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Wahlström E, Audisio RA, Selvaggi G. Aspects to consider regarding breast cancer risk in trans men: A systematic review and risk management approach. PLoS One 2024; 19:e0299333. [PMID: 38451995 PMCID: PMC10919728 DOI: 10.1371/journal.pone.0299333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/07/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The risk of breast cancer in trans men is currently a poorly understood subject and trans men likely carries a different level of risk from that of cis women. AIM This review aims to review several aspects that affects breast cancer risk in trans men and to apply the Swiss cheese model to highlight these risks. The study takes its cue from a systematic review of all described breast cancer cases in trans men following medical or surgical intervention because of gender dysphoria. METHODS PubMed was systematically searched on the 14th of March 2023 to find all published cases of breast cancer following chest contouring surgery in trans men. Included articles had to involve trans men, the diagnosis of breast cancer had to be preceded by either a medical or surgical intervention related to gender dysphoria, and cases needed to involve invasive breast cancer or ductal carcinoma in situ. Articles were excluded if gender identity in the case subject was unclear and/or a full English version of the report was unavailable. Quality and risk of bias was evaluated using the GRADE protocol. A literature review of specific risk altering aspects in this population followed. The Swiss cheese model was employed to present a risk analysis and to propose ways of managing this risk. RESULTS 28 cases of breast cancer in trans men have been published. The Swiss cheese model identified several weaknesses associated with methods of preventing breast cancer in trans men. CLINICAL IMPLICATIONS This study may highlight the difficulties with managing risk factors concerning breast cancer in trans men to clinicians not encountering this patient group frequently. CONCLUSION This review finds that evidence for most aspects concerning breast cancer in trans men are inadequate, which supports the establishment of a risk-management approach to breast cancer in trans men.
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Affiliation(s)
- Edvin Wahlström
- Department of Plastic Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Riccardo A. Audisio
- Department of General Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Gennaro Selvaggi
- Department of Plastic Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
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Yiltok SJ, Akintayo AJ, Karago CY, Choji JD, Sankey B, Agada E, Dafong AA, Ezekiel AS, Orkar KS. Reduction Mammoplasty for Macromastia: Our Experience Using the Inferior Pedicle with Inverted-T Skin Resection. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2023; 13:77-83. [PMID: 37538218 PMCID: PMC10395857 DOI: 10.4103/jwas.jwas_30_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/16/2023] [Indexed: 08/05/2023]
Abstract
Introduction Macromastia is a major reason why women seek for breast reduction especially when there are symptoms. Breast reduction is an uncommon procedure in our environment and this is a report of our experience with inferior pedicle with an inverted-T skin resection. Materials and Methods This is a report of breast reductions using the inferior pedicle with an inverted-T skin resection approach that were carried out between 2004 and 2022. The information that was retrieved from the case notes were age, marital status, parity, last child birth, family history of breast enlargement, presenting features, height, weight, the weight of tissue excised, and complications. The data obtained were then entered into the SPSS version 25 (IBM Corp.) software and analysed. Results Seventeen women were managed with an age range of 16-50 years and a mean of 31.06 ± 9.66 years. The most common features at presentation were heavy weight around the chest, backache, shoulder pain, no appropriate brassiere with low self-esteem and self-confidence. Ten had skin changes and recurrent rashes over the breast, whereas four complained of grooves with skin changes. The weight of excised breast tissue ranged from 0.2 to 5.5 kg with an average of 2.18 ± 1.28 kg for the right and 2.05 ± 1.00 kg for the left breast. All except one patient had blood transfusion. The common complications were delayed wound healing (47%) followed by partial wound dehiscence (17.6%), and flap necrosis (11.8%). Except for those with flap necrosis the wounds healed with some having broad scars. Conclusions Patients for breast reduction are mainly due to the symptoms and signs with the associated large breast. The inferior pedicle with inverted-T skin resection is a valuable technique with a very good outcome. To improve access to breast reduction, there is the need to enhance awareness through advocacy using women groups and health education.
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Affiliation(s)
- Simon Jekat Yiltok
- Department of Surgery, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | | | - Christopher Y. Karago
- Department of Plastic Surgery, Prince Mishari bin Saud Hospital, Baljurashi, Bahah Region, Kingdom of Saudi Arabia
| | - Joshua D. Choji
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Babangida Sankey
- Department of Plastic Surgery, Skin 101 Hospital, Maitama, Abuja, Nigeria
| | - Enye Agada
- Department of Surgery, Federal Medical Centre, Makurdi, Nigeria
| | - Atarang A. Dafong
- Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Anthony S. Ezekiel
- Department of Surgery, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | - Kusu Samuel Orkar
- Department of Plastic Surgery, Queen Victoria Hospital, West Sussex, UK
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Kuhnen RB, Sabino Neto M, Souza LV, Ferreira LM, Veiga DF. Antibiotic Prophylaxis in Reduction Mammaplasty: A National Survey. Aesthetic Plast Surg 2022; 46:2124-2130. [PMID: 35538245 DOI: 10.1007/s00266-022-02903-w] [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: 12/28/2021] [Accepted: 04/03/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Although there is limited evidence for regulating the use of prophylactic antibiotics in reduction mammaplasty, many plastic surgeons prescribe them, even in the postoperative period. This study aimed to conduct a national survey to investigate the antibiotic prophylaxis protocols followed by Brazilian plastic surgeons in reduction mammaplasty. METHODS An anonymous survey comprising 19 questions was sent to all 4864 active members of the Brazilian Society of Plastic Surgery (SBCP). The surgeons electronically received the invitation to participate in the survey and the link to fill out the electronic form. RESULTS In total, 859 surgeons (17.7%) responded. Most respondents (77.8%) were men and aged 35-55 years (61.5%); 58.6% of them had 10-29 years of specialty training. Only a minor proportion of the respondents (0.5%) reported not prescribing antibiotics at any time (95% confidence interval [CI]: 0.0-0.9), 9.9% (95% CI: 7.9-11.9) prescribed them only preoperatively, and 14.6% (95% CI: 12.2-16.9) prescribed continued antibiotic use for 24 h. The majority of the respondents (75.1%; 95% CI: 72.1-77.9) prescribed antibiotics for additional days after discharge. There were significant associations between antibiotic prescription and the surgeons' age group (p = 0.015), time since graduation (p < 0.001), experience in the specialty practice (p = 0.003), SBCP membership (p < 0.001), and surgical site infection rates (p = 0.011). CONCLUSION Most responding plastic surgeons affirmed that they prescribed prophylactic antibiotics for more than 24 h in reduction mammaplasty cases. LEVEL OF EVIDENCE V This journal requires that 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)
- Ricardo Beckhauser Kuhnen
- Translational Surgery Graduate Program, Universidade Federal de Sao Paulo, Rua Botucatu, 740, 2º andar. Vila Clementino, São Paulo, SP, Brazil
| | - Miguel Sabino Neto
- Translational Surgery Graduate Program, Universidade Federal de Sao Paulo, Rua Botucatu, 740, 2º andar. Vila Clementino, São Paulo, SP, Brazil
| | | | - Lydia Masako Ferreira
- Translational Surgery Graduate Program, Universidade Federal de Sao Paulo, Rua Botucatu, 740, 2º andar. Vila Clementino, São Paulo, SP, Brazil
| | - Daniela Francescato Veiga
- Translational Surgery Graduate Program, Universidade Federal de Sao Paulo, Rua Botucatu, 740, 2º andar. Vila Clementino, São Paulo, SP, Brazil.
- Division of Plastic Surgery, Universidade do Vale do Sapucaí, Pouso Alegre, MG, Brazil.
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Wound complications following reduction mammaplasty: which patients are at risk and what can we do about it? A systematic review. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-01990-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mortada H, Marouf A, Almutairi K. Preferences of different breast reduction techniques: Survey of board-certified plastic surgeons. Niger J Clin Pract 2022; 25:909-915. [DOI: 10.4103/njcp.njcp_1943_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Derebaşınlıoğlu H, Karaca SN. The importance of preoperative imaging methods in reduction mammoplasty. J Plast Reconstr Aesthet Surg 2021; 75:1424-1430. [PMID: 34949572 DOI: 10.1016/j.bjps.2021.11.073] [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: 02/05/2021] [Accepted: 11/14/2021] [Indexed: 11/15/2022]
Abstract
Breast reduction surgery is a common procedure in plastic surgery clinics, and there are varying practices regarding preoperative mammography and breast ultrasound in patients who have no history of cancer and no symptoms other than those caused by macromastia. In this study, we retrospectively analyzed the imaging findings of patients who presented to the plastic surgery outpatient clinic due to macromastia between January 1, 2006 and June 1, 2020 and underwent mammography and/or breast ultrasound for preoperative screening and breast magnetic resonance imaging for further examination. Patients with a history of breast cancer diagnosed prior to preoperative screening or any other breast disease were excluded. Radiologically suspicious findings were significantly more common in patients over 40 years of age and significantly less frequent in the group under 50 years of age. When the patients were grouped by the decade of life, the frequency of radiologically suspicious findings was significantly lower in the 20-29 group and significantly higher in the 40-49 and 50-59 groups. Malignancy was not detected by histopathological examination in any patient. Proliferative lesions were detected in 10 reduction mammoplasty specimens (2.4%) of 7 patients (3.1%). The correlation between radiological and histopathological findings may be weak in macromastia patients. Most suspicious radiological findings appear to be the population between 40 and 59 years of age .
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Affiliation(s)
- Handan Derebaşınlıoğlu
- Plastic Reconstructive and Aesthetic Surgery Department, Sivas Cumhuriyet University Medical Faculty, 58140 Sivas, Turkey.
| | - Sanem Nemmezi Karaca
- Family Medicine Department, Sivas Cumhuriyet University Medical Faculty, 58140 Sivas, Turkey
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Anker AM, Prantl L, Baringer M, Ruewe M, Klein SM. [Abdominoplasty without closed-suction drains: a randomised controlled trial]. HANDCHIR MIKROCHIR P 2020; 53:420-425. [PMID: 32823324 DOI: 10.1055/a-1170-5345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION There is insufficient scientific evidence from randomised controlled trials to support the routine use of closed-suction drains in body contouring procedures. The aim of this study was to evaluate cumulative seroma volume, length of hospital stay and complication rates in abdominoplasty patients without drains in direct comparison with a cohort receiving drains. MATERIAL AND METHODS Abdominoplasty patients were prospectively randomised in two study groups with (MD) and without (OD) placement of closed-suction drains. Patients with a BMI ≤ 30 kg/m2 undergoing horizontal or combined horizontal/vertical incision abdominoplasty were included. Scarpa's fascia was preserved during dissection. Exclusion criteria comprised simultaneous liposuction, coagulation disorders and ASA score ≥ 3. Cumulative seroma volume over a four-week follow-up period was assessed as the primary outcome measure. Secondary outcome measures were complications requiring surgical revision and length of hospital stay. RESULTS This trial did not identify a statistically significant difference in cumulative seroma volume between the MD (30/53) and OD (23/53) cohorts in 53 patients (MMD 493 ± SD 407 ml; MOD 459 ± SD 624 ml; p = 0.812). However, a significantly shorter average length of hospital stay was observed in the OD population (MMD 5.1 ± SD 1.4 d; MOD 4.2 ± SD 1.5 d; p = 0.023). Complication rates were equal in both study groups (nMD = 1; nOD = 1). CONCLUSION The results of this trial do not justify routine placement of closed-suction drains in abdominoplasty procedures (horizontal or combined horizontal/vertical incision) in the pre-obese patient cohort (BMI ≤ 30 kg/m2). Drain placement should be evaluated on an individual patient-specific basis.
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Affiliation(s)
- Alexandra M Anker
- Universitätsklinikum Regensburg Zentrum für Plastische, Hand- und Wiederherstellungschirurgie
| | - Lukas Prantl
- Universitätsklinikum Regensburg Zentrum für Plastische, Hand- und Wiederherstellungschirurgie
| | - Magnus Baringer
- Universitätsklinikum Regensburg Zentrum für Plastische, Hand- und Wiederherstellungschirurgie
| | - Marc Ruewe
- Universitätsklinikum Regensburg Zentrum für Plastische, Hand- und Wiederherstellungschirurgie
| | - Silvan M Klein
- Universitätsklinikum Regensburg Zentrum für Plastische, Hand- und Wiederherstellungschirurgie
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Cohet M, De Runz A, Remen T, Brix M, Simon E. [Factors influencing drainage productivity in breast reduction: A retrospective study of 222 breasts]. ANN CHIR PLAST ESTH 2020; 66:144-150. [PMID: 32690427 DOI: 10.1016/j.anplas.2020.06.003] [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: 07/24/2019] [Revised: 05/29/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The objective of this study is to highlight the factors that influence drain productivity in reduction mastoplasty. MATERIALS AND METHODS We have retrospectively referenced from November 2015 to November 2017 all breast reduction performed in the plastic surgery, reconstructive and esthetic surgery department of the University Hospital of Nancy. A total of 222 breasts were analyzed by listing age, weight, height, Body Mass Index (BMI), smoking status, surgeon, technical used, hospitalization stay, breast volume removed, type and size of drain and their productivity. Multivariate analysis were realised. RESULTS 118 patients were included with an average age of 42.2 years. The average productivity of drains was 50 millilitres (ml). There was a significant difference in productivity of drainage according to the operator with a median ranging from 10ml to 60ml (P<0.0001). The median was 20ml for 10 Redon-Jost drains versus 50ml for the 16 Redon-Jost drains (P<0.0001). Multivariate analysis of the various factors influencing the total productivity of postoperative drainage showed a relative risk of 1.16 for smokers, 0.24 for one surgeon, 1.68 for the Skoog technique, and 1.000 for breast volume removed. CONCLUSION The drain productivity is not predictable before a breast reduction. Indeed, none of the characteristics studied have sufficient influence on the productivity of the drains.
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Affiliation(s)
- M Cohet
- Service de chirurgie maxillo-facial, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - A De Runz
- Service de chirurgie esthétique, plastique et reconstructrice, 97, rue Claude-Bernard, 57070 Metz, France.
| | - T Remen
- Service de la PARC, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - M Brix
- Service de chirurgie maxillo-facial, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
| | - E Simon
- Service de chirurgie maxillo-facial, 29, avenue du Maréchal-de-Lattre-de-Tassigny, 54035 Nancy, France.
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Incidence of Complications in Delayed Abdominal-Based Flap Breast Reconstruction Using a Drainless Recipient Site: A Case Series. Ann Plast Surg 2020; 85:S37-S40. [PMID: 32205496 DOI: 10.1097/sap.0000000000002328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Seroma is a common complication after breast surgery such as mastectomy and immediate reconstruction. However, there is a lack of evidence for the utility of drains in the recipient site in delayed autologous breast reconstruction. We reviewed our experience with delayed abdominal-based flap breast reconstruction with a drainless recipient site. METHODS A single-surgeon retrospective case review was performed for delayed abdominal-based flap breast reconstruction using drainless recipient sites from May 2018 to June 2019. Primary outcomes were recipient-site complications. RESULTS Thirty-one delayed abdominal-based flap breast reconstructions that did not use drains in the recipient site were identified in 22 patients. Mean age was 52.8 years (SD, 9.7 years). Mean body mass index was 30.1 kg/m (interquartile range [IQR], 28.2-35.0 kg/m). Common comorbidities were obesity (45.4%), prior tobacco use (31.8%), and diabetes (10.0%). Median time to abdominal-based flap reconstruction was 27.5 months (IQR, 9.9-105.2 months). There were 22 muscle-sparing transverse rectus abdominis musculocutaneous flaps and 9 deep inferior epigastric artery perforator flaps performed. Ten patients (45.4%) underwent bilateral reconstruction. Mean operative time was 302 minutes (SD, 85 minutes). Flap take back occurred in 1 case (3.2%). Mean length of stay was 4 days (SD, 0.8 days). Recipient-site complications were healing complications (32.3%), seroma (3.2%), hematoma (3.2%), and fat necrosis (19.4%). Median follow-up was 4.2 months (IQR, 2.5-11.5). CONCLUSIONS In this case series, our data indicate that delayed autologous reconstruction without drain placement at the recipient site has been proven to be safe and successful and did not increase the rate of seroma or other complications. Adopting a drainless approach may also improve patient comfort and satisfaction.
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Anker AM, Miranda BH, Prantl L, Kehrer A, Strauss C, Brébant V, Klein SM. 50 Shades of Red: The Predictive Value of Closed Suction Drains for the Detection of Postoperative Bleeding in Breast Surgery. Aesthetic Plast Surg 2019; 43:608-615. [PMID: 30903252 DOI: 10.1007/s00266-019-01345-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 02/21/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND While closed suction drains (CSDs) are still frequently employed in clinical practice, the supporting evidence is limited with some studies demonstrating a failure of routine CSD use in preventing hematoma or seroma. Nonetheless, CSD quantity and quality fluid assessment is still appreciated by clinicians to detect postoperative bleeding. This study investigates the value of routine CSD use, in breast surgery, to predict postoperative bleeding. METHODS A retrospective, intra-individual analysis, of CSD fluid volumes between the hematoma side and the unaffected contralateral breast, was undertaken in patients (n = 20) with unilateral postoperative bleeding following bilateral breast surgery (2003-2018). Statistical analysis was undertaken to establish a minimum cutoff fluid volume that might assist in the detection of postoperative bleeding. To determine the usefulness of quality assessment of CSD fluid output by visual inspection, surgeons (n = 56) prospectively matched six eligible hemoglobin concentrations corresponding to pre-filled CSDs. RESULTS Statistical analysis did not yield a clinically reliable cutoff fluid volume indicating postoperative bleeding. All six eligible hemoglobin concentrations were completely successfully matched to pre-filled CSDs by 30.4% (17/56) of surgeons. CONCLUSIONS This study questions the significance of routine CSD use to assist in the decision-making process to return to the theater and address postoperative bleeding. Quantity as well as quality analysis of CSD fluid output failed the reliability and diagnostic validity tests. Hemoglobin measurements in drain fluid specimens via blood gas analysis might contribute to the detection of postoperative bleeding. LEVEL OF EVIDENCE IV This journal requires that 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)
- A M Anker
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
| | - B H Miranda
- Plastic and Reconstructive Surgery Department, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, NW3 2QG, UK
| | - L Prantl
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - A Kehrer
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - C Strauss
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - V Brébant
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - S M Klein
- Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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Klement KA, Hijjawi JB, Neuner J, Kelley K, Kong AL. Discussion of preoperative mammography in women undergoing reduction mammaplasty. Breast J 2019; 25:439-443. [PMID: 30924231 DOI: 10.1111/tbj.13237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/06/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Reduction mammaplasty is one of the most common procedures performed by plastic surgeons. Previous studies demonstrated that most plastic surgeons do not require preoperative mammography prior to reduction mammaplasty. The incidental discovery of malignant or high-risk lesions in breast reduction specimens may preclude the possibility of breast-conserving surgery. The purpose of this study was to examine the factors associated with discussion of preoperative mammography with reduction mammaplasty patients. METHODS About 638 consecutive patients were identified between January 2000 and December 2010 who underwent reduction mammaplasty. Clinicopathologic and treatment information was collected. Factors associated with discussion of preoperative mammography prior to surgery were compared. RESULTS Of 638 patients, the median age was 36 (range 18-77) with 44% ≥40. Approximately half (56.0%) were White and 37.5% were African-American. The use of mammography was discussed in 43.3% of patients and completed in 41.5%. On final pathology, eight patients (1.3%) had high-risk lesions and two (0.3%) demonstrated malignancy (1 DCIS, 1 invasive). Of these 10 patients, two were under the age of 40 and four had preoperative mammograms. Factors associated with mammography discussion were age ≥40, White race, the presence of comorbidities, family history of breast cancer, prior breast surgery, prior breast biopsy, history of breast cancer (all P < 0.0001) and tobacco use (P = 0.04). CONCLUSIONS Due to the potential risk of invasive cancer and high-risk lesions in the final surgical specimen, preoperative mammography should be discussed with selected patients by plastic surgeons, particularly those who fall within national screening guidelines.
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Affiliation(s)
- Kristen A Klement
- Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Joan Neuner
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Katherine Kelley
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amanda L Kong
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Zapata-Copete J, Aguilera-Mosquera S, García-Perdomo HA. Antibiotic prophylaxis in breast reduction surgery: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2017; 70:1689-1695. [PMID: 28890343 DOI: 10.1016/j.bjps.2017.08.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/19/2017] [Accepted: 08/06/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine the effectiveness and harm of using antibiotic prophylaxis versus placebo or no intervention in patients undergoing breast reduction surgery to prevent surgical site infection. MATERIALS AND METHODS A search strategy was conducted in the MEDLINE, CENTRAL, EMBASE, and LILACS databases. Searches were also conducted in other databases and unpublished literature. Clinical trials were included without language restrictions. The risk of bias was evaluated with the Cochrane Collaboration's tool. An analysis of fixed effects was conducted. The primary outcome was surgical site infection. The secondary outcomes were delayed wound healing and adverse effects. The measure of the effect was the risk difference (RD) with a 95% confidence interval (CI). The planned interventions were antibiotic prophylaxis versus placebo/no intervention. RESULTS Five articles were included in the qualitative and quantitative analysis. A total of 584 patients were included from the five studies. A low risk of bias was shown for most of the study items. The overall RD for surgical site infection was -0.08 (95% CI -0.14--0.03), favoring antibiotic prophylaxis compared with placebo. CONCLUSION Antibiotic prophylaxis lowers the incidence of surgical site infection in breast reduction surgery compared with placebo or no intervention.
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Affiliation(s)
- James Zapata-Copete
- Epidemiology Department, Universidad Libre, Cali, Colombia; UROGIV Research Group at Universidad del Valle, Cali, Colombia.
| | | | - Herney Andrés García-Perdomo
- Epidemiology Department, Universidad Libre, Cali, Colombia; UROGIV Research Group at Universidad del Valle, Cali, Colombia; School of Medicine, Universidad del Valle, Cali, Colombia
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Garcia ES, Veiga DF, Veiga-Filho J, Cabral IV, Pinto NLL, Novo NF, Sabino Neto M, Ferreira LM. Antibiotic prophylaxis in reduction mammaplasty: study protocol for a randomized controlled trial. Trials 2016; 17:567. [PMID: 27899130 PMCID: PMC5129235 DOI: 10.1186/s13063-016-1700-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 11/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background The role of antibiotics in surgical procedures where the risk of surgical site infection (SSI) is low remains uncertain. There is, to date, no evidence to justify the routine use of antibiotics in postoperative reduction mammaplasty. The aim of this study is to evaluate the effect of postoperative antibiotic treatment on the occurrence of SSI after breast reduction surgery. Methods This is a double-blind randomized clinical trial with 124 breast hypertrophy patients allocated to two treatment groups: antibiotic (n = 62) and placebo (n = 62). All patients will undergo reduction mammoplasty, performed by the same surgical team. The surgeons will raise the nipple-areola complex by the superomedial pedicle technique. The patients will receive antibiotics intravenously during anesthetic induction and every 6 hours thereafter during their 24-hour hospital stay. During discharge from the hospital, each patient will receive a numbered package containing either cephalexin or placebo capsules and will be directed to take one capsule every 6 hours for 7 days. Neither the surgery team nor the patients will know the contents of the capsules. Patients will be monitored for the occurrence of SSI once weekly during the first 30 days following hospital discharge by a single surgeon who is blinded to their treatment group. SSI will be evaluated based on the definition adopted by the Centers for Disease Control and Prevention. Discussion Due to the variety of risk factors for SSI and limited case studies, conclusions regarding the effect of antibiotics on the occurrence of SSIs following reduction mammaplasty are potentially biased. In recent studies, perioperative antibiotic prophylaxis was effective in preventing infection and is therefore recommended in clinical practice. However, antibiotic use in the postoperative period still remains controversial. Trial registration Clinicaltrials.gov Identifier: NCT02569866. Registered on 4 October 2015.
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Affiliation(s)
- Edgard Silva Garcia
- Translational Surgery Graduate Program, Federal University of São Paulo, Rua Napoleão de Barros, 725, 4th Floor, Vila Clementino, CEP: 04024-002, São Paulo, SP, Brazil.,Division of Plastic Surgery, Universidade do Vale do Sapucaí, Rua Comendador José Garcia, 777, Centro, CEP: 37550-000, Pouso Alegre, MG, Brazil
| | - Daniela Francescato Veiga
- Translational Surgery Graduate Program, Federal University of São Paulo, Rua Napoleão de Barros, 725, 4th Floor, Vila Clementino, CEP: 04024-002, São Paulo, SP, Brazil. .,Division of Plastic Surgery, Universidade do Vale do Sapucaí, Rua Comendador José Garcia, 777, Centro, CEP: 37550-000, Pouso Alegre, MG, Brazil.
| | - Joel Veiga-Filho
- Division of Plastic Surgery, Universidade do Vale do Sapucaí, Rua Comendador José Garcia, 777, Centro, CEP: 37550-000, Pouso Alegre, MG, Brazil
| | - Isaías Vieira Cabral
- Division of Plastic Surgery, Universidade do Vale do Sapucaí, Rua Comendador José Garcia, 777, Centro, CEP: 37550-000, Pouso Alegre, MG, Brazil
| | - Natália Lana Larcher Pinto
- Division of Plastic Surgery, Universidade do Vale do Sapucaí, Rua Comendador José Garcia, 777, Centro, CEP: 37550-000, Pouso Alegre, MG, Brazil
| | - Neil Ferreira Novo
- Translational Surgery Graduate Program, Federal University of São Paulo, Rua Napoleão de Barros, 725, 4th Floor, Vila Clementino, CEP: 04024-002, São Paulo, SP, Brazil
| | - Miguel Sabino Neto
- Translational Surgery Graduate Program, Federal University of São Paulo, Rua Napoleão de Barros, 725, 4th Floor, Vila Clementino, CEP: 04024-002, São Paulo, SP, Brazil
| | - Lydia Masako Ferreira
- Translational Surgery Graduate Program, Federal University of São Paulo, Rua Napoleão de Barros, 725, 4th Floor, Vila Clementino, CEP: 04024-002, São Paulo, SP, Brazil
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Current Practice of Therapeutic Mammaplasty: A Survey of Oncoplastic Breast Surgeons in England. Int J Surg Oncol 2016; 2016:1947876. [PMID: 27110398 PMCID: PMC4821971 DOI: 10.1155/2016/1947876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/03/2016] [Indexed: 11/21/2022] Open
Abstract
Introduction. Therapeutic mammaplasty (TM) is a useful technique in the armamentarium of the oncoplastic breast surgeon (OBS). There is limited guidance on patient selection, technique, coding, and management of involved margins. The practices of OBS in England remain unknown. Methods. Questionnaires were sent to all OBS involved with the Training Interface Group. We assessed the number of TM cases performed per surgeon, criteria for patient selection, pedicle preference, contralateral symmetrisation, use of routine preoperative MRI, management of involved margins, and clinical coding. Results. We had an overall response rate of 43%. The most common skin resection technique utilised was wise pattern followed by vertical scar. Superior-medial pedicle was preferred by the majority of surgeons (62%) followed by inferior pedicle (34%). Twenty percent of surgeons would always proceed to a mastectomy following an involved margin, whereas the majority would offer reexcision based on several parameters. The main absolute contraindication to TM was tumour to breast ratio >50%. One in five surgeons would not perform TM in smokers and patients with multifocal disease. Discussion. There is a wide variation in the practice of TM amongst OBS. Further research and guidance would be useful to standardise practice, particularly management of involved margins and coding for optimal reimbursement.
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Ahmed A, Al-Tamimi DM, Shwarby MA, Al-Nemer AM, Al-Sayyah AA, Kussaibi HA, Hegazi MM. Prerequisites for histopathological evaluation of reduction mammoplasty specimens: Recommendations based on an audit in a tertiary care hospital. J Taibah Univ Med Sci 2016. [DOI: 10.1016/j.jtumed.2016.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Khan SM, Smeulders MJC, Van der Horst CM. Wound drainage after plastic and reconstructive surgery of the breast. Cochrane Database Syst Rev 2015; 2015:CD007258. [PMID: 26487173 PMCID: PMC8627700 DOI: 10.1002/14651858.cd007258.pub3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Wound drains are often used after plastic and reconstructive surgery of the breast, in order to reduce potential complications. It is unclear whether there is any evidence to support this practice and we therefore undertook a systematic review of the best evidence available. OBJECTIVES To compare the safety and efficacy of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. SEARCH METHODS For the first update of this review we searched the Cochrane Wounds Group Specialised Register (searched 4 March 2015); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 2); Ovid MEDLINE (2012 to March 3 2015); Ovid MEDLINE (In-Process & Other Non-Indexed Citations March 3 2015); Ovid EMBASE (2012 to March 3 2015); and EBSCO CINAHL (2012 to March 4 2015). There were no restrictions on the basis of date or language of publication. SELECTION CRITERIA Three review authors undertook independent screening of the search results. All randomised trials (RCTs) that compared the use of a wound drain with no wound drain following plastic and reconstructive surgery of the breast (breast augmentation, breast reduction and breast reconstruction) in women were eligible. DATA COLLECTION AND ANALYSIS Two review authors undertook independent data extraction of study characteristics, methodological quality and outcomes (e.g. infection, other wound complications, pain, and length of hospital stay). Risk of bias was assessed independently by two review authors. We calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals. Analysis was on an intention-to-treat basis. MAIN RESULTS Three randomised trials were identified and included in the review out of 190 studies that were initially screened; all evaluated wound drainage after breast reduction surgery. No new trials were identified for this first update. In total there were 306 women in the three trials, and 505 breasts were studied (254 drained, and 251 who were not drained). Apart from a significantly shorter duration of hospital stay for those participants who did not have drains (MD 0.77; 95% CI 0.40 to 1.14), there was no statistically significant impact of the use of drains on outcomes. AUTHORS' CONCLUSIONS The limited evidence available shows no significant benefit of using post-operative wound drains in reduction mammoplasty, though hospital stay may be shorter when drains are not used. No data are available for breast augmentation or breast reconstruction, and this requires investigation.
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Affiliation(s)
- Sameena M Khan
- University of YorkDepartment of Health SciencesYorkUKYO10 5DD
| | - Mark J C Smeulders
- Academic Medical CentreDepartment of Plastic, Reconstructive and Hand SurgeryPO Box 22700AmsterdamNetherlands1100 DE
| | - Chantal M Van der Horst
- Academic Medical CentreDepartment of Plastic, Reconstructive and Hand SurgeryPO Box 22700AmsterdamNetherlands1100 DE
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Sugrue CM, McInerney N, Joyce CW, Jones D, Hussey AJ, Kelly JL, Kerin MJ, Regan PJ. Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain. J Plast Surg Hand Surg 2015; 49:363-6. [PMID: 26397754 DOI: 10.3109/2000656x.2015.1062386] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Bilateral breast reduction (BBR) is one of the most frequently performed female breast operations. Despite no evidence supporting efficacy of drain usage in BBRs, postoperative insertion is common. Recent high quality evidence demonstrating potential harm from drain use has subsequently challenged this traditional practice. The aim of this study is to assess the current practice patterns of drains usage by Plastic & Reconstructive and Breast Surgeons in UK and Ireland performing BBRs. METHOD An 18 question survey was created evaluating various aspects of BBR practice. UK and Irish Plastic & Reconstructive and Breast Surgeons were invited to participate by an email containing a link to a web-based survey. Statistical analysis was performed with student t-test and chi-square test. RESULTS Two hundred and eleven responding surgeons were analysed, including 80.1% (171/211) Plastic Surgeons and 18.9% (40/211) Breast Surgeons. Of the responding surgeons, 71.6% (151/211) routinely inserted postoperative drains, for a mean of 1.32 days. Drains were used significantly less by surgeons performing ≥20 BBRs (p = 0.02). With the majority of BBRs performed as an inpatient procedure, there was a trend towards less drain usage in surgeons performing this procedure as an outpatient; however, this was not statistically significant (p = 0.07). CONCLUSION Even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilised. In an era of evidence- based medicine, surgeons performing breast reductions must adopt the results from scientific research into their clinical practice.
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Affiliation(s)
| | | | | | - Deidre Jones
- a 1 Department of Plastic & Reconstructive Surgery
| | | | - Jack L Kelly
- a 1 Department of Plastic & Reconstructive Surgery
| | - Michael J Kerin
- b 2 Department of Breast Surgery, Galway University Hospital , Galway, Ireland
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Isiguzo C, Ogbonnaya SI, Udezue AO. Reduction Mammoplasty in a Developing Country: A 10-year Review (2001-2010) at the National Orthopaedic Hospital, Enugu. Niger J Surg 2015; 21:21-5. [PMID: 25838761 PMCID: PMC4382637 DOI: 10.4103/1117-6806.152719] [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] [Indexed: 11/16/2022] Open
Abstract
Context: Large breast is a major problem because of associated symptomatology and aesthetic concerns. Reduction mammoplasty (RM) resolves the symptom and at the same time improves the aesthetic appearance of the breast, hence improving self-esteem and social integration. Aims: To describe the pattern of RM in a hospital in the developing world and its impact on postgraduate surgical training. Settings and Design: A retrospective review of all the RMs done in the National Orthopaedic Hospital, Enugu (a major plastic surgery training center in Nigeria) over a ten-year period (2001–2010), in the developing country of Nigeria. Subjects and Methods: All RMs done in the hospital were reviewed after retrieving their records from operation register and medical records department. Fifteen (15) cases were retrieved and analyzed. Data Analysis: Data was analyzed with Microsoft excel 2007. Results: Average age of female patients who had RM was 26.5 years and 83.3% were single. The most common complaint was abnormally large breast (macromastia). Inferior pedicle technique was commonly used. Conclusions: The results of RM are remarkable as it impact positively on the quality of life of the patients. However, the level of awareness about the availability of this service is still low in the region as shown by few cases done over the period of review and this impacts negatively on the training. The need for public awareness cannot be overemphasized.
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Affiliation(s)
- Chimaobi Isiguzo
- Department of Surgery, Enugu State University Teaching Hospital, Enugu, Nigeria
| | | | - Anthonia O Udezue
- Department of Plastic Surgery, National Orthopaedic Hospital, Enugu, Nigeria
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Srinivasaiah N, Iwuchukwu OC, Stanley PR, Hart NB, Platt AJ, Drew PJ. Risk Factors for Complications Following Breast Reduction: Results from a Randomized Control Trial. Breast J 2014; 20:274-8. [DOI: 10.1111/tbj.12256] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Nicholas B. Hart
- Department of Plastic Surgery; Castle Hill Hospital; Cottingham UK
| | | | - Philip J. Drew
- Department of Plastic Surgery; Royal Cornwall Hospitals NHS Trust; Truro UK
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Are Systemic Antibiotics Indicated in Aesthetic Breast Surgery? A Systematic Review of the Literature. Plast Reconstr Surg 2013; 131:1395-1403. [DOI: 10.1097/prs.0b013e31828bd752] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stojkovic CA, Smeulders MJC, Van der Horst CM, Khan SM. Wound drainage after plastic and reconstructive surgery of the breast. Cochrane Database Syst Rev 2013:CD007258. [PMID: 23543550 DOI: 10.1002/14651858.cd007258.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Wound drains are often used after plastic and reconstructive surgery of the breast, in order to reduce potential complications. It is unclear whether there is any evidence to support this practice and we therefore undertook a systematic review of the best evidence available. OBJECTIVES To compare the safety and efficacy of the use of wound drains following elective plastic and reconstructive surgery procedures of the breast. SEARCH METHODS We searched the Cochrane Wounds Group Specialised Register (searched 3 August 2012); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 7); Ovid MEDLINE (1950 to July Week 4 2012); Ovid MEDLINE (In-Process & Other Non-Indexed Citations August 2, 2011); Ovid EMBASE (1980 to 2012 Week 30); and EBSCO CINAHL (1982 to 2 August 2012). There were no restrictions on the basis of date or language of publication. SELECTION CRITERIA Two review authors undertook independent screening of the search results. All randomised trials that compared the use of a wound drain with no wound drain following plastic and reconstructive surgery of the breast (breast augmentation, breast reduction and breast reconstruction) in women were eligible. DATA COLLECTION AND ANALYSIS Two review authors undertook independent data extraction of study characteristics, methodological quality and outcomes (e.g. infection, other wound complications, pain, and length of hospital stay). Risk of bias was assessed independently by two review authors. We calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals. Analysis was on an intention-to-treat basis. MAIN RESULTS Three randomised trials were identified and included in the review out of 109 studies that were initially screened; all evaluated wound drainage after breast reduction surgery. In total there were 306 women in the three trials, and 505 breasts were studied (254 drained, and 251 who were not drained). Apart from a significantly shorter duration of hospital stay for those participants who did not have drains (MD 0.77; 95% CI 0.40 to 1.14), there was no statistically significant impact of the use of drains on outcomes. AUTHORS' CONCLUSIONS The limited evidence available shows no significant benefit of using post-operative wound drains in reduction mammoplasty, though hospital stay may be shorter when drains are not used. No data are available for breast augmentation or breast reconstruction, and this requires investigation.
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Affiliation(s)
- Christa A Stojkovic
- Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Centre, Amsterdam, Netherlands.
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Panjari M, Bell RJ, Fradkin P, Davis SR. Cosmetic surgery prior to diagnosis of breast cancer. Climacteric 2011; 15:195-9. [PMID: 22136260 DOI: 10.3109/13697137.2011.614026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Cosmetic breast surgery is amongst the top five most commonly performed cosmetic surgical procedures. With breast cancer being the most common non-skin malignancy in women, the likelihood that a woman undergoing cosmetic breast surgery may have an occult breast cancer needs to be considered. Most of the available data pertaining to breast cancer diagnosis in the setting of cosmetic surgery are from studies of cosmetic breast surgery populations. We report on the prevalence of breast cancer as an incidental finding during cosmetic breast surgery in the context of women subsequently diagnosed with invasive breast cancer. METHODS The Bupa Health Foundation Health and Wellbeing after Breast Cancer Study is a prospective cohort study of 1684 women recruited within 12 months of their first diagnosis with invasive breast cancer. Participants completed an enrolment questionnaire and annual follow-up questionnaires for 5 years. RESULTS At the second follow-up, 1.5% of women reported having undergone cosmetic breast surgery prior to being diagnosed with breast cancer, 16 had undergone breast reduction and seven had augmentations. Invasive breast cancer was diagnosed at the time of a cosmetic breast procedure in two women, in both an augmentation and a reduction procedure, which is 8.7% (95% confidence interval 23.5% to +20.9%) of the women in our study reporting a cosmetic breast procedure prior to diagnosis. CONCLUSIONS Although prior cosmetic breast surgery was reported by few women, breast cancer was diagnosed in two women during the procedure. Surgeons performing elective breast surgery need to understand and apply consistent, reliable breast cancer screening practices.
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Affiliation(s)
- M Panjari
- Women's Health Research Program, School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Australia
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Campbell MJ, Clark CJ, Paige KT. The role of preoperative mammography in women considering reduction mammoplasty: a single institution review of 207 patients. Am J Surg 2010; 199:636-40. [DOI: 10.1016/j.amjsurg.2010.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Revised: 01/22/2010] [Accepted: 01/22/2010] [Indexed: 11/25/2022]
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Green M, Aspinall S, Kollias J. Safety and efficacy of contra-lateral breast reduction for women with mammary hypertrophy undergoing mastectomy for breast cancer. Breast 2009; 18:276-8. [PMID: 19850479 DOI: 10.1016/j.breast.2009.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 07/18/2009] [Accepted: 09/13/2009] [Indexed: 11/25/2022] Open
Abstract
Women with mammary hypertrophy undergoing mastectomy for breast cancer suffer disability because of disproportionate asymmetry. The case notes of all women with mammary hypertrophy undergoing mastectomy and immediate contra-lateral reduction mammaplasty for primary breast cancer from February 2001 to December 2008 were reviewed. Thirty-three women were identified of whom twenty-seven underwent inferior pedicle reduction mammaplasty and six inferior dermoglandular pedicle reduction with free nipple graft. The duration of surgery ranged from 75 to 146 (median 110) minutes. Between 475 and 2350 (median 1090) grams of breast tissue was excised from the contra-lateral breast. No immediate or delayed complications were observed and there were no delays in commencing adjuvant therapy. Immediate contra-lateral breast reduction in women with mammary hypertrophy undergoing mastectomy for breast cancer is safe and effective means of reducing the physical, psychological and cosmetic problems associated with unilateral mammary hypertrophy following mastectomy.
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Affiliation(s)
- Michael Green
- Breast, Endocrine and Surgical Oncology Unit, Royal Adelaide Hospital, Adelaide, Australia
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Nelson RA, Colohan SM, Sigurdson LJ, Lalonde DH. Practice profiles in breast reduction: a survey among Canadian plastic surgeons. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2009; 16:157-61. [PMID: 19721794 DOI: 10.1177/229255030801600311] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Breast reduction is an increasingly common procedure performed by Canadian plastic surgeons. Recent studies in the United States show that use of the inferior/central pedicle inverted T scar method is predominant. However, it is unknown what the practice preferences are among Canadian plastic surgeons. OBJECTIVE The goal of the present study was to assess trends in breast reduction surgery among Canadian surgeons, including patient selection criteria, surgical techniques and outcomes. METHOD Surveys were distributed to plastic surgeons at the Canadian Society for Plastic Surgery meetings in 2005 and 2006. Completed surveys were obtained from 140 respondents, and results were analyzed with Excel and SAS software. RESULTS There was a 40% response rate. The majority of surgeons (66%) used more than one technique for breast reduction. Most commonly, surgeons use the inverted T scar technique (66%) followed by vertical scar techniques (26%). The most popular vertical scar techniques included the Hall-Findlay (14%) and Lejour (13%) methods. Most surgeons (55%) reported complication rates of less than 5% and the most common complication reported was wound dehiscence. There was no difference in overall complication rates between inverted T scar and vertical scar surgeries. The majority of surgeons (98%) carried out breast reduction either exclusively as day surgery or in combination with same-day admission. Breast reduction performed as day surgery resulted in cost savings of $873 per patient. CONCLUSIONS Canadian plastic surgeons are performing more vertical scar breast reductions than American surgeons. However, both groups rely predominantly on inverted T scar techniques.
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Affiliation(s)
- Rebecca A Nelson
- Division of Plastic Surgery, Dalhousie University, Halifax, Nova Scotia
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Tan J, Timmons MJ, Watt DAL. Breast reduction surgery without drains. J Plast Reconstr Aesthet Surg 2007; 60:1168-9. [PMID: 17692585 DOI: 10.1016/j.bjps.2007.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Accepted: 06/07/2007] [Indexed: 11/27/2022]
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Iwuagwu OC, Drew PJ. Deskinning versus deepithelialization for inferior pedicle reduction mammoplasty: a prospective comparative analysis. Aesthetic Plast Surg 2005; 29:202-4. [PMID: 15959690 DOI: 10.1007/s00266-004-0120-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2004] [Accepted: 01/31/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Deepithelialization is time consuming, but has been performed traditionally in reduction mammaplasty to ensure a better blood supply to the transposed nipple-areolar complex. METHODS For this study, 18 patients were recruited, and each patient served as an individual control by undergoing both deskinning and deepithelialization of the contralateral breast. The patient's age, body mass index, specimen weight, complications, and subjective cosmetic assessment were recorded. RESULTS The mean age was 42 years, and the mean body mass index was 27.94 respectively. There were no differences recorded in terms of complications or patient perceived cosmetic outcomes. The only statistical difference involved the times required for deepithelialization (15.5 min) and deskinning (6 min). Deskinning thus saved approximately 9 min. CONCLUSIONS Deskinning is as effective as deepithelialization and is significantly more expedient, with no added risk to the patient.
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Affiliation(s)
- O C Iwuagwu
- Academic Surgical Unit, University of Hull, Castle Hill Hosptital, Castle Road, Cottingham, HU16 5JQ, U. K
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