Nerve Injuries in Aesthetic Breast Surgery: Systematic Review and Treatment Options

Quality of life and satisfaction after breast augmentation: A systematic review and meta-analysis of Breast-Q patient-reported outcomes

BACKGROUND

Breast augmentation ranks among the most popular plastic surgery procedures. Yet, reports on post-operative patient-reported quality of life (QoL) and satisfaction remain conflicting.

METHODS

A systematic review was conducted following the PRISMA guidelines. Three databases were searched for eligible studies that reported pre-and/or post-operative Breast-Q™ augmentation scores for patient QoL (psychosocial, sexual, and physical well-being) and/or satisfaction.

RESULTS

A total of 39 studies (53 patient cohorts and 18,322 patients) were included in the quantitative synthesis. The pairwise meta-analysis revealed significant improvements in patient-reported psychosocial (MD: +38.10) and sexual well-being (MD: +40.20) as well as satisfaction with breast (MD: +47.88) (all p < 0.00001). Physical well-being improved slightly after breast augmentation (MD: +6.97; p = 0.42). The single-arm meta-analysis yielded comparable results, with Breast-Q™ scores in psychosocial and sexual well-being as well as satisfaction with breast increasing from 37.2, 31.1, and 26.3 to 75.0, 70.6, and 72.7, respectively (all p < 0.00001). Physical well-being improved by 8.1 (75.8 pre-operatively to 83.9 post-operatively; p = 0.17). Subgroup analyses highlighted higher QoL and satisfaction following breast augmentation for purely esthetic purposes and alloplastic mammaplasty. Although patient-reported physical and sexual well-being increased in the long term, psychosocial well-being was the highest in the short term.

CONCLUSION

Patient satisfaction with breast, psychosocial, and sexual well-being increased significantly after breast augmentation. In contrast, patient-reported physical well-being yielded ambivalent results, varying by mammaplasty technique and post-operative follow-up time. Plastic surgeons should be sensitized about our findings to refine eligibility criteria and gain a deeper understanding of the patients' perceived surgical experience.

PROSPERO TRIAL REGISTRATION NO

CRD42023409605.

Nanographene-Au fine-tuning to intensify plasmonic-resonance of polymeric hybrid bionanosystem for synergistic phototherapy and nerve photobiomodulation

Here, we report the multi-photo-bioactivity of the plasmonic-nano graphitic coordinated polycaprolactone-based aligned nanofibrous scaffolds-based bionanosystem for photothermal breast and colon cancer therapies and peripheral nerve photobiomodulation. The size-optimized colloidal reduced graphene oxide (nRGO, 180 nm) nanosheets, for enhanced photothermal impact, were surface-functionalized with gold nanospheres (AuNPs) to prepare the nRGO@AuNP monodispersed nano-composite and then doped 2.0 mg of nRGO@AuNP in biocompatible and biodegradable polymer polycaprolactone (PCL) to fabricate the nRGO@AuNP-PCL (2.0 mg) plasmonic aligned nanofibrous scaffolds. More than 90% of cancer cells, breast cancer (MCF-7) as well as colon cancer (CT-26), ablated after 5 min of low NIR (808 nm) laser power (0.72 W/cm2) illumination with nRGO@AuNP-PCL (2.0 mg) aligned nanofibrous scaffolds. Besides, the nRGO@AuNP-PCL (2.0 mg) provided an extraordinary microenvironment for adhesion, nerve growth, proliferation, and differentiation of PC12 and S42 cells which mimics the natural extracellular matrix. The 2.5-fold increase in neurite length was observed with NIR illumination after 3 days whereas 1.7-fold was found without NIR illumination after 7 days in comparison to PCL (pure). The current findings will be useful to provide a new crucial approach for preparing biocompatible multifunctional composite plasmonic nanofibers as a highly efficient distinct platform for photothermal therapies and promising bioimplants to overcome the loss of sensation after cancer surgery through nerve photobiomodulation.

Bee Sting Venom as a Viable Therapy for Breast Cancer: A Review Article

Breast cancer is a kind of aggressive cancer that significantly affects women worldwide, thus making research on alternative and new therapies necessary. The potential impact of bee venom on breast cancer is the main subject of this analysis of this research article. Bee venom has drawn the attention of the world with the help of its constituent ingredients, namely the bioactive compounds, enzymes, and complex blend of proteins. They have a particularly varied chemical makeup and proven anti-cancer capabilities. This is a detailed review demonstrating the components of bee venom and their individual functions in fighting cancer, as well as the results of previously conducted in-vitro and in-vivo research. As described later, bee venom has given positive results in triggering apoptosis, preventing cell migration, inhibiting metastasis and invasion, and suppressing the existing breast cancer cells. It is found to have worked better along with the already existing chemotherapy treatments. These results were also proved with the help of various animal studies that showed reduced tumor development, reduced metastasis, and improved therapeutic effectiveness. Furthermore, certain studies and case reports from all over the world have exhibited consistent results in females affected by breast cancer. This study found that people receiving chemotherapy experienced improved health outcomes and reduced discomfort, with fewer negative side effects. It is important to conduct extensive research on the safety and effectiveness of this treatment because it is yet to be approved. The ideal dosage and administration methods must be explored in clinical trials. Moreover, it is imperative to evaluate the results of any combined treatments with current medications. There should be constant monitoring to prevent any potential side effects. Other important things like allergic reactions and hidden concerns should also be considered.

Occurrence and treatment of peripheral nerve injuries after cosmetic surgeries

Although non-invasive and minimally invasive aesthetic procedures increasingly dominate the cosmetic market, traditional plastic surgery remains the most effective improvement method. One of the most common complications in plastic surgery, peripheral nerve injuries, though has a low incidence but intrigued plastic surgeons globally. In this article, a narrative review was conducted using several databases (PubMed, EMBASE, Scopus, and Web of Science) to identify peripheral nerve injuries following cosmetic surgeries such as blepharoplasty, rhinoplasty, rhytidectomy, breast surgeries, and abdominoplasty. Surgery-related nerve injuries were discussed, respectively. Despite the low incidence, cosmetic plastic surgeries can cause iatrogenic peripheral nerve injuries that require special attention. The postoperative algorithm approaches can be effective, but the waiting and treatment processes can be long and painful. Preventive measures are undoubtedly more effective than postoperative remedies. The best means of preventing disease is having a good understanding of anatomy and conducting a careful dissection.

Shoulder function and health outcomes in newly diagnosed breast cancer patients receiving surgery: a prospective study

BACKGROUND

Breast cancer surgery is associated with upper-body morbidities that may last several years postsurgery. Research has not determined if the type of surgery leads to differential effects on shoulder function, activity levels, and QoL during the early rehabilitation period. The main objective of this study is to examine changes in shoulder function, health, and fitness outcomes from the day before to surgery to 6 months postsurgery.

PATIENTS AND METHODS

We recruited breast cancer patients (N = 70) scheduled to receive breast cancer surgery at Severance Hospital in Seoul to participate in this prospective study. Shoulder range of motion (ROM) and upper body strength, the disabilities of Arm, Shoulder, and Hand (quick-DASH), body composition, physical activity levels, and QoL were measured at baseline (presurgery) and then weekly for 4 weeks, and at 3 months and 6 months postsurgery.

RESULTS

During 6 months after surgery, shoulder ROM was reduced only affected arm while shoulder strength was significantly declined in both affected and unaffected arms. Within 4 weeks postsurgery, patients who underwent total mastectomy were significantly less recovered than patients with partial mastectomy in ROM of flexion (P < .05) and abduction (P < .05). However, shoulder strength of both arms observed no interaction between surgical type and time. We observed significant changes in body composition, quick-DASH score, physical activity levels, and QoL from presurgery to 6-months postsurgery.

CONCLUSIONS

Shoulder function, activity levels, and QoL improved significantly from surgery to 6-months postsurgery. Surgery type influenced changes in shoulder ROM.

Anticancer Activity of Bee Venom Components against Breast Cancer

While the survival rate has increased due to treatments for breast cancer, the quality of life has decreased because of the side effects of chemotherapy. Various toxins are being developed as alternative breast cancer treatments, and bee venom is drawing attention as one of them. We analyzed the effect of bee venom and its components on breast cancer cells and reviewed the mechanism underlying the anticancer effects of bee venom. Data up to March 2022 were searched from PubMed, EMBASE, OASIS, KISS, and Science Direct online databases, and studies that met the inclusion criteria were reviewed. Among 612 studies, 11 were selected for this research. Diverse drugs were administered, including crude bee venom, melittin, phospholipase A2, and their complexes. All drugs reduced the number of breast cancer cells in proportion to the dose and time. The mechanisms of anticancer effects included cytotoxicity, apoptosis, cell targeting, gene expression regulation, and cell lysis. Summarily, bee venom and its components exert anticancer effects on human breast cancer cells. Depending on the mechanisms of anticancer effects, side effects are expected to be reduced by using various vehicles. Bee venom and its components have the potential to prevent and treat breast cancer in the future.

Patient-Reported Outcome Measures Used for Assessing Breast Sensation after Mastectomy: Not Fit for Purpose

AIMS

The aims of this review were (i) to evaluate whether patient-reported outcome measures used in clinical studies for assessing sensation after mastectomy and breast reconstruction are suitable for this purpose, and (ii) to explore whether any measures used for assessing sensation after non-oncologic breast surgery are worth modifying for use in post-mastectomy patients.

Methods

PRISMA guidelines were followed (PROSPERO number CRD42020178066). We searched six databases for studies of oncologic (i.e., therapeutic, prophylactic, and reconstructive) and non-oncologic breast surgery (e.g., breast reduction) in which sensation was assessed with a patient-reported outcome measure. From the selected studies, we extracted eligible measures, evaluated their fitness for purpose, and summarized the content of sensation-specific items.

Results

Of 6728 articles identified, we selected 135 studies that used 124 eligible patient-reported outcome measures. For 97% of these measures, details regarding development and measurement properties were unavailable. Four (3%) validated measures—the Sensory Disturbances subscale of the Breast Cancer Sequelae Cause Scales, the Discomfort subscale of the Breast Sensation Assessment Scale (BSAS), Didier et al.’s questionnaire for “Assessment of the patients’ satisfaction with cosmetic results, physical and emotional impact of mastectomy”, and the Breast Specific Pain subscale of the Breast Cancer Treatment Outcomes Scale (BCTOS)—each contain at least one item pertaining to breast sensation, but target different concepts of interest. In total, the measures feature 215 sensation-specific items, most of which concern symptom severity (97%) as opposed to impact on daily functioning (3%).

Conclusion

Patient-reported outcome measures used in clinical studies for assessing sensation after mastectomy and breast reconstruction are unsuitable for this purpose: they are either non-validated or non-specific. We failed to identify any measures for use in non-oncologic breast surgery populations worth modifying. To collect meaningful, patient-relevant data regarding sensation after mastectomy, it is pertinent that future clinical trials adopt psychometrically robust, specific patient-reported outcome measures.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40271-021-00565-5.

"Innervation of the Female Breast and Nipple: A Systematic Review and Meta-Analysis of Anatomical Dissection Studies"

BACKGROUND

Primary cadaveric studies were reviewed to give a contemporary overview of what is known about innervation of the female breast and nipple/nipple-areola complex (NAC).

METHODS

We performed a PRISMA-compliant systematic review and meta-analysis (PROSPERO number CRD42020150250). We searched four electronic databases for studies investigating which nerve branches supply the female breast and nipple/NAC or describing the trajectory and other anatomical features of these nerves. Inclusion criteria for meta-analysis were at least five studies of known sample size and with numerical observed values. Pooled prevalence (PP) estimates of nerve branches supplying the nipple/NAC were calculated using random-effects meta-analyses; the remaining results were structured using qualitative synthesis. Risk of bias within individual studies was assessed with the Anatomical Quality Assurance (AQUA) checklist.

RESULTS

Of 3653 studies identified, 19 were eligible for qualitative synthesis and 7 for meta-analysis. The breast skin is innervated by anterior cutaneous branches (ACBs) and lateral cutaneous branches (LCBs) of the 2nd - 6th and the nipple/NAC primarily by ACBs and LCBs of the 3rd - 5th intercostal nerves. The ACB and LCB of the 4th intercostal nerve supply the largest surface area of the breast skin and nipple/NAC. The LCB of the 4th intercostal nerve is the most consistent contributory nerve to the nipple/NAC (PP 89.0%; 95% CI 0.80-0.94).

CONCLUSIONS

The ACB and LCB of the 4th intercostal nerve are the most important nerves to spare or repair during reconstructive and cosmetic breast surgery. Future studies are required to elicit the course of dominant nerves through the breast tissue.

Evaluating the Quality of Systematic Reviews and Meta-Analyses About Breast Augmentation Using AMSTAR

BACKGROUND

Breast augmentation is one of the most commonly performed cosmetic surgeries worldwide. Therefore, it is imperative to have evidence with high methodological quality to guide clinical decision making.

OBJECTIVES

To evaluate the methodological quality of the systematic reviews (SRs) focused on breast augmentation.

METHODS

A comprehensive search of MEDLINE, Embase, and the Cochrane Library of Systematic Reviews was performed. SRs that have a particular focus on breast augmentation and were published in the top 15 plastic and reconstructive surgery journals were included. Quality assessment was performed using a measurement tool to assess systematic reviews (AMSTAR). Study characteristics were extracted including journal and impact factor, year of publication, country affiliation of the corresponding author, reporting adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, number of citations, and number of studies included.

RESULTS

Among the 22 studies included for analysis, the mean AMSTAR score was moderate (5.55), with no SR achieving good quality (AMSTAR score of ≥9). There were no significant associations between AMSTAR score and journal impact factor, number of citations, year of publication, or number of included studies. Studies that reported adherence to PRISMA guidelines on average scored higher on the AMSTAR tool (P = 0.03).

CONCLUSIONS

The methodological quality of reviews about breast augmentation was found to be moderate, with no significant increase in studies or quality over time. Adherence to PRISMA guidelines and increased appraisal of SRs about breast augmentation using methodological assessment tools would further strengthen methodological quality and confidence in study findings.

Change in Shoulder Function in the Early Recovery Phase after Breast Cancer Surgery: A Prospective Observational Study

Breast cancer surgery significantly affects the shoulder’s range of motion (ROM) and strength. However, the extent of shoulder impairment, as well as patterns of recovery immediately after surgery, is not fully understood. Therefore, we aimed to investigate shoulder ROM and strength during the early recovery phase after surgery. Thirty-two breast cancer patients were observed five times: the day before surgery, discharge day (postoperative day 1 (POD1) or (POD2)), first outpatient visit (POD7–10), second outpatient visit (POD14–20), and third outpatient visit (POD21–30). We assessed shoulder passive ROM and strength for both affected and unaffected arms at each observation. ROM decreased in both affected and unaffected sides post-surgery. ROM on the affected side did not recover to the pre-surgery level until the third outpatient visit (POD24). In contrast, the ROM on the unaffected side recovered to the pre-surgery level by the first outpatient visit (POD10). The shoulder strength of both arms declined and did not recover to pre-surgery levels. Shoulder strength in the affected arm significantly decreased immediately after surgery (52.9% of the pre-surgery levels) and did not recover until the third outpatient visit (62.5% of the pre-surgery levels), whereas that in the unaffected arm decreased gradually (83.1 ± 2.3 at POD 1 and 78.9 ± 2.9 at POD 24). Descriptively, patterns of recovery in ROM may vary according to types of surgery while patterns of recovery in shoulder strength did not: shoulder strength significantly decreased and did not recover notably regardless of types of surgery. Both shoulder ROM and strength reduced during the early recovery phase after breast cancer surgery regardless of types of surgery, although the degree of reduction was greater in shoulder strength than ROM. Our findings suggest that rehabilitation exercises should be implemented in both upper limbs.

Post-Breast Surgery Pain Syndrome: Shifting a Surgical Paradigm

Post-mastectomy pain syndrome and the less well-described post-breast surgery pain syndrome are long-term neuropathic pain conditions that may affect more than 50% of patients after mastectomy and breast surgery. While the etiology, risk factors, and management have been reviewed in our literature, we offer here a focused outline that will gear the plastic surgeon with tools to lead a multidisciplinary, algorithmic approach to the care of patients with post-mastectomy pain syndrome/post-breast surgery pain syndrome. After reading this article, we hope the reader will have improved awareness of post-mastectomy pain syndrome/post-breast surgery pain syndrome, and thus be able to incorporate appropriate treatments and preventative steps into their primary surgical routine.

Risk Factors for Explantation of Breast Implants: A Cross-Sectional Study

BACKGROUND

Explantation of breast implant surgery (EBIS) is an emerging surgical field. Precise information about patients undergoing EBIS is important for preoperative planning of breast, augmentation, complications management, and to address any medicolegal issues.

OBJECTIVES

The aim of this study was to further extend current knowledge of EBIS risk factors.

METHODS

An analytic cross-sectional study was conducted involving patients who had previously undergone cosmetic breast augmentation and were seeking EBIS.

RESULTS

The study recruited 138 patients. The average time from implant placement and decision to explantation was 59.1 months. On average, each 1-year increase in age resulted in a 4% increase in the relative risk (RR) of explantation (confidence interval (CI), 1.07-1.21). Patients who were obese or overweight present a 1.5 times higher risk of EBIS (CI 95%, 1.03-2.29). On average, this RR was 40% lower (CI 95%, 0.33-0.91) in patients who never smoked compared with those with a history of tobacco use. Women with mastalgia had a 72% higher RR for EBIS (CI 95%, 1.11-2.65). The RR of EBIS was 5.6 times higher (CI 95%, 2.42-11.47) in patients presenting major Shoenfeld's criteria for autoimmune/inflammatory syndrome induced by adjuvants (ASIA). The RR of EBIS was 4.3 times higher (CI 95%, 1.96-8.63) in patients presenting minor Shoenfeld's criteria for ASIA.

CONCLUSIONS

EBIS poses a higher risk to patients who are overweight/obese, have a history of tobacco use, suffer from mastalgia, or present Shoenfeld's criteria for ASIA. It is important to assess properly these individuals before performing implant surgery for breast augmentation.

LEVEL OF EVIDENCE: 4

Chronic Pain Following Cosmetic Breast Surgery: A Comprehensive Review

INTRODUCTION

Cosmetic breast surgery is commonly performed in the United States; 520,000 procedures of the total 1.8 million cosmetic surgical procedures performed in 2018 were breast related. Postoperative chronic pain, defined as lasting 3 or more months, has been reported in a wide variety of breast surgical procedures including breast augmentation, reduction mammaplasty, mastectomy, and mastectomy with reconstruction. Patient characteristics associated with the development of postoperative chronic pain following cosmetic breast surgery include a younger age, larger BMI, smaller height, postoperative hyperesthesia, and elevated baseline depression, anxiety, and catastrophizing scores. The anatomical distribution of chronic pain following breast augmentation procedures is dependent upon incision site placement; pectoral and intercostal nerves have been implicated. The purpose of this review is to provide an update on the current literature addressing the pathophysiology, clinical presentation, and treatment of patients presenting with chronic postoperative pain following cosmetic breast surgery.

METHODS

A comprehensive literature review was performed in MEDLINE, PubMed, and Cochrane databases from 1996 to 2019 using the terms "cosmetic surgery", "breast surgery", "postoperative pain", and "chronic pain".

RESULTS

Cosmetic breast surgery can have a similar presentation as post-mastectomy pain syndrome and thus have overlapping diagnostic criteria. Seven domains are identified for a diagnosis of PBSPS: Pain after breast surgery, neuropathic in nature, at least a moderate intensity of pain, as defined as within the middle one-third of the selected pain scale, pain for at least 6 months, symptoms occurring for 12 or more hours a day for a minimum of 4 days each week, pain in at least one of the following sites: breast, chest wall, axilla, or arm on the affected side, pain exacerbated by movement. Patient risk factors and surgical risk factors may influence the development of chronic post-cosmetic surgery breast pain. Improved perioperative analgesia including preoperative regional nerve anesthesia and postoperative catheter infusion have been shown to improve chronic postoperative pain outcomes.

CONCLUSIONS

The present review provides a discussion of clinical presentation, pathophysiology, and treatment and preventative strategies for chronic breast pain following cosmetic surgery. This review provides evidence from multiple randomized controlled trials (RCTs) and systematic reviews of efficacy and effectiveness. While chronic postoperative breast pain remains challenging to treat, various preventative strategies have been described to improve postoperative pain outcomes.

Re-visiting post-breast surgery pain syndrome: risk factors, peripheral nerve associations and clinical implications

Aesthetic and reconstructive breast surgery is among the most common operations performed by plastic surgeons. The prevalence of persistent pain after breast surgery remains underappreciated by plastic surgeons. Post breast surgery pain syndrome (PBSPS) is reported to range between 20-60%. It is the purpose of this paper to revisit chronic pain as a combination of the breast intervention and relate this to the peripheral nerve(s) transmitting the pain message, in order to understand the underlying etiology and to improve breast pain treatment outcomes.

Anatomical Considerations to Optimize Sensory Recovery in Breast Neurotization with Allograft

Background:

Breast numbness is a recognized problem following mastectomy and subsequent reconstruction. Contemporary literature acknowledges the positive role of breast neurotization, but it is characterized by a variety of technical approaches and substantial heterogeneity with respect to the degree of recovered sensibility that remains suboptimal in comparison with other sensory nerve reconstructions. This study’s purpose was to provide an anatomical basis for observed inconsistencies and therein provide a principle that can be used to develop a technical approach that will optimize sensory recovery.

Methods:

Anatomical dissections on 6 fresh cadavers, that is, 12 hemi-abdominal flaps and 12 hemi-chest dissections, were performed. The technical aspects of harvesting the abdominal flap with a nerve target, that is, inclusion of a sensory nerve branch only, recipient nerves in the chest, and the applications of allograft for acquired nerve gap reconstruction were investigated.

Results:

Abdominal flaps that include sensory-only intercostal nerve 10–12 segments and identification of recipient chest wall intercostal nerves 2–4 could be consistently performed. The dissection and extraction of the donor sensory nerve target allowed preservation of the motor rectus innervation. The acquired nerve gap was easily bridged by an interposing allograft, allowing free arch of rotation for flap inset, suitable for either single or dual neurotization.

Conclusions:

We provide a likely anatomical explanation for suboptimal sensory recovery after deep inferior epigastric perforator (DIEP) flap breast neurotization, as mixed intercostal autograft is prohibitive to maximal sensory recovery. Breast neurotization with allograft that bridges sensory donor intercostal nerves to sensory recipient intercostal nerves should anatomically optimize restoration of breast sensibility.

Do Breast Implants Influence Breastfeeding? A Meta-Analysis of Comparative Studies

BACKGROUND

Aesthetic breast implant augmentation surgery is the most popular plastic surgery worldwide. Many women choose to receive breast implants during their reproductive ages, although the long-term effects are still controversial. Research aim: We conducted a meta-analysis to assess the influence of aesthetic breast augmentation on breastfeeding. We also compared the exclusive breastfeeding rates of periareolar versus inframammary incision.

METHODS

A systematic search for comparative studies about breast implants and breastfeeding was performed in PubMed, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ScienceDirect, Scopus, and Web of Science through May 2018. Meta-analysis was conducted with a random-effects model (or fixed effects, if heterogeneity was absent).

RESULTS

Four cohorts and one cross-sectional study were included. There was a significant reduction in the exclusive breastfeeding rate for women with breast implants compared with women without implants, pooled relative risk = 0.63, 95% confidence interval [0.46, 0.86], as well as the breastfeeding rate, pooled relative risk = 0.88, 95% confidence interval [0.81, 0.95]. There was no evidence that periareolar incision was associated with a reduction in the exclusive breastfeeding rate, pooled relative risk = 0.84, 95% confidence interval [0.45, 1.58].

CONCLUSION

Participants with breast implants are less likely to establish breastfeeding, especially exclusive breastfeeding. Periareolar incision does not appear to reduce the exclusive breastfeeding rate.

Cohort Study to Assess the Impact of Breast Implants on Breastfeeding

BACKGROUND

The objective of this study was to evaluate the impact of breast implant surgery and its approaches on lactation by comparing women with and without breast implants at the time of childbirth.

METHODS

Between April of 2013 and July of 2014, in Rosario (Sanatorio de la Mujer and Centro Quirúrgico Rosario), Argentina, a prospective cohort study of women with and without breast implants was performed. Of a total of 3950 births that occurred during this period, 200 patients with similar anthropometric characteristics (maternal and newborn) were selected. Breastfeeding (exclusive or mixed) was compared with artificial feeding at 24 and 48 hours and 30 days in both groups, and the type of incision was also compared.

RESULTS

Breastfeeding at 30 days showed a nonsignificant trend favoring the control group (OR, 7.39; 95 percent CI, 0.92 to 339.2). The percentage of women with implants who succeeded in establishing breastfeeding (exclusive or mixed) was very high (93 percent). In the control group, 99 percent of the women were breastfeeding at 30 days. In a comparison of the submammary and areola incision, breastfeeding showed odds ratios of 0.78 (95 percent CI, 0.33 to 1.87) at 24 hours, 1.10 (95 percent CI, 0.48 to 2.56) at 48 hours, and 0.18 (95 percent CI, 0.36 to 1.82) at 30 days.

CONCLUSIONS

This study shows that most patients with breast implants were able to establish breastfeeding. However, there is a higher number of women without implants that established exclusive breastfeeding. No significant difference was found between the different surgical approaches.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, II.

Objective Sensory Changes Following Subfascial Breast Augmentation

BACKGROUND

Sensory changes occur following breast augmentation, and describing the incidence, pattern, and course of deficit is important for informed consent.

OBJECTIVES

To examine sensory changes following subfascial breast augmentation, and the influence of change in breast volume caused by an implant.

METHODS

One hundred and sixty-two consecutive patients undergoing subfascial breast augmentation were assessed for sensory changes using a Semmes Weinstein monofilament test before surgery, 2, 6, and 12 weeks postoperatively. Morphometric measurements allowed a breast volume to be calculated and the percentage change in volume produced by the implant.

RESULTS

Most women (92.5%) regained preoperative levels of sensation in all areas of the breast, excepting the lower-outer quadrants (16.15%) by 12 weeks following surgery. Four percent of nipple-areolar complexes (NAC) failed return to preoperative levels of sensitivity by 12 weeks after surgery. Younger patients or those who have a high BMI and a measurably thicker soft tissue envelope were more likely to experience sensory deficits. Breast augmentation in this series produced calculated volume changes by an implant of between 12.1% and 102.7%. Within these limits there is no association between percentage increase in breast volume and sensory deficits.

CONCLUSIONS

The study demonstrates that for calculated volume increases of up to 102% of the initial breast volume, sensory loss at 12 weeks after surgery is 4% at the NAC. The commonest area of diminished sensitivity is the lower-outer quadrant (16.15%), relating to the use of the inframammary crease incision. It provides a useful adjunct in monitoring patient recovery following subfascial breast augmentation. LEVEL OF EVIDENCE 4: Therapeutic.

Sensitivity of the Nipple-Areola Complex and Sexual Function Following Reduction Mammaplasty

BACKGROUND

The sensitivity of the nipple-areola complex (NAC) is very relevant to female sexuality.

OBJECTIVE

To evaluate NAC sensitivity and sexual function after breast reduction, and to assess whether altered NAC sensitivity is related to sexual dysfunction.

METHODS

The study included 80 patients, who were allocated to a control group with eutrophic breasts (CG, n = 20), a hypertrophy group without surgery (HG, n = 20), or a mammaplasty group (MG, n = 40). The MG was assessed preoperatively and 6 months postoperatively. The HG and CG were evaluated once. NAC sensitivity was assessed for touch, temperature, vibration, and pressure in four areola quadrants and the nipple. Sexual function was assessed with the Brazilian version of the Female Sexual Function Index, which has six domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) and a total score that indicates the presence or absence of sexual dysfunction.

RESULTS

Compared to the CG, the MG had worse sensitivity to temperature and pressure in the nipple and areola medial quadrants postoperatively (P < 0.01). Compared to their preoperative assessment, the MG had reduced temperature and pressure sensitivity in the nipple and areola medial quadrants postoperatively (P < 0.05). Compared to the CG and HG, patients in the MG had higher postoperative scores of excitation (P = 0.0001), lubrication (P = 0.0004), orgasm (P < 0.0001), and satisfaction (P < 0.0001). There was an association between sexual dysfunction and low NAC sensitivity to temperature and vibration (P ≤ 0.041) in the MG's preoperative and postoperative scores, and to touch, temperature, and pressure across all three groups.

CONCLUSIONS

Breast reduction with a superomedial pedicle reduced NAC sensitivity but did not interfere with sexual function.

Cancer treatment-related neuropathic pain syndromes--epidemiology and treatment: an update

Cancer treatment-related chronic neuropathic pain (NP) is a pervasive and distressing problem that negatively influences function and quality of life for countless cancer survivors. It occurs because of cancer treatment-induced damage to peripheral and central nervous system structures. NP becomes chronic when pain signal transmission persists, eventually sensitizing neurons in the dorsal horn and other pain-processing regions in the central nervous system. Frequently overlooked, NP due to cancer treatment has been understudied. Consequently, only a few pharmacologic interventions have been shown to be effective based on the results of randomized controlled trials. Future research designed to explore pathophysiologic mechanisms and effective mechanism-targeted interventions is sorely needed.