areola, in a Japanese patient with ptotic, fatty breasts. We designed two equilateral triangles: one just upon the resected area and the other on the axilla. They were located on a straight line, with one top pointed to the cranial side and one to the caudal side. A crescent area around the areola was de-epithelialized in the 12 o’clock and 6 o’clock directions. Columnar-shaped breast tissue and an equilateral triangular skin flap and fatty tissue were removed together. To fill the defect, a skin-glandular flap was slid horizontally after suturing the inframammary line. Although an incision scar was formed on the breast and lateral chest wall in a Z-shape, this new technique was able to achieve not only cancer control but also excellent cosmetic results.
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3
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Kijima Y, Hirata M, Higo N, Toda H. Oncoplastic breast surgery combining partial mastectomy with V-rotation mammoplasty for breast cancer on the upper inner area of the breast. Surg Today 2020; 51:1241-1245. [PMID: 33033958 DOI: 10.1007/s00595-020-02152-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/13/2020] [Indexed: 12/01/2022]
Abstract
The treatment of early breast cancer using breast conservation therapy (BCT) commonly ensures local control and acceptable cosmetic results. We herein report a useful technique for obtaining symmetry of the breast shape and a level inframammary line and nipple-areola that achieved excellent results. Four Japanese patients with early breast cancer located on the upper inner area of the breast were enrolled into this study. De-epithelialized skin close to the resected area and skin from the epigastric area with subdermal fatty tissue were moved to repair the defect. Oncoplastic breast surgery (OBS) combining partial mastectomy with the V-rotation mammoplasty technique was useful for patients with breast cancer on the upper inner area of minimal ptotic breasts.
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Affiliation(s)
- Yuko Kijima
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Munetsugu Hirata
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Naotomo Higo
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Hiroko Toda
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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4
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Kijima Y, Hirata M, Higo N, Toda H, Morise Z, Shinden Y, Natsugoe S. Oncoplastic breast surgery combining partial mastectomy with a triangular skin resection and re-centralization of the nipple-areola. Surg Today 2020; 50:1707-1711. [PMID: 32524271 DOI: 10.1007/s00595-020-02041-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
The treatment of early breast cancer using breast conservation therapy (BCT) commonly ensures local control and acceptable cosmetic results. We herein report a useful technique to obtain symmetry of the breast shape and a level inframammary line and nipple-areola, which achieved excellent results. Six Japanese patients with early breast cancer located on the upper area of the breast were enrolled into this study. A triangle-shaped area of skin was removed together with cancerous and healthy-surrounding breast tissue. Two crescents were designed and de-epithelialized in the directions of 9 o'clock and 3 o'clock. The width of the crescent was decided to be the same as a half or the length of the base of a triangle to be removed. After partial mastectomy, the inner and outer glandular flaps were horizontally sutured. The operations were simple to perform and were not associated with any postoperative complications. Oncoplastic breast surgery combining partial mastectomy with triangular skin resection and re-centralization of the nipple-areola was useful for patients with breast cancer on the upper quadrant area of non-ptotic breasts.
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Affiliation(s)
- Yuko Kijima
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. .,Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan. .,Department of General Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Munetsugu Hirata
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.,Department of General Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Naotomo Higo
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.,Department of General Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Hiroko Toda
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.,Department of General Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Zenichi Morise
- Department of General Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yoshiaki Shinden
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Shoji Natsugoe
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
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Ozmen V, Ilgun S, Celet Ozden B, Ozturk A, Aktepe F, Agacayak F, Elbuken F, Alco G, Ordu C, Erdogan Iyigun Z, Emre H, Pilancı K, Soybir G, Ozmen T. Comparison of breast cancer patients who underwent partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (M + I) regarding quality of life (QOL), cosmetic outcome and survival rates. World J Surg Oncol 2020; 18:87. [PMID: 32370753 PMCID: PMC7201547 DOI: 10.1186/s12957-020-01858-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 04/20/2020] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The latissimus dorsi muscle has long been used in breast cancer (BC) patients for reconstruction. This study aimed to compare early stage BC patients who had partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (MI) with respect to quality of life (QoL), cosmetic outcome (CO), and survival rates. PATIENTS AND METHODS The data of patients who underwent PM + MLDF (Group 1) and M + I (Group 2) between January 2010 and January 2018 were evaluated. Both groups were compared in terms of demographics, clinical and pathological characteristics, surgical morbidity, survival, quality of life, and cosmetic results. The EORTC-QLQ C30 and EORTC-QLO BR23 questionnaires and the Japanese Breast Cancer Society (JBCS) Cosmetic Evaluation Scale were used to assess the quality of life and the cosmetic outcome, respectively. RESULTS A total of 317 patients were included in the study, 242 (76.3%) of them in group 1 and 75 (23.6%) of them in group 2. Median follow-up time was 56 (14-116) months. There were no differences identified between the groups in terms of tumor histology, hormonal receptors and HER-2 positivity, surgical morbidity, and 5-year overall and disease-free survival. Group 2 patients were significantly younger than group 1 (p = 0.003). The multifocality/multicentricity rate was higher in group 2 (p ≤ 0.001), whereas tumor size (p = 0.009), body mass index (BMI, p = 0.006), histological grade (p ≤ 0.001), lymph node positivity (p = 0.002), axillary lymph node dissection (ALND) rate (p = 0.005), and presence of lympho-vascular invasion (LVI, p = 0.013) were significantly higher in group 1. When the quality of life was assessed by using the EORTC QLQ C30 and BR23 questionnaires, it was seen that the body image perception (p < 0.001) and nausea/vomiting score (p = 0.024) were significantly better in PM + MLDF group whereas physical function score was significantly better in M + I group (p = 0.012). When both groups were examined in terms of cosmesis with JBCS Cosmetic Evaluation Scale, good cosmetic evaluation score was significantly higher in patients in MLDF group (p = 0.01). DISCUSSION The results of this study indicate that in comparison to M + I procedure, the PM + MLDF procedure provides significantly superior results in terms of body image and cosmetic result with similar morbidity and oncologic outcomes. In selected patients with small breasts and a high tumor/breast ratio, PM + MLDF may be an alternative to subcutaneous mastectomy and implant.
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Affiliation(s)
- Vahit Ozmen
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Istanbul, Turkey
| | - Serkan Ilgun
- Department of General Surgery, School of Medicine, Demiroglu Bilim University, Istanbul, Turkey
| | - Burcu Celet Ozden
- Department of Plastic and Reconstructive Surgery, School of Medicine, Altinbas University, Istanbul, Turkey
| | - Alper Ozturk
- Department of General Surgery, School of Medicine, Biruni University, Istanbul, Turkey
| | - Fatma Aktepe
- Department of Pathology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Filiz Agacayak
- Department of Radiology, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Filiz Elbuken
- Department of Radiology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Gul Alco
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Cetin Ordu
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Zeynep Erdogan Iyigun
- Department of Physical Therapy and Rehabilitation, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Hocaoglu Emre
- Department of Plastic & Reconstructive Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Kezban Pilancı
- Department of Medical Oncology, Bahcesehir Memorial Hospital, Istanbul, Turkey
| | - Gursel Soybir
- Department of General Surgery, Sisli Memorial Hospital, Istanbul, Turkey
| | - Tolga Ozmen
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Oncoplastic breast surgery combining partial mastectomy with immediate breast reshaping using multiple local flaps for a patient with slim body. Breast Cancer 2019; 26:529-534. [PMID: 30684232 DOI: 10.1007/s12282-019-00948-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
Abstract
Oncoplastic breast surgery (OBS), which combines the concepts of oncologic and plastic surgery, is becoming more common worldwide. We report the results of OBS in a Japanese patient with early breast cancer located on the outer lower quadrant area. We performed OBS combining partial mastectomy with immediate breast reshaping using multiple adipofascial cutaneous flaps and free dermal fat graft because she refused any other OBS. We selected three local flaps to repair the defect. Perioperative and postoperative complications were not seen. The cosmetic findings 3 years after surgery were not excellent, but the patient was satisfied with the results. OBS combining partial mastectomy with immediate breast reshaping using a combination of several flaps was successfully performed in a patient with early breast cancer.
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Ito S, Kai Y, Masuda T, Tanaka F, Matsumoto T, Kamohara Y, Hayakawa H, Ueo H, Iwaguro H, Hedrick MH, Mimori K, Mori M. Long-term outcome of adipose-derived regenerative cell-enriched autologous fat transplantation for reconstruction after breast-conserving surgery for Japanese women with breast cancer. Surg Today 2017; 47:1500-1511. [PMID: 28555267 DOI: 10.1007/s00595-017-1544-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/02/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE More effective methods are needed for breast reconstruction after breast-conserving surgery for breast cancer. The aim of this clinical study was to assess the perioperative and long-term outcomes of adipose-derived regenerative cell (ADRC)-enriched autologous fat grafting. METHODS Ten female patients who had undergone breast-conserving surgery and adjuvant radiotherapy for breast cancer were enrolled. An ADRC-enriched fat graft prepared from the patient's adipose tissue was implanted at the time of adipose tissue harvest. The perioperative and long-term outcomes of the grafts, which included safety, efficacy, and questionnaire-based patient satisfaction, were investigated. RESULTS The mean operation time was 188 ± 30 min, and the mean duration of postoperative hospitalization was 1.2 ± 0.4 days. No serious postoperative complications were associated with the procedure. Neither recurrence nor metastatic disease was observed during the follow-up period (7.8 ± 1.5 years) after transplantation. Of 9 available patients, "more than or equal to average" satisfaction with breast appearance and overall satisfaction were reported by 6 (66.7%) and 5 (55.6%) patients, respectively. CONCLUSIONS ADRC-enriched autologous fat transplantation is thus considered to be safe perioperatively, with no long-term recurrence, for patients with breast cancer treated by breast-conserving surgery, and it may be an option for breast reconstruction, even after adjuvant radiotherapy.
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Affiliation(s)
- Shuhei Ito
- Department of Surgery, Kyushu University Beppu Hospital, 4546 Tsurumihara, Beppu, 874-0838, Japan
| | - Yuichiro Kai
- Department of Surgery, Kyushu University Beppu Hospital, 4546 Tsurumihara, Beppu, 874-0838, Japan.,Ueo Breast Surgical Hospital, Oita, Japan
| | - Takaaki Masuda
- Department of Surgery, Kyushu University Beppu Hospital, 4546 Tsurumihara, Beppu, 874-0838, Japan
| | - Fumiaki Tanaka
- Department of Surgery, Kyushu University Beppu Hospital, 4546 Tsurumihara, Beppu, 874-0838, Japan
| | - Toshifumi Matsumoto
- Department of Surgery, Kyushu University Beppu Hospital, 4546 Tsurumihara, Beppu, 874-0838, Japan
| | - Yukio Kamohara
- Department of Surgery, Kyushu University Beppu Hospital, 4546 Tsurumihara, Beppu, 874-0838, Japan
| | | | | | | | | | - Koshi Mimori
- Department of Surgery, Kyushu University Beppu Hospital, 4546 Tsurumihara, Beppu, 874-0838, Japan.
| | - Masaki Mori
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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De Biasio F, Zingaretti N, Marchesi A, Vaienti L, Almesberger D, Parodi PC. A Simple and Effective Technique of Breast Remodelling After Conserving Surgery for Lower Quadrants Breast Cancer. Aesthetic Plast Surg 2016; 40:887-895. [PMID: 27704197 DOI: 10.1007/s00266-016-0709-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 09/23/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Quadrantectomy is an oncologically safe procedure for the treatment of early-stage breast cancer, but it often results in poor aesthetic outcomes such as breast shape deformity, which is more visible if the tumour is located in the lower pole. We recommend the use of the transverse incision, which retains the oncological advantages of the quadrantectomy while leading to better aesthetical results. METHOD We evaluated the clinical results of 24 patients with breast cancer who underwent quadrantectomy of the lower breast pole and volume replacement with remodelling through three posterior scorings from January 2012 to January 2014, with cosmetic evaluations performed according to the criteria set by the Japanese Breast Cancer Society. RESULTS Minimum follow-up after surgery was 2 years, with an average of 28.4 months. Among treated patients, the percentage of complications was extremely low and the degree of satisfaction fairly good. Moreover, the assessment of the medical team matched patient self-assessments. CONCLUSION Immediate breast reconstruction of a defect performed after a quadrantectomy of the lower breast pole using the "posterior scoring technique" provided better cosmetic results compared to the transposition of residual breast tissue. This technique provides reliable and reproducible results, and it also appears to be rather successful on patients with small-moderate breasts in the absence of a certain degree of ptosis, therefore increasing its already considerable appeal. LEVEL OF EVIDENCE V This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Fabrizio De Biasio
- Breast Unit, Department of Plastic and Reconstructive Surgery, University of Udine, c/o Ospedale "S. Maria della Misericordia", piazzale santa maria della misericordia 15, 33100, Udine, Italy
| | - Nicola Zingaretti
- Breast Unit, Department of Plastic and Reconstructive Surgery, University of Udine, c/o Ospedale "S. Maria della Misericordia", piazzale santa maria della misericordia 15, 33100, Udine, Italy.
| | - Andrea Marchesi
- Plastic Surgery Department, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Luca Vaienti
- Plastic Surgery Department, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Daria Almesberger
- Breast Unit, Department of Plastic and Reconstructive Surgery, University of Udine, c/o Ospedale "S. Maria della Misericordia", piazzale santa maria della misericordia 15, 33100, Udine, Italy
| | - Pier Camillo Parodi
- Breast Unit, Department of Plastic and Reconstructive Surgery, University of Udine, c/o Ospedale "S. Maria della Misericordia", piazzale santa maria della misericordia 15, 33100, Udine, Italy
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Autologous fat transfer to the subcutaneous tissue in the context of breast reconstructive procedures. Postepy Dermatol Alergol 2016; 33:323-328. [PMID: 27881936 PMCID: PMC5110620 DOI: 10.5114/ada.2016.62835] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 12/28/2015] [Indexed: 02/03/2023] Open
Abstract
Autologous fat transfer (AFT) is an appropriate technique for aesthetic rejuvenation of the face, aesthetic enhancement of hands, correction of the facial appearance in various disorders and constitutes a surgical alternative of treatment of numerous breast deformities ranging from distorting posttraumatic scars, post-eczema lesions, post-burn deformities to partial or total breast reconstruction. Our work is aimed to familiarize dermatologists with the technique of harvesting and implanting the aspirate of adipose cells in patients consulted for deformities of the breast. In addition, the review summarizes the most common applications of AFT in the breast reconstructive procedures. In summary, AFT is an oncologically safe, relatively complication-free, minimally invasive surgical technique, which can be used to correct a wide range of deformities, which are commonly seen by dermatologists, in the area of the face, trunk and extremities. The procedure can correct a wide range of breast deformities, from contour or single quadrant deformities up to the state after mastectomy.
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Shima H, Kutomi G, Kyuno T, Satomi F, Uno S, Maeda H, Kameshima H, Omura T, Kimura Y, Mizuguchi T, Hirata K, Takemasa I. Flap revascularization in patients following immediate reconstruction using an autologous free dermal fat graft for breast cancer: a report of two cases. Surg Case Rep 2016; 2:54. [PMID: 27256332 PMCID: PMC4891313 DOI: 10.1186/s40792-016-0181-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 05/29/2016] [Indexed: 11/24/2022] Open
Abstract
It has been reported that use of the free dermal fat graft (FDFG) technique produces a good cosmetic outcome for breast cancer. An FDFG is harvested from the lower abdomen as a columnar-shaped specimen and implanted into the defect of the breast after a partial mastectomy as a volume replacement technique. In this report, two patients who underwent breast-conserving surgery with immediate reconstruction using an autologous FDFG are described in order to show the difference in status between one case with and one without blood flow in the graft. To assess the benefit of this technique using FDFGs, their cosmetic satisfaction was evaluated using a questionnaire, graft shrinkage was measured by CT, and blood flow was assessed using contrast-enhanced ultrasound (CEUS). Both patients scored 10 of 12 points on the questionnaire. After 2 years, shrinkage of the grafts was 21.6 and 25.2 %, respectively. Although one patient had no blood flow in the center of the graft, the other had blood flow from the pectoralis major muscle to the center of the graft. While satisfaction and graft shrinkage were similar in the two patients, one case showed blood flow and had a somewhat softer graft than the other. The graft status was maintained with a good cosmetic outcome for 3 years after breast-conserving surgery with immediate reconstruction using an autologous FDFG, despite mild shrinkage and hardness of the graft. It is notable that blood flow was observed into the graft on CEUS, and more distinct perfusion was seen in the softer graft case after more than 3 years.
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Affiliation(s)
- Hiroaki Shima
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S 1, W 16, Chuo-ku, Sapporo, 060-8543, Japan.
| | - Goro Kutomi
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S 1, W 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Takuro Kyuno
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S 1, W 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Fukino Satomi
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S 1, W 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Satoko Uno
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S 1, W 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Hideki Maeda
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S 1, W 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Hidekazu Kameshima
- Breast Cancer Center, Higashi-Sapporo Hospital, Higashi-Sapporo 3 Jou 3 Tyoume, Shiroishi-ku, Sapporo, 003-8585, Japan
| | - Tosei Omura
- Breast Cancer Center, Higashi-Sapporo Hospital, Higashi-Sapporo 3 Jou 3 Tyoume, Shiroishi-ku, Sapporo, 003-8585, Japan
| | - Yasutoshi Kimura
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S 1, W 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Toru Mizuguchi
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S 1, W 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Koichi Hirata
- Department of Surgery, JR Sapporo Hospital, N3, E1, Chuo-ku, Sapporo, 060-0033, Japan
| | - Ichiro Takemasa
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, S 1, W 16, Chuo-ku, Sapporo, 060-8543, Japan
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11
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Kijima Y, Koriyama C, Fujii T, Hirokaga K, Ishigure K, Kaneko T, Kayano S, Miyamoto S, Sagara Y, Sakurai T, Sakurai T, Sotome K, Ueo H, Wakita K, Watatani M. Immediate breast volume replacement using a free dermal fat graft after breast cancer surgery: multi-institutional joint research of short-term outcomes in 262 Japanese patients. Gland Surg 2015; 4:179-94. [PMID: 26005649 DOI: 10.3978/j.issn.2227-684x.2015.01.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/05/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Immediate volume replacement using a free dermal fat graft (FDFG) has been proven safe with early postoperative benefits. The aims of the present study were to clarify adequate indications and risk factors associated with operative morbidity. PATIENTS AND METHODS A multi-institutional analysis of partial mastectomy with immediate volume replacement with FDFG was undertaken in 14 hospitals specializing in breast cancer treatment. Clinical and oncological variables were analyzed to identify factors associated with postoperative complications. RESULTS A total of 262 cases were analyzed. Considering the observation period and overlap of patients, 13 (5.4%) out of 242 patients had complications within 1 month of surgery while 7 (4.6%) out of 151 patients developed complications 1-12 months after surgery. Two hundred and eleven out of 242 patients were statistically examined using a multivariate analysis, which revealed that the weight of resected breast tissue, size of implanted FDFG (cranio-caudal length), and weight of implanted FDFG were associated with a higher likelihood of postoperative complications. CONCLUSIONS Immediate breast volume replacement using a FDFG after breast cancer surgery should be done for selected patients with breast cancer to avoid postoperative complications. The prospective and larger investigations are warranted for the establishment of appropriate guidelines.
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Affiliation(s)
- Yuko Kijima
- 1 Department of Digestive Surgery, Breast and Thyroid Surgery, 2 Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan ; 3 Breast Care Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan ; 4 Department of Breast Oncology, Hyogo Cancer Center, Hyogo, Japan ; 5 Department of Surgery, Konan Kosei Hospital, Aichi, Japan ; 6 Kaneko Clinic, Kagoshima, Japan ; 7 Plastic and Reconstructive Surgery Department, National Cancer Center Hospital, Tokyo, Japan ; 8 Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan ; 9 Department of Breast Surgery, Sagara Hospital, Kagoshima, Japan ; 10 Division of Surgery, Saitama Social Insurance Hospital, Saitama, Japan ; 11 Department of Surgery, Wakayama Medical University, Kihoku Hospital, Wakayama, Japan ; 12 Department of Surgery, Fussa Hospital, Tokyo, Japan ; 13 Ueo Breast Cancer Hospital, Oita, Japan ; 14 Chayamachi Breast Clinic, Osaka, Japan ; 15 Department of Breast Surgery, Kinki University Faculty of Medicine, Nara Hospital, Osaka, Japan
| | - Chihaya Koriyama
- 1 Department of Digestive Surgery, Breast and Thyroid Surgery, 2 Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan ; 3 Breast Care Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan ; 4 Department of Breast Oncology, Hyogo Cancer Center, Hyogo, Japan ; 5 Department of Surgery, Konan Kosei Hospital, Aichi, Japan ; 6 Kaneko Clinic, Kagoshima, Japan ; 7 Plastic and Reconstructive Surgery Department, National Cancer Center Hospital, Tokyo, Japan ; 8 Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan ; 9 Department of Breast Surgery, Sagara Hospital, Kagoshima, Japan ; 10 Division of Surgery, Saitama Social Insurance Hospital, Saitama, Japan ; 11 Department of Surgery, Wakayama Medical University, Kihoku Hospital, Wakayama, Japan ; 12 Department of Surgery, Fussa Hospital, Tokyo, Japan ; 13 Ueo Breast Cancer Hospital, Oita, Japan ; 14 Chayamachi Breast Clinic, Osaka, Japan ; 15 Department of Breast Surgery, Kinki University Faculty of Medicine, Nara Hospital, Osaka, Japan
| | - Teruhiko Fujii
- 1 Department of Digestive Surgery, Breast and Thyroid Surgery, 2 Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan ; 3 Breast Care Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan ; 4 Department of Breast Oncology, Hyogo Cancer Center, Hyogo, Japan ; 5 Department of Surgery, Konan Kosei Hospital, Aichi, Japan ; 6 Kaneko Clinic, Kagoshima, Japan ; 7 Plastic and Reconstructive Surgery Department, National Cancer Center Hospital, Tokyo, Japan ; 8 Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan ; 9 Department of Breast Surgery, Sagara Hospital, Kagoshima, Japan ; 10 Division of Surgery, Saitama Social Insurance Hospital, Saitama, Japan ; 11 Department of Surgery, Wakayama Medical University, Kihoku Hospital, Wakayama, Japan ; 12 Department of Surgery, Fussa Hospital, Tokyo, Japan ; 13 Ueo Breast Cancer Hospital, Oita, Japan ; 14 Chayamachi Breast Clinic, Osaka, Japan ; 15 Department of Breast Surgery, Kinki University Faculty of Medicine, Nara Hospital, Osaka, Japan
| | - Kouichi Hirokaga
- 1 Department of Digestive Surgery, Breast and Thyroid Surgery, 2 Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan ; 3 Breast Care Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan ; 4 Department of Breast Oncology, Hyogo Cancer Center, Hyogo, Japan ; 5 Department of Surgery, Konan Kosei Hospital, Aichi, Japan ; 6 Kaneko Clinic, Kagoshima, Japan ; 7 Plastic and Reconstructive Surgery Department, National Cancer Center Hospital, Tokyo, Japan ; 8 Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan ; 9 Department of Breast Surgery, Sagara Hospital, Kagoshima, Japan ; 10 Division of Surgery, Saitama Social Insurance Hospital, Saitama, Japan ; 11 Department of Surgery, Wakayama Medical University, Kihoku Hospital, Wakayama, Japan ; 12 Department of Surgery, Fussa Hospital, Tokyo, Japan ; 13 Ueo Breast Cancer Hospital, Oita, Japan ; 14 Chayamachi Breast Clinic, Osaka, Japan ; 15 Department of Breast Surgery, Kinki University Faculty of Medicine, Nara Hospital, Osaka, Japan
| | - Kiyoshi Ishigure
- 1 Department of Digestive Surgery, Breast and Thyroid Surgery, 2 Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan ; 3 Breast Care Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan ; 4 Department of Breast Oncology, Hyogo Cancer Center, Hyogo, Japan ; 5 Department of Surgery, Konan Kosei Hospital, Aichi, Japan ; 6 Kaneko Clinic, Kagoshima, Japan ; 7 Plastic and Reconstructive Surgery Department, National Cancer Center Hospital, Tokyo, Japan ; 8 Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan ; 9 Department of Breast Surgery, Sagara Hospital, Kagoshima, Japan ; 10 Division of Surgery, Saitama Social Insurance Hospital, Saitama, Japan ; 11 Department of Surgery, Wakayama Medical University, Kihoku Hospital, Wakayama, Japan ; 12 Department of Surgery, Fussa Hospital, Tokyo, Japan ; 13 Ueo Breast Cancer Hospital, Oita, Japan ; 14 Chayamachi Breast Clinic, Osaka, Japan ; 15 Department of Breast Surgery, Kinki University Faculty of Medicine, Nara Hospital, Osaka, Japan
| | - Tomoyo Kaneko
- 1 Department of Digestive Surgery, Breast and Thyroid Surgery, 2 Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan ; 3 Breast Care Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan ; 4 Department of Breast Oncology, Hyogo Cancer Center, Hyogo, Japan ; 5 Department of Surgery, Konan Kosei Hospital, Aichi, Japan ; 6 Kaneko Clinic, Kagoshima, Japan ; 7 Plastic and Reconstructive Surgery Department, National Cancer Center Hospital, Tokyo, Japan ; 8 Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan ; 9 Department of Breast Surgery, Sagara Hospital, Kagoshima, Japan ; 10 Division of Surgery, Saitama Social Insurance Hospital, Saitama, Japan ; 11 Department of Surgery, Wakayama Medical University, Kihoku Hospital, Wakayama, Japan ; 12 Department of Surgery, Fussa Hospital, Tokyo, Japan ; 13 Ueo Breast Cancer Hospital, Oita, Japan ; 14 Chayamachi Breast Clinic, Osaka, Japan ; 15 Department of Breast Surgery, Kinki University Faculty of Medicine, Nara Hospital, Osaka, Japan
| | - Shuji Kayano
- 1 Department of Digestive Surgery, Breast and Thyroid Surgery, 2 Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan ; 3 Breast Care Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan ; 4 Department of Breast Oncology, Hyogo Cancer Center, Hyogo, Japan ; 5 Department of Surgery, Konan Kosei Hospital, Aichi, Japan ; 6 Kaneko Clinic, Kagoshima, Japan ; 7 Plastic and Reconstructive Surgery Department, National Cancer Center Hospital, Tokyo, Japan ; 8 Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan ; 9 Department of Breast Surgery, Sagara Hospital, Kagoshima, Japan ; 10 Division of Surgery, Saitama Social Insurance Hospital, Saitama, Japan ; 11 Department of Surgery, Wakayama Medical University, Kihoku Hospital, Wakayama, Japan ; 12 Department of Surgery, Fussa Hospital, Tokyo, Japan ; 13 Ueo Breast Cancer Hospital, Oita, Japan ; 14 Chayamachi Breast Clinic, Osaka, Japan ; 15 Department of Breast Surgery, Kinki University Faculty of Medicine, Nara Hospital, Osaka, Japan
| | - Sachio Miyamoto
- 1 Department of Digestive Surgery, Breast and Thyroid Surgery, 2 Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan ; 3 Breast Care Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan ; 4 Department of Breast Oncology, Hyogo Cancer Center, Hyogo, Japan ; 5 Department of Surgery, Konan Kosei Hospital, Aichi, Japan ; 6 Kaneko Clinic, Kagoshima, Japan ; 7 Plastic and Reconstructive Surgery Department, National Cancer Center Hospital, Tokyo, Japan ; 8 Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan ; 9 Department of Breast Surgery, Sagara Hospital, Kagoshima, Japan ; 10 Division of Surgery, Saitama Social Insurance Hospital, Saitama, Japan ; 11 Department of Surgery, Wakayama Medical University, Kihoku Hospital, Wakayama, Japan ; 12 Department of Surgery, Fussa Hospital, Tokyo, Japan ; 13 Ueo Breast Cancer Hospital, Oita, Japan ; 14 Chayamachi Breast Clinic, Osaka, Japan ; 15 Department of Breast Surgery, Kinki University Faculty of Medicine, Nara Hospital, Osaka, Japan
| | - Yasuaki Sagara
- 1 Department of Digestive Surgery, Breast and Thyroid Surgery, 2 Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan ; 3 Breast Care Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan ; 4 Department of Breast Oncology, Hyogo Cancer Center, Hyogo, Japan ; 5 Department of Surgery, Konan Kosei Hospital, Aichi, Japan ; 6 Kaneko Clinic, Kagoshima, Japan ; 7 Plastic and Reconstructive Surgery Department, National Cancer Center Hospital, Tokyo, Japan ; 8 Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan ; 9 Department of Breast Surgery, Sagara Hospital, Kagoshima, Japan ; 10 Division of Surgery, Saitama Social Insurance Hospital, Saitama, Japan ; 11 Department of Surgery, Wakayama Medical University, Kihoku Hospital, Wakayama, Japan ; 12 Department of Surgery, Fussa Hospital, Tokyo, Japan ; 13 Ueo Breast Cancer Hospital, Oita, Japan ; 14 Chayamachi Breast Clinic, Osaka, Japan ; 15 Department of Breast Surgery, Kinki University Faculty of Medicine, Nara Hospital, Osaka, Japan
| | - Takashi Sakurai
- 1 Department of Digestive Surgery, Breast and Thyroid Surgery, 2 Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan ; 3 Breast Care Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan ; 4 Department of Breast Oncology, Hyogo Cancer Center, Hyogo, Japan ; 5 Department of Surgery, Konan Kosei Hospital, Aichi, Japan ; 6 Kaneko Clinic, Kagoshima, Japan ; 7 Plastic and Reconstructive Surgery Department, National Cancer Center Hospital, Tokyo, Japan ; 8 Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan ; 9 Department of Breast Surgery, Sagara Hospital, Kagoshima, Japan ; 10 Division of Surgery, Saitama Social Insurance Hospital, Saitama, Japan ; 11 Department of Surgery, Wakayama Medical University, Kihoku Hospital, Wakayama, Japan ; 12 Department of Surgery, Fussa Hospital, Tokyo, Japan ; 13 Ueo Breast Cancer Hospital, Oita, Japan ; 14 Chayamachi Breast Clinic, Osaka, Japan ; 15 Department of Breast Surgery, Kinki University Faculty of Medicine, Nara Hospital, Osaka, Japan
| | - Teruhisa Sakurai
- 1 Department of Digestive Surgery, Breast and Thyroid Surgery, 2 Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan ; 3 Breast Care Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan ; 4 Department of Breast Oncology, Hyogo Cancer Center, Hyogo, Japan ; 5 Department of Surgery, Konan Kosei Hospital, Aichi, Japan ; 6 Kaneko Clinic, Kagoshima, Japan ; 7 Plastic and Reconstructive Surgery Department, National Cancer Center Hospital, Tokyo, Japan ; 8 Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan ; 9 Department of Breast Surgery, Sagara Hospital, Kagoshima, Japan ; 10 Division of Surgery, Saitama Social Insurance Hospital, Saitama, Japan ; 11 Department of Surgery, Wakayama Medical University, Kihoku Hospital, Wakayama, Japan ; 12 Department of Surgery, Fussa Hospital, Tokyo, Japan ; 13 Ueo Breast Cancer Hospital, Oita, Japan ; 14 Chayamachi Breast Clinic, Osaka, Japan ; 15 Department of Breast Surgery, Kinki University Faculty of Medicine, Nara Hospital, Osaka, Japan
| | - Keiichi Sotome
- 1 Department of Digestive Surgery, Breast and Thyroid Surgery, 2 Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan ; 3 Breast Care Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan ; 4 Department of Breast Oncology, Hyogo Cancer Center, Hyogo, Japan ; 5 Department of Surgery, Konan Kosei Hospital, Aichi, Japan ; 6 Kaneko Clinic, Kagoshima, Japan ; 7 Plastic and Reconstructive Surgery Department, National Cancer Center Hospital, Tokyo, Japan ; 8 Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan ; 9 Department of Breast Surgery, Sagara Hospital, Kagoshima, Japan ; 10 Division of Surgery, Saitama Social Insurance Hospital, Saitama, Japan ; 11 Department of Surgery, Wakayama Medical University, Kihoku Hospital, Wakayama, Japan ; 12 Department of Surgery, Fussa Hospital, Tokyo, Japan ; 13 Ueo Breast Cancer Hospital, Oita, Japan ; 14 Chayamachi Breast Clinic, Osaka, Japan ; 15 Department of Breast Surgery, Kinki University Faculty of Medicine, Nara Hospital, Osaka, Japan
| | - Hiroaki Ueo
- 1 Department of Digestive Surgery, Breast and Thyroid Surgery, 2 Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan ; 3 Breast Care Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan ; 4 Department of Breast Oncology, Hyogo Cancer Center, Hyogo, Japan ; 5 Department of Surgery, Konan Kosei Hospital, Aichi, Japan ; 6 Kaneko Clinic, Kagoshima, Japan ; 7 Plastic and Reconstructive Surgery Department, National Cancer Center Hospital, Tokyo, Japan ; 8 Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan ; 9 Department of Breast Surgery, Sagara Hospital, Kagoshima, Japan ; 10 Division of Surgery, Saitama Social Insurance Hospital, Saitama, Japan ; 11 Department of Surgery, Wakayama Medical University, Kihoku Hospital, Wakayama, Japan ; 12 Department of Surgery, Fussa Hospital, Tokyo, Japan ; 13 Ueo Breast Cancer Hospital, Oita, Japan ; 14 Chayamachi Breast Clinic, Osaka, Japan ; 15 Department of Breast Surgery, Kinki University Faculty of Medicine, Nara Hospital, Osaka, Japan
| | - Kazuyuki Wakita
- 1 Department of Digestive Surgery, Breast and Thyroid Surgery, 2 Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan ; 3 Breast Care Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan ; 4 Department of Breast Oncology, Hyogo Cancer Center, Hyogo, Japan ; 5 Department of Surgery, Konan Kosei Hospital, Aichi, Japan ; 6 Kaneko Clinic, Kagoshima, Japan ; 7 Plastic and Reconstructive Surgery Department, National Cancer Center Hospital, Tokyo, Japan ; 8 Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan ; 9 Department of Breast Surgery, Sagara Hospital, Kagoshima, Japan ; 10 Division of Surgery, Saitama Social Insurance Hospital, Saitama, Japan ; 11 Department of Surgery, Wakayama Medical University, Kihoku Hospital, Wakayama, Japan ; 12 Department of Surgery, Fussa Hospital, Tokyo, Japan ; 13 Ueo Breast Cancer Hospital, Oita, Japan ; 14 Chayamachi Breast Clinic, Osaka, Japan ; 15 Department of Breast Surgery, Kinki University Faculty of Medicine, Nara Hospital, Osaka, Japan
| | - Masahiro Watatani
- 1 Department of Digestive Surgery, Breast and Thyroid Surgery, 2 Department of Epidemiology and Preventive Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan ; 3 Breast Care Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan ; 4 Department of Breast Oncology, Hyogo Cancer Center, Hyogo, Japan ; 5 Department of Surgery, Konan Kosei Hospital, Aichi, Japan ; 6 Kaneko Clinic, Kagoshima, Japan ; 7 Plastic and Reconstructive Surgery Department, National Cancer Center Hospital, Tokyo, Japan ; 8 Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan ; 9 Department of Breast Surgery, Sagara Hospital, Kagoshima, Japan ; 10 Division of Surgery, Saitama Social Insurance Hospital, Saitama, Japan ; 11 Department of Surgery, Wakayama Medical University, Kihoku Hospital, Wakayama, Japan ; 12 Department of Surgery, Fussa Hospital, Tokyo, Japan ; 13 Ueo Breast Cancer Hospital, Oita, Japan ; 14 Chayamachi Breast Clinic, Osaka, Japan ; 15 Department of Breast Surgery, Kinki University Faculty of Medicine, Nara Hospital, Osaka, Japan
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12
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Ozaki S, Ohara M. Endoscopy-assisted breast-conserving surgery for breast cancer patients. Gland Surg 2014; 3:94-108. [PMID: 25083503 DOI: 10.3978/j.issn.2227-684x.2013.12.04] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/17/2013] [Indexed: 12/15/2022]
Abstract
Breast-conserving surgery (BCS) combined with postoperative radiotherapy is a standard therapy for early-stage breast cancer patients. In addition, recent developments in oncoplastic surgery have improved cosmetic outcomes and patient satisfaction. Therefore, a breast surgeon's current role in BCS is not only to perform a curative resection of cancerous lesions with adequate surgical margins, but also to preserve the shape and appearance of the treated breast. Endoscopy-assisted breast-conserving surgery (EBCS), which has the advantage of a less noticeable scar, was developed more than ten years ago. Recently, some clinical studies have reported the feasibility, oncological outcomes, aesthetic outcomes, and patient satisfaction of EBCS. Herein, we will review the EBCS clinical studies that have been conducted so far and discuss current issues regarding this operative method.
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Affiliation(s)
- Shinji Ozaki
- Department of Surgical Oncology Research, Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Masahiro Ohara
- Department of Surgical Oncology Research, Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
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13
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Mizoguchi T, Kijima Y, Hirata M, Kaneko K, Arima H, Nakajo A, Higashi M, Tabata K, Koriyama C, Arigami T, Uenosono Y, Okumura H, Maemura K, Ishigami S, Yoshinaka H, Shinden Y, Ueno S, Natsugoe S. Histological findings of an autologous dermal fat graft implanted onto the pectoralis major muscle of a rat model. Breast Cancer 2014; 22:578-85. [PMID: 24574276 PMCID: PMC4623073 DOI: 10.1007/s12282-014-0523-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 02/03/2014] [Indexed: 11/11/2022]
Abstract
Background The aim of this study was to investigate the maintenance of volume as a spacer by comparing vascular supply and apoptosis in an implanted autologous-free dermal fat graft (FDFG) and free fat graft (FFG). An autologous FDFG is a material used in plastic surgery and oncoplastic breast surgery that is ideal for immediate volume replacement after partial mastectomy because of its easy availability and minimal invasion of the donor site; however, immunohistochemical findings and survival procedures have not yet been reported. Methods An experimental protocol using a unique animal model was designed for the present study. The expression of vascular endothelial growth factor (VEGF) was measured in FDFGs and FFGs implanted onto the pectoral major muscle of Wistar rats. Thirty Wistar rats were divided into two groups and postoperatively 1, 2, 4, 8, and 16 weeks (POW1, 2, 4, 8, 16). Six samples from three rats in each group were used as control samples (POW0). Results The thickness of the implanted FDFG was not significantly different from the control sample at POW1, 2, 4, 8, and 16 between FDFG and FFG group; however, the thickness at POW8 and 16 was significantly lesser in the FFG group than in the control samples. The average proportion of fatty tissue to whole tissue ranged from 34.2 to 48.6 % in the FDFG group and from 57.2 to 76.7 % in the FFG group during the observation period; however, there was no significant difference in the proportion of fatty tissue between these two groups. There were no significant differences between the average number of VEGF-positive cells in the FDFG group and the FFG group at POW1, 2, 4, 8, and 16. The average number of TUNEL-positive cells in the early period at POW1 was significantly lower in the FDFG group than in the FFG group. Conclusions This rat model was useful for investigating the mechanisms of angiogenesis, apoptosis, structure maintenance, and fibromatous changes. From the present experimental study, we believe that FDFG is one of the most convenient materials currently available to repair small defects at the time of BCS even in the clinical field.
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Affiliation(s)
- Tadao Mizoguchi
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Yuko Kijima
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan.
| | - Munetsugu Hirata
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Koichi Kaneko
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Hideo Arima
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Akihiro Nakajo
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Michiyo Higashi
- Division of Human Pathology, Department of Oncology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Kazuhiro Tabata
- Division of Human Pathology, Department of Oncology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Chihaya Koriyama
- Department of Epidemiology and Preventive Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Takaaki Arigami
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Yoshikazu Uenosono
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Hiroshi Okumura
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Kosei Maemura
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Sumiya Ishigami
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Heiji Yoshinaka
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Yoshiaki Shinden
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Shinichi Ueno
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Shoji Natsugoe
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8520, Japan
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14
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Kijima Y, Yoshinaka H, Shinden Y, Hirata M, Nakajo A, Arima H, Okumura H, Kurahara H, Ishigami S, Natsugoe S. Oncoplastic breast surgery for centrally located breast cancer: a case series. Gland Surg 2014; 3:62-73. [PMID: 25083497 PMCID: PMC4115775 DOI: 10.3978/j.issn.2227-684x.2013.11.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 11/11/2013] [Indexed: 11/14/2022]
Abstract
Oncoplastic breast surgery (OBS), which combines the concepts of oncologic and plastic surgery, is becoming more common worldwide. We herein report the results of OBS in Japanese patients with centrally located breast cancer (CLBC) and Paget's disease. We performed OBS combining partial mastectomy and immediate volume replacement on patients with non-ptotic and/or small breasts, and volume reduction surgery for patients with ptotic breasts, as reported in Western countries. Japanese encounters are described in this report as a case series.
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Affiliation(s)
- Yuko Kijima
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan
| | - Heiji Yoshinaka
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan
| | - Yoshiaki Shinden
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan
| | - Munetsugu Hirata
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan
| | - Akihiro Nakajo
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan
| | - Hideo Arima
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan
| | - Hiroshi Okumura
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan
| | - Hiroshi Kurahara
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan
| | - Sumiya Ishigami
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan
| | - Shoji Natsugoe
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1, Sakuragaoka, Kagoshima 890-8520, Japan
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15
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Scuderi N, Ceccarelli S, Onesti MG, Fioramonti P, Guidi C, Romano F, Frati L, Angeloni A, Marchese C. Human adipose-derived stromal cells for cell-based therapies in the treatment of systemic sclerosis. Cell Transplant 2013; 22:779-95. [PMID: 22526170 DOI: 10.3727/096368912x639017] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The present study was designed to evaluate the clinical outcome of cell-based therapy with cultured adipose derived stromal cells (ASCs) for the treatment of cutaneous manifestations in patients affected by systemic sclerosis (SSc). ASCs have an extraordinary developmental plasticity, including the ability to undergo multilineage differentiation and self-renewal. Moreover, ASCs can be easily harvested from small volumes of liposuction aspirate, showing great in vitro viability and proliferation rate. Here we isolated, characterized, and expanded ASCs, assessing both their mesenchymal origin and their capability to differentiate towards the adipogenic, osteogenic, and chondrogenic lineage. We developed an effective method for ASCs transplantation into sclerodermic patients by means of a hyaluronic acid (HA) solution, which allowed us to achieve precise structural modifications. ASCs were isolated from subcutaneous adipose tissue of six sclerodermic patients and cultured in a chemical-defined medium before autologous transplantation to restore skin sequelae. The results indicated that transplantation of a combination of ASCs in HA solution determined a significant improvement in tightening of the skin without complications such as anechoic areas, fat necrosis, or infections, thus suggesting that ASCs are a potentially valuable source of cells for skin therapy in rare diseases such as SSc and generally in skin disorders.
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Affiliation(s)
- Nicolò Scuderi
- Department of Surgery P. Valdoni, University Sapienza, Rome, Italy
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Oncoplastic breast surgery combining partial mastectomy with immediate breast reshaping using a keyhole-shaped skin glandular flap for Paget’s disease. Surg Today 2013; 44:1783-8. [DOI: 10.1007/s00595-013-0687-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 07/19/2013] [Indexed: 10/26/2022]
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Oncoplastic breast surgery combining periareolar mammoplasty with volume displacement using a crescent-shaped cutaneous flap for early breast cancer in the upper quadrant. Surg Today 2013; 43:946-53. [DOI: 10.1007/s00595-013-0506-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 10/26/2012] [Indexed: 12/31/2022]
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Kijima Y, Yoshinaka H, Hirata M, Shinden Y, Ishigami S, Nakajo A, Arima H, Arigami T, Okumura H, Natsugoe S. Oncoplastic Breast Surgery Using Spindle Shaped-Partial Mastectomy for Early Breast Cancer in the Upper Quadrant Area. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/mps.2013.32011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ozaki S, Ohara M, Shigematsu H, Sasada T, Emi A, Masumoto N, Kadoya T, Murakami S, Kataoka T, Fujii M, Arihiro K, Okada M. Technical feasibility and cosmetic advantage of hybrid endoscopy-assisted breast-conserving surgery for breast cancer patients. J Laparoendosc Adv Surg Tech A 2012; 23:91-9. [PMID: 23272727 DOI: 10.1089/lap.2012.0224] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We developed a new procedure called hybrid endoscopy-assisted breast-conserving surgery (EBCS), which consists of a combination of plastic surgery and endoscopic surgery techniques. The purpose of this study was retrospectively to analyze the clinical outcome of hybrid EBCS and compare the cosmetic outcomes between hybrid EBCS and conventional breast-conserving surgery (CBCS). PATIENTS AND METHODS We reviewed medical records of patients who had undergone hybrid EBCS (n=73) or CBCS (n=90) between May 2005 and April 2011 and had been followed up in our department until March 2012. The clinical outcomes and cosmetic outcomes of these two groups were compared. The safety of hybrid EBCS was also analyzed by confirming its complications and pathological surgical margin. RESULTS In the hybrid EBCS group, operation time was longer by 30-50 minutes. Blood loss was not significantly different between the two groups. The surgical margin of hybrid EBCS was as follows: 1 patient (1.4%) had a positive margin, 4 patients (5.5%) had a margin of <2 mm, in 9 patients (12.3%) the margin was ≥2 mm and <5 mm, and in 59 patients (80.8%) it was ≥5 mm. Seven cases (9.6%) of postoperative complications occurred in 6 hybrid EBCS patients. To date, no local recurrence has been observed in hybrid EBCS patients (postoperative observation period, 18.1±5.6 months). Compared with the CBCS group, the hybrid EBCS group had better cosmetic results, especially with a less noticeable operative scar (P<.01). CONCLUSIONS Hybrid EBCS can provide sufficient free margin, and its surgical curability is acceptable. Additionally, this method is superior to CBCS in terms of cosmetic outcome.
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Affiliation(s)
- Shinji Ozaki
- Department of Surgical Oncology Research, Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
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Kijima Y, Yoshinaka H, Hirata M, Nakajo A, Arima H, Ishigami S, Arigami T, Okumura H, Natsugoe S. Immediate volume replacement using a modified free dermal fat graft from the lateral abdomen for a patient with early breast cancer. Int Cancer Conf J 2012. [DOI: 10.1007/s13691-012-0071-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Morishima H, Matsunami N, Hasegawa J, Mikata S, Shimizu J, Kim Y, Hirota M, Mokutani Y, Araki M, Miyake Y, Nezu R. Cosmetic evaluation following volume replacement using lateral tissue flap in breast-conserving surgery. Breast Cancer 2012; 21:28-32. [DOI: 10.1007/s12282-012-0355-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Accepted: 03/08/2012] [Indexed: 10/28/2022]
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Kijima Y, Yoshinaka H, Hirata M, Umekita Y, Sohda M, Koriyama C, Mizoguchi T, Arima H, Nakajo A, Ishigami S, Ueno S, Natsugoe S. Clinical and pathologic evaluation of implanted free dermal fat grafts after breast cancer surgery: a retrospective analysis. Surgery 2011; 151:444-55. [PMID: 21911237 DOI: 10.1016/j.surg.2011.07.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 07/07/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE The efficacy of immediate breast reconstruction using a free dermal fat graft (FDFG) was evaluated clinically. PATIENTS AND METHODS A total of 22 breasts in 21 patients who underwent partial mastectomy for early breast cancer involving mainly the inner upper quadrant were enrolled in this study. The defect was reconstructed immediately by filling it with an autologous FDFG. At 6 months and 1, 2, 3, 4, and 5 years postoperatively, the width (horizontal length) and thickness (distance perpendicular to skin) of the FDFG on computed tomography (CT) scans were measured. Histologic samples from the implanted FDFG were collected by core needle biopsy (CNB). The correlations between clinical findings and volume of the FDFG on CT and the proportion of fatty tissue in the CNB were examined statistically. Cosmetic results were also evaluated. RESULTS On CT, the mean width of the FDFG was 95%, 81%, 79%, 73%, 68%, and 47% and the mean thickness were 125%, 121%, 120%, 115%, 104%, and 103% at 6 months, and 1-5 years postoperatively, respectively. In the CNB samples, the mean fatty tissue distribution was 76%, 63%, and 54% at 1 year, 1-4 years, and >4 years postoperatively, respectively. The percent change in the width of the FDFG at 6 months after the operation displayed a significant negative correlation with the postmenopausal period and a significant positive correlation with the maximum surgical margin. On CT, thickness was negatively correlated with the size of the resected breast tissue, and thickness of the implanted FDFG. No clinicopathologic factors or technical factors were related to FDFG outcome and the proportion of fat tissue in the CNB sample, except for axillary dissection. Nineteen of 21 patients had good to excellent cosmesis. CONCLUSION FDFG implanted into breast defects after partial mastectomy undergo mild resorption and degeneration to fibrous tissue, but most patients have good to excellent cosmesis.
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Affiliation(s)
- Yuko Kijima
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Sakuragaoka, Kagoshima, Japan.
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Oncoplastic surgery in Japanese patients with breast cancer close to the areola: partial mastectomy using periareolar mammoplasty: a case report. Case Rep Surg 2011; 2011:121985. [PMID: 22606571 PMCID: PMC3350227 DOI: 10.1155/2011/121985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 07/13/2011] [Indexed: 11/21/2022] Open
Abstract
We report the results of oncoplastic surgery in two Japanese patients with early breast cancer. Their breasts were large and ptotic, and their lesions, which were close to the areola, were considered to be suitable for breast conservative surgery. Oncoplastic surgery involving partial resection of the gland and a periareolar mammoplasty were performed. The technique was easy to perform, and the cosmetic outcome was excellent.
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