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Dhoundiyal S, Alam MA. Advancements in Biotechnology and Stem Cell Therapies for Breast Cancer Patients. Curr Stem Cell Res Ther 2024; 19:1072-1083. [PMID: 37815191 DOI: 10.2174/011574888x268109230924233850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/09/2023] [Accepted: 08/18/2023] [Indexed: 10/11/2023]
Abstract
This comprehensive review article examines the integration of biotechnology and stem cell therapy in breast cancer diagnosis and treatment. It discusses the use of biotechnological tools such as liquid biopsies, genomic profiling, and imaging technologies for accurate diagnosis and monitoring of treatment response. Stem cell-based approaches, their role in modeling breast cancer progression, and their potential for breast reconstruction post-mastectomy are explored. The review highlights the importance of personalized treatment strategies that combine biotechnological tools and stem cell therapies. Ethical considerations, challenges in clinical translation, and regulatory frameworks are also addressed. The article concludes by emphasizing the potential of integrating biotechnology and stem cell therapy to improve breast cancer outcomes, highlighting the need for continued research and collaboration in this field.
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Affiliation(s)
- Shivang Dhoundiyal
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar
Pradesh, India
| | - Md Aftab Alam
- Department of Pharmacy, School of Medical and Allied Sciences, Galgotias University, Greater Noida, Uttar
Pradesh, India
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2
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Quality of life after autologous fat transfer additional to prosthetic breast reconstruction in women after breast surgery: A systematic review. Eur J Surg Oncol 2020; 47:772-777. [PMID: 33243607 DOI: 10.1016/j.ejso.2020.10.021] [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: 06/19/2020] [Revised: 10/13/2020] [Accepted: 10/18/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Breast cancer is the most frequent form of cancer among women worldwide. Reconstructive surgery may improve the quality of life (QoL), after mastectomy. Various techniques are used to reconstruct the female breast; however, few is known about its specific post-surgery influence represented in patient-reported outcomes. OBJECTIVE This systematic review assesses the difference in patient-reported QoL between prosthetic reconstruction alone, and prosthetic reconstruction with additional autologous fat transfer (AFT). DATA SOURCES A literature search was performed in PubMed, Embase, Cochrane and CINAHL online databases from inception to February 11th, 2020. STUDY SELECTION Inclusion and exclusion criteria were used to assess the eligibility of the retrieved articles. The only eligible studies were cohort studies. DATA COLLECTION AND ANALYSIS Relevant data for the research question was extracted from the articles and systematically documented. Results not contributing to answering the objective were intentionally left out. No meta-analysis was realized. RESULTS This systematic review resulted in the inclusion of only six relevant studies, all cohort studies, consisting of 1437 unique patients. These studies evaluated the quality of life of patients by means of the validated BREAST-Q questionnaire. Outcomes varied for which reason no definite answer could be provided to whether additional AFT results in a higher QoL. CONCLUSIONS It is unclear whether additional AFT after prosthetic surgery leads to a higher QoL when compared to sole prosthetic reconstruction or not. Additional studies, assessing the QoL of patients who received additional AFT, are required to draw solid conclusions. LEVEL OF EVIDENCE Level III; systematic literature review of cohort studies.
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3
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Surgical Management of the Explant Patient: An Update on Options for Breast Contouring and Volume Restoration. Plast Reconstr Surg 2020; 146:978-985. [PMID: 33136939 DOI: 10.1097/prs.0000000000007288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast implant removal is becoming a common procedure in light of the current events and controversies with silicone breast implants. The authors believe strongly in informing patients about the indications and options regarding both explantation and the management of the secondary breast deformity. METHODS Relevant literature regarding the management of the explant patient was reviewed and organized to provide an update on prior publications addressing the explant patient population. RESULTS Surgical management options after implant removal include breast contouring and volume restoration. Fat augmentation has been used in both aesthetic and reconstructive breast surgery. CONCLUSIONS The authors review the surgical management for explantation, breast contouring, and autologous fat grafting for volume restoration. In the explant patient, autologous fat grafting serves as a reliable option for volume restoration.
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O'Connor RÍ, Kiely PA, Dunne CP. The relationship between post-surgery infection and breast cancer recurrence. J Hosp Infect 2020; 106:522-535. [PMID: 32800825 DOI: 10.1016/j.jhin.2020.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/06/2020] [Indexed: 02/06/2023]
Abstract
Breast cancer is the second most prevalent form of cancer in women worldwide, with surgery remaining the standard treatment. The adverse impact of the surgery remains controversial. It has been suggested that systemic factors during the postoperative period may increase the risk of recurrence, specifically surgical site infection (SSI). The aim of this review was to critically appraise current published literature regarding the influence of SSIs, after primary breast cancer surgery, on breast cancer recurrence, and to delve into potential links between these. This systematic review adopted two approaches: to identify the incidence rates and risk factors related to SSI after primary breast cancer surgery; and, secondly, to examine breast cancer recurrence following SSI occurrence. Ninety-nine studies with 484,605 patients were eligible in the SSI-focused searches, and 53 studies with 17,569 patients for recurrence-focused. There was a 13.07% mean incidence of SSI. Six-hundred and thirty-eight Gram-positive and 442 Gram-negative isolates were identified, with methicillin-susceptible Staphylococcus aureus and Escherichia coli most commonly identified. There were 2077 cases of recurrence (11.8%), with 563 cases of local recurrence, 1186 cases of distant and 25 cases which recurred both locally and distantly. Five studies investigated the association between SSI and breast cancer recurrence with three concluding that an association did exist. In conclusion, there is association between SSI and adverse cancer outcomes, but the cellular link between them remains elusive. Confounding factors of retrospective study design, surgery type and SSI definition make results challenging to compare and interpret. A standardized prospective study with appropriate statistical power is justified.
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Affiliation(s)
- R Í O'Connor
- School of Medicine, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland; Bernal Institute, University of Limerick, Ireland
| | - P A Kiely
- School of Medicine, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland; Bernal Institute, University of Limerick, Ireland; Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - C P Dunne
- School of Medicine, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland; Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland.
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5
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International Expert Panel Consensus on Fat Grafting of the Breast. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2426. [PMID: 31772879 PMCID: PMC6846285 DOI: 10.1097/gox.0000000000002426] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 07/02/2019] [Indexed: 12/24/2022]
Abstract
Background Autologous fat grafting has broad applications in reconstructive and aesthetic breast surgery as a natural filler and for its regenerative purposes. Despite the widespread use of fat grafting, there remains no shared consensus on what constitutes the optimal fat grafting technique and its oncological safety. For this reason, the authors of this study have organized a Survey and an International Consensus Conference that was held at the Aesthetic Breast Meeting in Milan (December 15, 2018). Methods All studies on fat grafting, both for breast aesthetic and reconstructive purposes, were electronically screened. The literature review led to 17 "key questions" that were used for the Survey. The authors prepared a set of 10 "key statements" that have been discussed in a dedicated face-to-face session during the meeting. Results The 10 key statements addressed all the most debated topics on fat grafting of the breast. Levels of evidence for the key statements ranged from III to IV with 2 statements (20%) supported by a level of evidence III and 6 statements (60%) by level of evidence IV. Overall consensus was reached for 2 statements (20%) with >75% agreement reached for 7 statements. Conclusions The survey demonstrated a diversity of opinion and attitude among the panelists with regard to technique. Clear recommendations for evidence-based clinical practice for fat grafting use both in aesthetic and reconstructive breast surgery could not be defined due to the scarcity of level 1 or 2 studies.
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6
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Variability in breast cancer surgery training across Europe: An ESSO-EUSOMA international survey. Eur J Surg Oncol 2019; 45:567-572. [DOI: 10.1016/j.ejso.2019.01.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 01/02/2019] [Indexed: 12/31/2022] Open
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Lindegren A, Schultz I, Wickman M. Improved patient-reported outcomes after autologous fat transplantation and corrective surgery after breast surgery. J Plast Surg Hand Surg 2019; 53:111-118. [PMID: 30652957 DOI: 10.1080/2000656x.2018.1561456] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Autologous fat transplantation (AFT) is being increasingly used to improve the results after breast-conserving surgery and breast reconstruction. However, studies on patient-reported outcomes (PROs) and health-related quality of life (HRQoL) after AFT are scarce. The aim of this prospective longitudinal case-series study was to assess PRO in women who had undergone AFT after surgery for breast cancer or risk-reducing mastectomy. METHODS Fifty women, who had undergone breast-conserving surgery or breast reconstruction, needing corrective surgery, were consecutively included between 2008 and 2013. A 20-item study-specific questionnaire (SSQ) and the Short Form Health Survey (SF-36) were used pre-operatively and 6 months, 1 year and 2 years post-operatively, to evaluate PRO and HRQoL. RESULTS The patients underwent three (1-4) AFT procedures, with the injection of 164 ml (median) (range 40-516) fat. Thirty-eight and 34 patients completed the study-specific questionnaire and the SF-36, respectively, both pre-operatively and after 2 years. Sixteen of the 20 items in the SSQ were improved after 2 years, including breast size (p < 0.0001), shape (p < 0.0001), appearance (p < 0.0001), softness of the breast (p = 0.001), pain in the region (p = 0.005), scarring from previous breast surgery (p < 0.001) and willingness to participate in public physical activities (p < 0.001). HRQoL did not largely differ before and after AFT, or between the study group and a reference population. CONCLUSIONS AFT alone or in combination with other corrective surgical procedures, improved PRO after breast-conserving surgery and breast reconstruction in both irradiated and non-irradiated women.
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Affiliation(s)
- Anna Lindegren
- a Department of Molecular Medicine and Surgery , Karolinska Institutet , Stockholm , Sweden.,b Department of Surgery , South Hospital , Stockholm , Sweden
| | - Inkeri Schultz
- a Department of Molecular Medicine and Surgery , Karolinska Institutet , Stockholm , Sweden.,c Plastic and Reconstructive Surgery , Karolinska University Hospital , Stockholm , Sweden
| | - Marie Wickman
- a Department of Molecular Medicine and Surgery , Karolinska Institutet , Stockholm , Sweden.,c Plastic and Reconstructive Surgery , Karolinska University Hospital , Stockholm , Sweden.,d Sophiahemmet University , Stockholm , Sweden
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8
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Krastev TK, Alshaikh GA, Hommes J, Piatkowski A, van der Hulst RR. Efficacy of autologous fat transfer for the correction of contour deformities in the breast: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2018; 71:1392-1409. [DOI: 10.1016/j.bjps.2018.05.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 05/09/2018] [Accepted: 05/27/2018] [Indexed: 12/16/2022]
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9
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Krastev TK, Schop SJ, Hommes J, Piatkowski AA, Heuts EM, van der Hulst RRWJ. Meta-analysis of the oncological safety of autologous fat transfer after breast cancer. Br J Surg 2018; 105:1082-1097. [PMID: 29873061 PMCID: PMC6055707 DOI: 10.1002/bjs.10887] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/09/2018] [Accepted: 04/07/2018] [Indexed: 12/21/2022]
Abstract
Lipofilling ok
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Affiliation(s)
- T K Krastev
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S J Schop
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J Hommes
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A A Piatkowski
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E M Heuts
- Department of General Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - R R W J van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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Bennett KG, Qi J, Kim HM, Hamill JB, Wilkins EG, Mehrara BJ, Kozlow JH. Association of Fat Grafting With Patient-Reported Outcomes in Postmastectomy Breast Reconstruction. JAMA Surg 2017; 152:944-950. [PMID: 28658472 DOI: 10.1001/jamasurg.2017.1716] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Fat grafting has proven to be a useful adjunct to breast reconstruction for the treatment of contour irregularities and volume deficits, but the proposed US Food and Drug Administration regulations may severely limit the ability of plastic surgeons to continue its use in this clinical context. Objective To determine whether fat grafting is associated with patient-reported outcomes (PROs) in patients undergoing breast reconstruction. Design, Setting, and Participants A longitudinal, multicenter, prospective cohort study was conducted between February 1, 2012, and July 31, 2016, at the 11 sites associated with the Mastectomy Reconstruction Outcomes Consortium Study. Eligible patients included women 18 years or older presenting for breast reconstruction after mastectomy with 2 years or more of follow-up. All primary procedure types (implant based and flap based) were eligible. Patients were excluded if they had not completed breast mound reconstruction by 1 year after starting reconstruction. Interventions Fat grafting as an adjunct to breast mound reconstruction. Main Outcomes and Measures Primary end points were patient-reported outcome measures as assessed by the validated BREAST-Q survey, with higher scores on a 0- to 100-point scale indicating better health-related quality of life. Survey subscales included breast satisfaction, as well as psychosocial, physical, and sexual well-being. Patient-reported outcomes were compared between those who received and did not receive fat grafting. Results A total of 2048 women were included (mean [SD] age, 49.4 [10] years), with 165 (8.1%) undergoing fat grafting between years 1 and 2. One year postoperatively, patients who later underwent fat grafting reported significantly lower breast satisfaction (adjusted mean difference [AMD], -4.74; 95% CI, -8.21 to -1.28; P = .008), psychosocial well-being (AMD, -3.87; 95% CI, -7.33 to -0.40; P = .03), and sexual well-being (AMD, -5.59; 95% CI, -9.70 to -1.47; P = .008), compared with those who did not receive subsequent fat grafting. Following the procedure, the fat-grafted cohort reported similar breast satisfaction (AMD, -0.68; 95% CI, -4.42 to 3.06; P = .72), psychosocial well-being (AMD, -0.59; 95% CI, -3.92 to 2.74; P = .73), and sexual well-being (AMD, -2.94; 95% CI, -7.01 to 1.12; P = .15) 2 years postoperatively. Conclusions and Relevance Fat grafting may improve breast satisfaction, psychosocial well-being, and sexual well-being in patients undergoing breast reconstruction.
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Affiliation(s)
- Katelyn G Bennett
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor
| | - Ji Qi
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor
| | - Hyungjin M Kim
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor.,Department of Biostatistics, University of Michigan, Ann Arbor
| | - Jennifer B Hamill
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor
| | - Edwin G Wilkins
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor
| | - Babak J Mehrara
- Plastic and Reconstructive Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jeffrey H Kozlow
- Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor
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11
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Brown A, Kabir M, Sherman K, Meybodi F, French J, Elder E. Patient reported outcomes of autologous fat grafting after breast cancer surgery. Breast 2017. [DOI: 10.1016/j.breast.2017.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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12
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Abstract
Cosmetic and reconstructive surgeries always have a primary aim of the best outcome for the patient, with a big emphasis on the aesthetics. Lipomodelling is one such technique, originally described over a century ago but still used to this day, to provide a patient with the highest quality results. This is particularly true for lipomodelling of the breast, whether it be purely cosmetic, or for a post-mastectomy reconstruction for a breast cancer patient. Lipomodelling provides an effective way of restoring and even improving the look and aesthetics of the breast and of helping achieve the patient's expectations. With the added advantage of being autologous, the procedure is safe and effective. This review discusses the latest guidelines and literature on autologous lipomodelling.
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Affiliation(s)
- Ketan Agarwal
- Core Surgical Trainee, Department of Urology, Royal Liverpool and Broadgreen University Hospital, Liverpool L7 8XP
| | - Meera Mistry
- Foundation Year 1 Doctor, Department of Respiratory Medicine, Royal Liverpool and Broadgreen University Hospital, Liverpool
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13
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De Decker M, De Schrijver L, Thiessen F, Tondu T, Van Goethem M, Tjalma WA. Breast cancer and fat grafting: efficacy, safety and complications-a systematic review. Eur J Obstet Gynecol Reprod Biol 2016; 207:100-108. [PMID: 27835828 DOI: 10.1016/j.ejogrb.2016.10.032] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 10/07/2016] [Accepted: 10/21/2016] [Indexed: 01/19/2023]
Abstract
Autologous fat grafting (AFG) or lipofilling is nowadays a popular technique for breast reconstruction after breast cancer surgery. There is debate regarding the oncological safety and risks of this procedure in breast cancer patients. A systematic review of the literature published between January first 1995 and October first 2016 was conducted regarding the efficacy, safety and complications of this technique in breast cancer patients after their cancer treatment. The databases PubMed, Science Direct and Thomson Reuters Web of Science were used to search for qualified articles. Inclusion criteria were women with a personal history of breast cancer and at least one lipofilling procedure. Only studies containing a minimum of 20 patients were included in this systematic review. The search yielded a total of 23 suitable articles: 18 case series, 4 retrospective cohort studies and one prospective cohort study. The systematic review encompassed a total of 2419 patients. Medical imaging was used in the majority of the studies to assess the follow-up. Mammography was the most popular technique (65.2%), followed by ultrasound (47.8%) and MRI (30.4%). The prevalence of complications was the following: fat necrosis in 5.31%, benign lesions, like cysts or calcifications in 8.78%, infections in 0.96% and local cancer recurrence in 1.69%. AFG or lipofilling appears to be an oncological safe technique with a low morbidity in women with a history of breast cancer. In order to have a better understanding and evidence of the oncological safety a randomised controlled trial is urgently needed. We further recommend that all AFG be registered in the cancer register.
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Affiliation(s)
- M De Decker
- Multidisciplinary Breast Clinic Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium
| | - L De Schrijver
- Multidisciplinary Breast Clinic Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium
| | - F Thiessen
- Multidisciplinary Breast Clinic Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium; Plastic Surgery Unit, Antwerp University Hospital, Antwerpen, Belgium
| | - T Tondu
- Multidisciplinary Breast Clinic Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium; Plastic Surgery Unit, Antwerp University Hospital, Antwerpen, Belgium
| | - M Van Goethem
- Multidisciplinary Breast Clinic Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium; Department of Radiology, Antwerp University Hospital, Antwerpen, Belgium
| | - W A Tjalma
- Multidisciplinary Breast Clinic Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium; Unit of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium.
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14
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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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15
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Spear SL, Coles CN, Leung BK, Gitlin M, Parekh M, Macarios D. The Safety, Effectiveness, and Efficiency of Autologous Fat Grafting in Breast Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e827. [PMID: 27622095 PMCID: PMC5010318 DOI: 10.1097/gox.0000000000000842] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 06/08/2016] [Indexed: 01/15/2023]
Abstract
Background: For years, the safety and effectiveness of autologous fat grafting (AFG) for breast reconstruction have been in question, with particular concern over fat necrosis, calcifications, cyst formation, and interfering with the detection of breast cancer. However, increasing evidence suggests that the complication rates and clinical results are generally acceptable to both clinicians and patients. The emerging challenge is the numerous AFG techniques and systems, where there are limited knowledge and data. The objective of this study was to conduct a literature review that focuses on the safety, effectiveness, and efficiency of various AFG techniques as applied to the breast. Methods: A PubMed search using terms related to AFG was performed over a 5-year period (April 1, 2010–April 30, 2015). Original articles focused on AFG to the breast, with outcomes on safety, effectiveness, and efficiency, were included. Results: Five hundred ninety-eight articles were identified with 36 articles included (n = 4306 patients). Satisfaction rates were high although the prevalence of complications was low—similar to previous findings. Seven studies reported average operating room time with an overall mean of 125 minutes (range: 40–210). The mean volume of fat harvested was 558 mL (range: 120–1299), and fat injected was 145 mL (range: 20–607). A positive association between injection volume and operating time was observed. Conclusions: This review validates previous findings on the safety and effectiveness of AFG to the breast and highlights its efficiency. The efficiency data available, although limited, suggest that there is an opportunity to achieve time and cost savings while not sacrificing safety and effectiveness.
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Affiliation(s)
- Scott L Spear
- Georgetown University Hospital, Washington, D.C.; BluePath Solutions, Santa Monica, Calif.; and Acelity, Bridgewater, N.J
| | - Courtney N Coles
- Georgetown University Hospital, Washington, D.C.; BluePath Solutions, Santa Monica, Calif.; and Acelity, Bridgewater, N.J
| | - Braden K Leung
- Georgetown University Hospital, Washington, D.C.; BluePath Solutions, Santa Monica, Calif.; and Acelity, Bridgewater, N.J
| | - Matthew Gitlin
- Georgetown University Hospital, Washington, D.C.; BluePath Solutions, Santa Monica, Calif.; and Acelity, Bridgewater, N.J
| | - Mousam Parekh
- Georgetown University Hospital, Washington, D.C.; BluePath Solutions, Santa Monica, Calif.; and Acelity, Bridgewater, N.J
| | - David Macarios
- Georgetown University Hospital, Washington, D.C.; BluePath Solutions, Santa Monica, Calif.; and Acelity, Bridgewater, N.J
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16
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The Oncologic Safety of Breast Fat Grafting and Contradictions Between Basic Science and Clinical Studies: A Systematic Review of the Recent Literature. Ann Plast Surg 2016; 75:471-9. [PMID: 26360655 DOI: 10.1097/sap.0000000000000604] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Fat grafting is increasingly popular and is becoming a common practice in plastic surgery for postmastectomy breast reconstruction and aesthetic breast augmentation; however, concerns over the oncologic safety remains a controversial and hot topic among scientists and surgeons. Basic science and laboratory research repeatedly show a potentially dangerous effect of adipose-derived stem cells on breast cancer cells; however, clinical research, although limited, continually fails to show an increase in breast cancer recurrence after breast fat grafting, with the exception of 1 small study on a subset patient population with intraepithelial neoplasm of the breast. The aim of this review is to summarize the recent conflicting basic science and clinical data to better understand the safety of breast fat grafting from an oncological perspective.
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Two-Stage Latissimus Dorsi Flap with Implant for Unilateral Breast Reconstruction: Getting the Size Right. Arch Plast Surg 2016; 43:197-203. [PMID: 27018318 PMCID: PMC4807175 DOI: 10.5999/aps.2016.43.2.197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/03/2015] [Accepted: 11/05/2015] [Indexed: 11/27/2022] Open
Abstract
Background The aim of unilateral breast reconstruction after mastectomy is to craft a natural-looking breast with symmetry. The latissimus dorsi (LD) flap with implant is an established technique for this purpose. However, it is challenging to obtain adequate volume and satisfactory aesthetic results using a one-stage operation when considering factors such as muscle atrophy, wound dehiscence and excessive scarring. The two-stage reconstruction addresses these difficulties by using a tissue expander to gradually enlarge the skin pocket which eventually holds an appropriately sized implant. Methods We analyzed nine patients who underwent unilateral two-stage LD reconstruction. In the first stage, an expander was placed along with the LD flap to reconstruct the mastectomy defect, followed by gradual tissue expansion to achieve overexpansion of the skin pocket. The final implant volume was determined by measuring the residual expander volume after aspirating the excess saline. Finally, the expander was replaced with the chosen implant. Results The average volume of tissue expansion was 460 mL. The resultant expansion allowed an implant ranging in volume from 255 to 420 mL to be placed alongside the LD muscle. Seven patients scored less than six on the relative breast retraction assessment formula for breast symmetry, indicating excellent breast symmetry. The remaining two patients scored between six and eight, indicating good symmetry. Conclusions This approach allows the size of the eventual implant to be estimated after the skin pocket has healed completely and the LD muscle has undergone natural atrophy. Optimal reconstruction results were achieved using this approach.
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Zhu L, Mohan AT, Vijayasekaran A, Hou C, Sur YJ, Morsy M, Saint-Cyr M. Maximizing the Volume of Latissimus Dorsi Flap in Autologous Breast Reconstruction with Simultaneous Multisite Fat Grafting. Aesthet Surg J 2016; 36:169-78. [PMID: 26546990 DOI: 10.1093/asj/sjv173] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2015] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The pedicled latissimus dorsi (LD) flap serves an important function in breast reconstruction, but its utility is limited by its inability to provide sufficient breast volume. OBJECTIVES The purpose of this preliminary report was to review the techniques and outcomes of utilizing fat-grafted, volume-enhanced LD flap transfer with fat grafting recipient sites in autologous breast reconstruction. METHODS A retrospective study was performed of 10 patients (14 breasts) who underwent autologous breast reconstruction utilizing the LD flap transfer technique and simultaneous fat grafting between August 2012 and September 2014. Multilayer, multisite fat grafting was performed to the LD muscle, LD skin paddle, mastectomy skin flaps, and the pectoralis major and serratus muscles simultaneously with the LD flap transfer. RESULTS Three patients underwent an immediate breast reconstruction, four underwent a delayed breast reconstruction, and four underwent a tertiary breast reconstruction following previously failed breast reconstructions (one patient underwent each of the first two procedures, one on each breast). The average age of the patients was 55 years (range, 39-76 years), the average body mass index of the patients was 29.3 (range, 19.6-39.9), and the average fat grafting volume for the patients was 176 mL (range, 50-300 mL). There was 100% flap survival and complete wound healing. No seroma or fat grafting-related complications were clinically detected. Three patients required additional fat grafting. CONCLUSIONS The fat-grafted, volume-enhanced LD flap procedure with fat grafting recipient sites offers a simple and safe technique for autologous breast reconstruction, with low morbidity and fast recovery. It can be a useful alternative to utilizing abdomen-based flaps in autologous breast reconstruction or could be performed to salvage both implant-based and free-flap breast reconstructions. LEVEL OF EVIDENCE 4: Therapeutic.
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Affiliation(s)
- Lin Zhu
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
| | - Anita T Mohan
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
| | - Aparna Vijayasekaran
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
| | - Christine Hou
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
| | - Yoo Joon Sur
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
| | - Mohamed Morsy
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
| | - Michel Saint-Cyr
- Dr Zhu is an Attending Surgeon, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China, and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Mohan is a Resident. Restoration of Appearance and Function Charitable Trust (RAFT), Middlesex, UK; and a Research Fellow, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Dr Aparna is a Resident, Drs Yoo Joon and Mohamed are Research Fellows, and Dr Saint-Cyr is a Professor, Division of Plastic Surgery, Mayo Clinic, Rochester, MN, USA. Ms Hou is a Medical Student, Mayo Medical School, Rochester, MN, USA
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Kristensen RN, Gunnarsson GL, Børsen-Koch M, Reddy A, Ømark H, Sørensen JA, Thomsen JB. Fast and simple fat grafting of the breast. Gland Surg 2015; 4:572-6. [PMID: 26645013 DOI: 10.3978/j.issn.2227-684x.2015.08.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Fat grafting (FG) is being used at an escalating rate for correction of shape and volume of all types of breast surgery in order to optimize the aesthetic result in spite of an ongoing debate of the oncologic safety. In this paper we demonstrate our simple and fast sedimentation based FG technique in the attached video as visualized surgery. We have used this simple approach for 348 procedures in 176 women to optimize and correct the aesthetic result following all types of breast surgery. We prefer this simple technique as no technique has been shown to be superior to other more costly techniques and furthermore there are still questions about the oncologic safety in using adipose derived stem cells (ADSC). Simple fat harvesting using low vacuum and preparation by sedimentation is a fast and effective method to perform FG successfully for correction of shape and volume deficits of the breast following both ablative surgery as well as benign conditions with a high margin of safety.
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Affiliation(s)
- Rasmus Nygård Kristensen
- 1 Department of Plastic Surgery, Lillebaelt Hospital, Vejle/Odense University Hospital, Denmark ; 2 Department of Plastic Surgery, Telemark Hospital, Skien, Norway ; 3 Slagelse Emergency Department, Slagelse Hospital, Denmark
| | - Gudjon L Gunnarsson
- 1 Department of Plastic Surgery, Lillebaelt Hospital, Vejle/Odense University Hospital, Denmark ; 2 Department of Plastic Surgery, Telemark Hospital, Skien, Norway ; 3 Slagelse Emergency Department, Slagelse Hospital, Denmark
| | - Mikkel Børsen-Koch
- 1 Department of Plastic Surgery, Lillebaelt Hospital, Vejle/Odense University Hospital, Denmark ; 2 Department of Plastic Surgery, Telemark Hospital, Skien, Norway ; 3 Slagelse Emergency Department, Slagelse Hospital, Denmark
| | - Ashwin Reddy
- 1 Department of Plastic Surgery, Lillebaelt Hospital, Vejle/Odense University Hospital, Denmark ; 2 Department of Plastic Surgery, Telemark Hospital, Skien, Norway ; 3 Slagelse Emergency Department, Slagelse Hospital, Denmark
| | - Henrik Ømark
- 1 Department of Plastic Surgery, Lillebaelt Hospital, Vejle/Odense University Hospital, Denmark ; 2 Department of Plastic Surgery, Telemark Hospital, Skien, Norway ; 3 Slagelse Emergency Department, Slagelse Hospital, Denmark
| | - Jens Ahm Sørensen
- 1 Department of Plastic Surgery, Lillebaelt Hospital, Vejle/Odense University Hospital, Denmark ; 2 Department of Plastic Surgery, Telemark Hospital, Skien, Norway ; 3 Slagelse Emergency Department, Slagelse Hospital, Denmark
| | - Jørn Bo Thomsen
- 1 Department of Plastic Surgery, Lillebaelt Hospital, Vejle/Odense University Hospital, Denmark ; 2 Department of Plastic Surgery, Telemark Hospital, Skien, Norway ; 3 Slagelse Emergency Department, Slagelse Hospital, Denmark
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Hivernaud V, Lefourn B, Guicheux J, Weiss P, Festy F, Girard AC, Roche R. Autologous Fat Grafting in the Breast: Critical Points and Technique Improvements. Aesthetic Plast Surg 2015; 39:547-61. [PMID: 26085223 DOI: 10.1007/s00266-015-0503-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/12/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Breast augmentation or reconstruction is a major challenge in esthetic and reconstructive surgery. While autologous fat grafting (AFG) provides a natural filler and seems easy to harvest, AFG in breast surgery is still problematic especially due to the high resorption rate associated with megavolume transfer. Despite this pending issue, there is growing interest in this method, which is becoming more and more widespread, as can be seen by the recent increase in the number of clinical studies. This review aims to highlight recent knowledge in the technique of AFG to the breast and recent refined procedures to improve fat viability and long-term success of the graft. METHODS Clinical publications and trials of AFG to the breast from the past 5 years were examined. Attention was focused on the different AFG steps and the clinical outcomes, in order to highlight the strengths and weaknesses of the available protocols. RESULTS Recent studies have concentrated on new techniques to improve fat viability and graft intake. However, all of these studies use different protocols at each step of the procedure. Furthermore, results may vary depending on the technique used for fat harvesting and processing. CONCLUSION This review points out the recent advances in breast AFG techniques and their associated outcomes and complications. The bibliography has been carefully examined to reach a consensus so that recommendations could be made for each step of the technique with the aim of improving graft viability and long-term volume maintenance.
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Affiliation(s)
- Vincent Hivernaud
- STEMCIS, Plateforme CYROI, Sainte Clotilde, Ile de la Réunion, France,
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Spring MA, Macias LH, Nadeau M, Stevens WG. Secondary augmentation-mastopexy: indications, preferred practices, and the treatment of complications. Aesthet Surg J 2014; 34:1018-40. [PMID: 25168806 DOI: 10.1177/1090820x14543943] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Increasing the volume of the breast while simultaneously decreasing the skin envelope equates to surgery involving opposing forces. Increasing patient demand and the evolving perceptions of surgeons have led to the growing popularity of the combined augmentation-mastopexy operation. In turn, secondary augmentation-mastopexies and revisional surgeries of primary augmentation-mastopexies also have increased in popularity. In this article, the authors describe indications for secondary augmentation-mastopexy, techniques for performing this combined procedure safely and effectively, adjunctive procedures, potential pitfalls, and the treatment of complications.
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Affiliation(s)
- Michelle A Spring
- Drs Spring and Macias are Clinical Assistant Professors of Surgery and Dr Stevens is a Clinical Professor of Surgery in the Keck School of Medicine at the University of Southern California in Los AngelesDr Nadeau is an Aesthetic Surgery Fellow at the University of Southern California in Los Angeles
| | - Luis H Macias
- Drs Spring and Macias are Clinical Assistant Professors of Surgery and Dr Stevens is a Clinical Professor of Surgery in the Keck School of Medicine at the University of Southern California in Los AngelesDr Nadeau is an Aesthetic Surgery Fellow at the University of Southern California in Los Angeles
| | - Meghan Nadeau
- Drs Spring and Macias are Clinical Assistant Professors of Surgery and Dr Stevens is a Clinical Professor of Surgery in the Keck School of Medicine at the University of Southern California in Los AngelesDr Nadeau is an Aesthetic Surgery Fellow at the University of Southern California in Los Angeles
| | - W Grant Stevens
- Drs Spring and Macias are Clinical Assistant Professors of Surgery and Dr Stevens is a Clinical Professor of Surgery in the Keck School of Medicine at the University of Southern California in Los AngelesDr Nadeau is an Aesthetic Surgery Fellow at the University of Southern California in Los Angeles
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Liedtke C, Thill M, Hanf V, Schütz F. AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2014. Breast Care (Basel) 2014; 9:189-200. [PMID: 25177261 PMCID: PMC4132219 DOI: 10.1159/000363591] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Cornelia Liedtke
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig Holstein, Campus Lübeck, Germany
| | - Marc Thill
- Klinik für Gynäkologie und Geburtshilfe, Agaplesion Markus Krankenhaus, Frankfurt/M., Germany
| | - Volker Hanf
- Frauenklinik, Klinikum Fürth, Universitätsklinikum Heidelberg, Germany
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