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Girard P, Berkane Y, Laloze J, Rousseau C, Lupon E, Schutz S, Watier E, Bertheuil N. Superior Pedicle Breast Reduction: Multivariate Analysis of Complication Risk Factors and Building a Predictive Score in 1306 Patients. Plast Reconstr Surg 2024; 153:1011-1019. [PMID: 37335587 DOI: 10.1097/prs.0000000000010828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Breast reduction surgery for hypertrophy is one of the most commonly performed procedures in plastic surgery. This surgery exposes patients to complications that are well-documented in the literature. The objective of this study is to identify risk factors to establish an estimate of the risk of developing complications. The authors propose the first predictive score of postoperative complications, including continuous preoperative variables such as body mass index (BMI) and suprasternal notch-to-nipple distance (SSN:N). METHODS An analytic observational retrospective cohort study was conducted including 1306 patients who underwent superior pedicle reduction mammaplasty at the Rennes University Hospital (France) between January 1, 2011, and December 31, 2016. The primary endpoint was to study the association between known preoperative risk factors and occurrence of any complications using multivariable logistic regression to identify independent risk factors. A secondary endpoint was to establish a score to estimate a probability of occurrence of complications. RESULTS A total of 1306 patients were analyzed. Multivariable logistic regression showed three independent risk factors: active smoking [OR, 6.10 (95% CI: 4.23, 8.78); P < 0.0001], BMI [OR, 1.16 (95% CI: 1.11, 1.22); P < 0.0001], and SSN:N [OR, 1.14 (95% CI: 1.08, 1.21); P < 0.0001]. The Rennes Plastic Surgery Score estimating the occurrence of postoperative complications was determined, integrating regression coefficients of each risk factor. CONCLUSIONS Active smoking, BMI, and SSN:N distance are independent preoperative risk factors for the occurrence of breast reduction complications. The Rennes Plastic Surgery Score including the continuous values of BMI and SSN:N allows us to provide our patients with a reliable estimation of the risk of occurrence of these complications. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Paul Girard
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Yanis Berkane
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Jérôme Laloze
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU Limoges
| | | | - Elise Lupon
- Department of Plastic, Reconstructive, and Aesthetic Surgery, CHU Toulouse
| | | | - Eric Watier
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Nicolas Bertheuil
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
- INSERM U1236, Hospital Sud, University of Rennes 1
- SITI Laboratory
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Aquino JU, Felix GDAA, Feitosa RGF, Tumeh RA, Neto MS. Congenital and Acquired Symmastia: Experience from 100 Cases Treated. Plast Reconstr Surg 2024; 153:873e-883e. [PMID: 37921632 DOI: 10.1097/prs.0000000000010827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Symmastia, first defined by Spence et al. in 1984, is a medical condition characterized by the convergence of breast tissues in the midline, resulting in the absence of adhesion between the skin and subcutaneous tissue over the presternal area. It can be either congenital or acquired. Currently, there is no universally accepted treatment for symmastia. This study presents a surgical approach and preoperative and postoperative care for the correction of symmastia. METHODS Between January of 2014 and December of 2020, a surgical technique was performed on 100 patients, including 59 with congenital symmastia and 41 with acquired symmastia. The technique involved creating a thin skin flap and attaching it to the sternum to reconstruct the intermammary V-shaped region. RESULTS All patients in both groups underwent subglandular implant placement, with textured/polyurethane prostheses used in 97% of cases. Three cases did not use any implants. In the corrective surgery, patients received smaller, round implants, following the steps of the surgical approach devised by the author. The median satisfaction scores were high in both groups. CONCLUSIONS The surgical approach described in this study is a safe, one-time procedure with a low risk of complications and high patient satisfaction. The technique is reproducible and provides consistent outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Rosell Echevarría MJ, Hernández Rodríguez RA, Perez-Etchepare E, Gómez Culebras MA. Supernumerary breast in vulva. An Pediatr (Barc) 2024; 100:e15-e16. [PMID: 38575469 DOI: 10.1016/j.anpede.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/24/2020] [Indexed: 04/06/2024] Open
Affiliation(s)
- María José Rosell Echevarría
- Servicio de Cirugía Pediátrica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Tenerife, Spain.
| | | | - Eduardo Perez-Etchepare
- Servicio de Cirugía Pediátrica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Tenerife, Spain
| | - Mario Alberto Gómez Culebras
- Servicio de Cirugía Pediátrica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Tenerife, Spain
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Blount T, Moffitt S, Fakhre F, Koussayer B, Alkaelani MT, Parus A, Moore MG, Foley B, Troy J. Readability of Online Materials in Spanish and English for Breast Reduction Insurance Coverage. Aesthetic Plast Surg 2024; 48:1436-1443. [PMID: 37697088 DOI: 10.1007/s00266-023-03570-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/17/2023] [Indexed: 09/13/2023]
Abstract
INTRODUCTION Breast reduction surgery aims to alleviate physical discomfort and improve the quality of life for individuals with macromastia. Insurance coverage plays a crucial role in making this surgery accessible, but navigating the complex approval process can be challenging. Online resources have become a primary information source, but limited research exists on the adequacy of online materials, particularly for Spanish-speaking patients. This study evaluates the readability, actionability, and understandability of online educational materials on breast reduction insurance coverage for Spanish- and English-speaking patients. METHODS We conducted an online search using the phrase "breast reduction insurance" and selected the first eight institutional or organizational websites that provided information on breast reduction insurance in both English and Spanish. We evaluated online materials using the Patient Education and Materials Assessment Tool (PEMAT), Cultural Sensitivity Assessment Tool (CSAT), and Simplified Measure of Gobbledygook, Spanish (SOL). These tools were used to assess factors such as understandability and actionability, cultural sensitivity, and readability of the materials. RESULTS Both English and Spanish materials scored high in understandability and actionability, with similar average scores between the languages. Cultural sensitivity scores indicated acceptable materials. However, Spanish materials had a higher reading grade level and more hard words compared to English materials. CONCLUSION There is a need for accessible and understandable online resources on breast reduction insurance coverage, particularly for Spanish-speaking patients. While the assessed websites generally provided comprehensible information, improvements can be made to enhance visual aids and simplify language. These improvements can better educate patients, improve outcomes, and reduce healthcare costs. 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)
- Taylor Blount
- Florida State University College of Medicine, 1115 W Call St, Tallahassee, FL, 32304, USA.
| | - Sarah Moffitt
- University of South Florida Health Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
| | - Fadia Fakhre
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - Bilal Koussayer
- University of South Florida Health Morsani College of Medicine, 560 Channelside Dr, Tampa, FL, 33602, USA
| | | | - Anamaria Parus
- University of South Florida Department of Plastic Surgery, 2 Tampa General Circle 7th Floor, Tampa, FL, 33606, USA
| | - Meredith G Moore
- University of South Florida Department of Plastic Surgery, 2 Tampa General Circle 7th Floor, Tampa, FL, 33606, USA
| | - Brandon Foley
- University of South Florida Department of Plastic Surgery, 2 Tampa General Circle 7th Floor, Tampa, FL, 33606, USA
| | - Jared Troy
- University of South Florida Department of Plastic Surgery, 2 Tampa General Circle 7th Floor, Tampa, FL, 33606, USA
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Rabe FH, Conradie M, Mahoko M, de Villiers RC, Edge J. Gestational gigantomastia complicated by pseudo-angiomatous stromal hyperplasia - a multidisciplinary management approach. S AFR J SURG 2024; 62:89-91. [PMID: 38568134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
SUMMARY Gestational gigantomastia is a rare condition typified by disproportionate bilateral breast enlargement in pregnant women, resulting in skin thinning, ulceration, and bleeding. Less than sixty cases have been documented worldwide, and only one other in South Africa. Pseudo-angiomatous stromal hyperplasia (PASH) is a rare benign proliferation of stromal tissue in a tumorous or diffuse pattern. This, to the best of our knowledge, is the first published case, a 27-year-old human immunodeficiency virus (HIV) positive woman, to present with both conditions concurrently. Medical management with cabergoline was initiated and, seven months post-delivery, a novel Goldilocks mastectomy was performed with acceptable outcomes.
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Affiliation(s)
- F H Rabe
- Stellenbosch University, South Africa
| | - M Conradie
- Division of Endocrinology, Department of Medicine, Faculty of Medicine and Health Sciences, Tygerberg Academic Hospital, Stellenbosch University, South Africa
| | - M Mahoko
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine and Health Sciences, Tygerberg Academic Hospital, Stellenbosch University, South Africa
| | - R C de Villiers
- Breast and Endocrine Division, Department of Surgery, Faculty of Medicine and Health Sciences, Tygerberg Academic Hospital, Stellenbosch University, South Africa
| | - J Edge
- Breast and Endocrine Division, Department of Surgery, Faculty of Medicine and Health Sciences, Tygerberg Academic Hospital, Stellenbosch University, South Africa
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Ninomiya K, Nakaza E, Yamashiro T, Abe T, Ikematsu N, Nagama H, Kakazu K, Fukasawa M. Shaken adult syndrome due to ocean wave: an autopsy case. Forensic Sci Med Pathol 2024; 20:233-238. [PMID: 37659006 DOI: 10.1007/s12024-023-00699-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/05/2023]
Abstract
Severe intracranial trauma during torture or assault is reportedly caused by shaken adult syndrome. However, intracranial traumas caused by natural forces, excluding human factors and collision impact, are extremely rare. We report an autopsy case of shaken adult syndrome caused by ocean wave forces. A man in his 40s without any medical history was washed away by a wave during recreational fishing. He was found approximately 500 m away from the fishing point drifting on the ocean in a state of cardiopulmonary arrest and was confirmed dead, with no response to cardiopulmonary resuscitation, 3 h after the accident. The autopsy revealed no mechanical trauma to the entire body surface, including the head. Both lungs were inflated, and pleural effusion was observed. The brain was swollen and congested, and subarachnoid hemorrhage was observed in the interhemispheric fissure and the convexity of the parietal occipital lobe. Macroscopic and microscopic hemorrhage spots were found in the brain, and the results of the blood alcohol test and urinary toxicological screening were negative. The cause of death was determined as drowning. This case demonstrates a rare but notable mechanism of injury observed in immersed bodies.
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Affiliation(s)
- Kenji Ninomiya
- Department of Legal Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
| | - Eizo Nakaza
- Department of Civil Engineering and Architecture, Graduate School of Engineering and Science, University of the Ryukyus, Okinawa, Japan
| | - Tsuneo Yamashiro
- Department of Radiology, Yokohama City University, Kanagawa, Japan
| | - Takayuki Abe
- Department of Surgery, Chubu Tokusyukai Hospital, Okinawa, Japan
| | - Natsuki Ikematsu
- Department of Legal Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hanae Nagama
- Department of Legal Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kazumichi Kakazu
- Department of Legal Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Maki Fukasawa
- Department of Legal Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Antoszewski B, Kasielska-Trojan A, Jones TE, Danilewicz M, Jones MW. The Immunohistochemical Profile of Mammary Tissue in Women With Macromastia and Its Potential Clinical Implications. Endocrinology 2024; 165:bqae026. [PMID: 38437158 DOI: 10.1210/endocr/bqae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/17/2024] [Accepted: 03/01/2024] [Indexed: 03/06/2024]
Abstract
Macromastia is an excessive, rapid, or slow growth of breast tissue in 1 or both breasts. While macromastia represents a benign lesion, it may cause breast, shoulder, back, and neck pain, poor posture, infections, and loss of nipple sensation. The pathogenesis of macromastia or hypertrophy of mammary tissue remains poorly understood. The purpose of this study is to investigate the immunohistochemical expression of several hormone receptors that may potentially influence the growth of breast tissue in women with macromastia. Immunohistochemical studies performed on representative sections of breast tissue from 63 patients diagnosed with macromastia included estrogen receptor, progesterone receptor, androgen receptor (AR), prolactin receptor, growth hormone receptor, and vascular endothelial growth factor. The expression of each stain was evaluated separately in the glandular epithelium and adipose tissue and calculated as an H-score. We observed that AR expression in breast glandular and adipose tissue in women with macromastia was significantly lower than benign, nonhypertrophic breast tissue of a control group. Although the analyses were controlled for the age, the fact the mean age and hormonal status differed between the patients and the controls could have affected the results. Additional large studies will be required to further verify this finding and increase the knowledge about the etiology of this condition and then guide pharmacological treatment of juvenile and/or idiopathic gigantomastia.
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Affiliation(s)
- Bogusław Antoszewski
- Plastic, Reconstructive, and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, 90-153 Lodz, Poland
| | - Anna Kasielska-Trojan
- Plastic, Reconstructive, and Aesthetic Surgery Clinic, Institute of Surgery, Medical University of Lodz, 90-153 Lodz, Poland
| | - Terri E Jones
- Department of Pathology, the Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Marian Danilewicz
- Department of Pathology, Medical University of Lodz, 92-213 Lodz, Poland
| | - Mirka W Jones
- Department of Pathology, the Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
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8
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Selamioğlu E, Agdoğan Ö. Mammoplasty Using Modified Superomedial Pedicle Technique in Severely Macromastia and Ptotic Breasts. Breast J 2024; 2024:7635485. [PMID: 38389976 PMCID: PMC10883735 DOI: 10.1155/2024/7635485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 12/21/2023] [Accepted: 01/17/2024] [Indexed: 02/24/2024]
Abstract
Mammoplasty is a surgery commonly used for macromastia. Many mammoplasty techniques are described, all with their specific pros and cons. However, the concern to avoid serious complications sometimes takes precedence, and the ideal result cannot be. For macromastia and severely ptotic breasts, usually the free nipple-areolar complex (NAC) mammoplasty technique is implemented. The results, however, may only be completely satisfactory regarding cosmetics. Loss of NAC, poor appearance, flabbiness, flattening, and ptosis are among the disadvantages of this technique. This study aimed to present the results of mammoplasty employing the superomedial pedicle technique without interrupting a macromastia central base with a pedicle length of 8 to 18 cm. According to the literature, many plastic surgeons recommend the free NAC rather than the pedicle technique because of the high complication rates in mammoplasties planned for highly ptotic breasts and macromastia. On the other hand, many free NAC techniques and their modifications with pedicle mammoplasty are described. The general conviction is that a standard method, protocol, or technique good for all patients does not exist. Our results are more acceptable both cosmetically and physiologically. Therefore, the superomedial pedicle technique can be modified to achieve ideal results where free NAC mammoplasty is considered for severe macromastia and ptotic patients. This combined method contributes to the viability of NAC by increasing blood supply to breast tissue and providing an ideal breast appearance.
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Affiliation(s)
- Engin Selamioğlu
- Haliç University, Department of Plastic Reconstructive and Aesthetic Surgery, İstanbul, Türkiye
| | - Özgür Agdoğan
- Private Clinic, Plastic Reconstructive and Aesthetic Surgery, İstanbul, Türkiye
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9
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Bonomi F, Harder Y, Treglia G, De Monti M, Parodi C. Is free nipple grafting necessary in patients undergoing reduction mammoplasty for gigantomastia? A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2024; 89:144-153. [PMID: 38183875 DOI: 10.1016/j.bjps.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/10/2023] [Accepted: 12/06/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Gigantomastia is a debilitating condition characterised by an excessive breast tissue growth impacting patients' quality of life. Surgically treatment options include the limited-length pedicle (LP) technique with free nipple grafting (FNG) and the elongated pedicle (EP) technique, which maintains continuity of the nipple-areola complex (NAC). Initially, despite the less satisfactory aesthetic outcome, FNG was preferred to treat hypertrophic breasts requiring resections over 1000 g of parenchymal and adipose tissue, due to concerns about NAC perfusion. Recently, many studies have questioned this indication. The aim of this study was therefore to evaluate the safety of the NAC-carrying EP technique in patients with gigantomastia eventually challenging the need for FNG. METHODS A literature search using PubMed and Cochrane databases was performed, including studies describing the outcome of EP technique for resection exceeding 1000 g of breast tissue. Thereby, a meta-analysis was conducted to evaluate the rate of NAC necrosis, whereas a descriptive statistic was applied to assess all other surgery-associated complications. RESULTS Twenty-five studies, encompassing 1355 patients (2656 breasts), were included. EP demonstrated an extremely low rate of NAC necrosis. Moreover, the analysis demonstrated a low rate of ischaemia-independent complications and a very high probability of maintaining NAC-sensation equal to the preoperative state. CONCLUSION Current evidence indicates that the EP technique should be the preferred surgical method to treat gigantomastia with or without massive ptosis whenever indicated. It has proven to be safe. Furthermore, it yields superior aesthetic and functional outcomes, including breast feeding and preservation of NAC-sensation compared to the LP technique.
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Affiliation(s)
- Francesca Bonomi
- Department of Surgery, Ospedale Beata Vergine di Mendrisio, Ente Ospedaliero Cantonale (EOC), Mendrisio, Switzerland
| | - Yves Harder
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - Giorgio Treglia
- Division of Medical Education and Research, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Marco De Monti
- Department of Surgery, Ospedale Beata Vergine di Mendrisio, Ente Ospedaliero Cantonale (EOC), Mendrisio, Switzerland; Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Corrado Parodi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland.
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Hizem S, Maamouri R, Zaouak A, Rejeb I, Karoui S, Sebai M, Jilani H, Elaribi Y, Fenniche S, Cheour M, Bilan F, Ben Jemaa L. Absent meibomian glands and cone dystrophy in ADULT syndrome: identification by whole exome sequencing of pathogenic variants in two causal genes TP63 and CNGB3. Ophthalmic Genet 2024; 45:84-94. [PMID: 37158316 DOI: 10.1080/13816810.2023.2206891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/20/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Ectrodactyly is a rare congenital limb malformation characterized by a deep median cleft of the hand and/or foot due to the absence of central rays. It could be isolated or depicts a part of diverse syndromic forms. Heterozygous pathogenic variants in the TP63 gene are responsible for at least four rare syndromic human disorders associated with ectrodactyly. Among them, ADULT (Acro-Dermato-Ungual-Lacrimal-Tooth) syndrome is characterized by ectodermal dysplasia, excessive freckling, nail dysplasia, and lacrimal duct obstruction, in addition to ectrodactyly and/or syndactyly. Ophthalmic findings are very common in TP63-related disorders, consisting mainly of lacrimal duct hypoplasia. Absent meibomian glands have also been well documented in EEC3 (Ectrodactyly Ectodermal dysplasia Cleft lip/palate) syndrome but not in ADULT syndrome. METHODS We report a case of syndromic ectrodactyly consistent with ADULT syndrome, with an additional ophthalmic manifestation of agenesis of meibomian glands. The proband, as well as her elder sister, presented with congenital cone dystrophy.The molecular investigation was performed in the proband using Whole Exome Sequencing. Family segregation of the identified variants was confirmed by Sanger sequencing. RESULTS Two clinically relevant variants were found in the proband: the novel de novo heterozygous missense c.931A > G (p.Ser311Gly) in the TP63 gene classified as pathogenic, and the homozygous nonsense pathogenic c.1810C > T (p.Arg604Ter) in the CNGB3 gene. The same homozygous CNGB3 variation was also found in the sister, explaining the cone dystrophy in both cases. CONCLUSIONS Whole Exome Sequencing allowed dual molecular diagnoses: de novo TP63-related syndromic ectrodactyly and familial CNGB3-related congenital cone dystrophy.
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Affiliation(s)
- Syrine Hizem
- Department of congenital and hereditary diseases, Mongi Slim hospital, La Marsa, Tunisia
- Human genetics laboratory, LR99ES10- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Rym Maamouri
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Ophthalmology, Habib Thameur hospital, Tunis, Tunisia
| | - Anissa Zaouak
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Dermatology, Genodermatosis and Cancers Laboratory LR12SP03, Habib Thameur Hospital, Tunis, Tunisia
| | - Imen Rejeb
- Department of congenital and hereditary diseases, Mongi Slim hospital, La Marsa, Tunisia
- Maternal and Child health laboratory, LR22SP01- Mongi Slim Hospital, Tunis, Tunisia
| | - Sana Karoui
- Department of congenital and hereditary diseases, Mongi Slim hospital, La Marsa, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Maternal and Child health laboratory, LR22SP01- Mongi Slim Hospital, Tunis, Tunisia
| | - Molka Sebai
- Department of congenital and hereditary diseases, Mongi Slim hospital, La Marsa, Tunisia
- Human genetics laboratory, LR99ES10- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Houweyda Jilani
- Department of congenital and hereditary diseases, Mongi Slim hospital, La Marsa, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Yasmina Elaribi
- Department of congenital and hereditary diseases, Mongi Slim hospital, La Marsa, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Sami Fenniche
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Dermatology, Genodermatosis and Cancers Laboratory LR12SP03, Habib Thameur Hospital, Tunis, Tunisia
| | - Monia Cheour
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Ophthalmology, Habib Thameur hospital, Tunis, Tunisia
| | - Frédéric Bilan
- Laboratoire de Génétique, Service de Génétique, CHU Poitiers, Poitiers, France
| | - Lamia Ben Jemaa
- Department of congenital and hereditary diseases, Mongi Slim hospital, La Marsa, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Maternal and Child health laboratory, LR22SP01- Mongi Slim Hospital, Tunis, Tunisia
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Siddiqui S, Miller M, Dumont A, Delashaw J, Wang A. Iatrogenic Cerebrospinal Fluid Breast Augmentation: Rare Complication of Ventriculoperitoneal Shunts and Management Strategies. World Neurosurg 2024; 181:e743-e751. [PMID: 37898269 DOI: 10.1016/j.wneu.2023.10.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/24/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Ventriculoperitoneal shunt is one of the most common neurosurgical procedures in the treatment of hydrocephalus. There are reports of migration of the distal catheter to the breast pocket where cerebrospinal fluid then collects and can develop into a pseudocyst. There exist case reports in the literature of patients with prior breast augmentation who present with distal catheter migration from the peritoneal space into the breast tissue. We present a case series of 3 patients with preexisting breast augmentation who returned with unilateral breast enlargement after ventriculoperitoneal shunt. In all 3 patients, the distal catheter migrated out of the peritoneal space and was found to be coiled around the breast prosthesis. Additionally, we offer recommendations for managing these complications and a review of the literature. METHODS We performed a systematic review without meta-analysis of studies involving management of shunt migration in the setting of preexisting breast implants. We present a case series of 3 patients whom we treated with breast cerebrospinal pseudocyst after migration of the distal catheter into the breast tissue. RESULTS A total of 17 studies, dating from 2002 to 2022, met our inclusion and exclusion criteria and were selected for full review. Catheter migration occurred between 2 weeks and 9 months of initial shunt placement. All patients presented with unilateral breast enlargement and cerebrospinal fluid pseudocyst formation. All patients underwent revision shunt surgery. Surgical treatment strategies used included reimplantation of the distal catheter into the pleural space or ipsilateral or contralateral peritoneal space or complete removal of the entire shunt system. CONCLUSIONS Breast-related ventriculoperitoneal shunt complication is a rare entity that is increasingly seen as more patients receive breast augmentation. Breast-related shunt complications most commonly present with cerebrospinal fluid pseudocyst formation in the breast. It is important for neurosurgeons to be aware of an underlying breast implant before placing a ventriculoperitoneal shunt. For patients who have migration of the distal catheter into the breast, a protocol for managing these situations should be followed to ensure no shunt infection and avoidance of future catheter migration complications with subsequent shunt revisions.
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Affiliation(s)
- Sarah Siddiqui
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Michelle Miller
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Aaron Dumont
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Johnny Delashaw
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Arthur Wang
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
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12
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Stahl S, Dannehl D, Daigeler A, Jorge C, Brendlin A, Hagen F, Santos Stahl A, Feng YS, Nikolaou K, Estler A. Definitions of Abnormal Breast Size and Asymmetry: A Cohort Study of 400 Women. Aesthetic Plast Surg 2023; 47:2242-2252. [PMID: 37253846 DOI: 10.1007/s00266-023-03400-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/23/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Macromastia, micromastia and breast asymmetry have an impact on health and quality of life. However, there is scarce information addressing breast size and asymmetry frequency distribution in reference populations. OBJECTIVE The current study aims to identify factors that influence breast size and symmetry and classifies abnormal breast sizes and breast asymmetries in an adult German population. METHODS Breast base dimensions, breast volume, symmetry, and other breast anthropometric parameters of 400 German female patients were determined in a retrospective review of the MRI archives at our institution. Professional medical MRI-segmentation software was used for volume measurement. RESULTS A total of 400 Patients were retrospectively enrolled. The patients had a mean age of 50 ± 12 years (min: 24; max: 82), mean BMI of 25.0 ± 5.0 (min: 14.7, max: 45.6), and a mean total breast volume of 976 ml (right: 973 ml, min: 64, max: 4777; left: 979 ml, min: 55, max: 4670). The strongest correlation of breast volume was observed with BMI (r = 0.834, p < 0.001), followed by breast base width (r = 0.799, p < 0.001). Smaller breasts have higher breast volume asymmetry ratios (r = - 0.124, p < 0.014). For a BMI between 18.5 and 24.9 kg/m2, micromastia is defined by breast volumes below 250 ml (5th percentile) and macromastia by volumes above 1250 ml (95th percentile). Abnormal breast volume asymmetry (< 5th and > 95th percentile) is equivalent to an absolute difference of approximately 25% relative to the smallest side (bidirectional asymmetry ratio 5th percentile - 19%; 95th percentile 26%). CONCLUSION This study provides normative data of German women, as well as selected size-for-BMI percentiles and asymmetry ratio percentiles. The normative data may help to establish transparent and objective coverage criteria for health insurances. 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)
- Stéphane Stahl
- CenterPlast Private Practice, Bahnhofstr. 36, 66111, Saarbrücken, Germany
| | - Dominik Dannehl
- Department of Women's Health, University Hospital Tübingen, Calwerstr 7/6, 72076, Tübingen, Germany
| | - Adrien Daigeler
- Department of Plastic Hand and Reconstructive Surgery, BG Trauma Center Tübingen, Schnarrenbergstr 95, 72076, Tübingen, Germany
| | - Cristina Jorge
- Department of General-, Visceral-, Vascular-, and Pediatric Surgery, Saarland University Medical Center, Kirrberger Straße, 66421, Homburg, Saar, Germany
| | - Andreas Brendlin
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Florian Hagen
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | | | - You-Shan Feng
- Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Arne Estler
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
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13
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Alvaro AI, Willet JW, Dounas GD, Jeeves A, Lodge M, Javed MU. A Systematic Review of Outcomes and Complications of Tuberous Breast Surgery. Aesthet Surg J 2023; 43:NP1001-NP1009. [PMID: 37439225 DOI: 10.1093/asj/sjad229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Tuberous breast is a complex congenital breast anomaly that can be challenging to correct surgically. OBJECTIVES The authors conducted a systematic review with pooled analysis of data, with the aim of determining the effectiveness and complications related to operative management of the deformity. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were adopted in performing this systematic review. A simplified classification system for tuberous breast deformity was developed to accurately compare data and guide analysis. RESULTS The review identified 38 studies, reporting a total of 897 patients undergoing tuberous breast surgery. The mean age of patients was 24 years (range 13-53 years). Mean follow-up was 39 months. A combination of tissue rearrangement and implant augmentation was the most common technique (73% of patients) followed by fat transfer alone (9%). Breast implants were employed in 83% of patients. The mean implanted volume per breast was 263 cc. Fat grafting was performed in 13% of patients and mean volume of fat grafted per breast was 185 cc. An overall complication rate of 20% was reported. Subjective assessment of patient satisfaction was 99%, and the mean score on BREAST-Q for satisfaction with clinical outcome was 86.7. Future studies should focus on robust study designs including randomized and cohort studies, use of patient-reported outcome measures, and long-term follow-up. CONCLUSIONS The surgical techniques to correct tuberous breast deformity are safe, effective, and have a high satisfaction rate. Fat transfer has the capacity to provide promising results in treating tuberous breast deformity. LEVEL OF EVIDENCE: 4
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14
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El Israwi D, Makdessi JP, Bassilios Habre S. The Surgical Treatment of Tuberous Breast Deformity: A Review Article. Ann Plast Surg 2023; 91:395-399. [PMID: 37566822 DOI: 10.1097/sap.0000000000003630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
ABSTRACT Tuberous breast is a common congenital deformity that might present as unilateral or bilateral breast base constriction, asymmetry, areolar herniation, hypoplasia, ptosis, and skin deficiency. Patients might present with one or more of the mentioned features, rendering a consensus about the optimal surgical technique to correct this deformity nonexistent. In our review article, we present the most common classifications of a tuberous breast, in addition to several surgical approaches that attempt to treat this deformity.
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15
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Radparvar J, Piplani C, Chatterjee A, Nardello SM. Oncoplastic Surgery in the Large-Breasted Breast Cancer gene Patient: A Staged Step to Enable Nipple Sparing Mastectomy. Am Surg 2023; 89:2049-2051. [PMID: 34053225 DOI: 10.1177/00031348211023454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patients with macromastia and/or moderate-severe ptosis who desire mastectomy are typically offered skin sparing mastectomies. Recent technical advances have broadened the inclusion criteria to allow for nipple sparing mastectomy (NSM) in this population; however, they have been limited to patients with unifocal disease. We report on the multidisciplinary approach used to offer a NSM to a patient with multicentric triple-negative breast cancer and symptomatic macromastia with severe ptosis in the setting of positive genetic testing. We discuss the combination of a staged oncoplastic approach with neoadjuvant and adjuvant chemotherapy, as well as the foundations of these approaches. We encourage further research and inclusion of patients such as ours in the criteria for NSM.
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Affiliation(s)
| | - Charoo Piplani
- Clara Swain Mission Hospital, Bareilly, Uttar Pradesh, India
| | - Abhishek Chatterjee
- Tufts Medical Center Community Care, Stoneham, MA, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, MA, USA
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16
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Karp NS. Discussion: The Impact of Combined Oral Contraceptives on Adolescents with Macromastia. Plast Reconstr Surg 2022; 150:739-740. [PMID: 36170439 DOI: 10.1097/prs.0000000000009514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Nolan S Karp
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine
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17
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Cruz NI. Symptomatic Macromastia and Days Lost from Work. P R Health Sci J 2022; 41:157-160. [PMID: 36018745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To compare the amount of days lost from work by women with symptomatic macromastia while on conservative management and after they undergo breast reduction surgery. METHODS Working women with symptomatic macromastia were requested to record the number of days lost from work as a result of back or neck pain associated with their large breasts during a 6 months period of conservative management required by their health insurance. The conservative management included physical therapy, weight loss and analgesics. A reduction mammoplasty was approved and performed in all the women following the period of conservative management. After the women returned to work, they were again requested to record the number of lost work days associated with back/neck pain during the next 6 months. Basic demographic information was also obtained. RESULTS One hundred twenty-three women with symptomatic macromastia participated. The mean age was 31±10, the mean body mass index was 29±4, mean bra size was 38-D, 45% had a college degree or higher, and 90% had full-time employment. The mean number of lost work days was 6±3 with conservative and 1±1 with surgical management in a 6 months period, a difference that was statistically significant (p<0.05). Based on gender-specific median wage rates from the Bureau of Labor Statistics, these lost days represent an economic loss of $1,642 annually per woman in conservative management. CONCLUSION Surgical treatment of breast hypertrophy resulted in significantly less days lost from work. There is a higher cost in loss productivity with conservative management.
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Affiliation(s)
- Norma I Cruz
- Div. of Plastic Surgery, Department of Surgery, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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18
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Chang LW, Kazlouskaya V, Georgesen C, Matsumoto M, Ho J, Jedrych J, Karunamurthy A, Picarsic J, Woerner A, Gehris R. Improvement of Unilateral Breast Hypoplasia With Oral Spironolactone in a Patient With Becker Nevus Syndrome. J Drugs Dermatol 2022; 21:425-426. [PMID: 35389596 DOI: 10.36849/jdd.5579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Becker nevus (BN) is a benign cutaneous smooth muscle hamartoma that presents with a hyperpigmented patch or plaque with or without hypertrichosis.1 BN may be associated with ipsilateral breast hypoplasia or other musculoskeletal abnormalities, an association which has been termed Becker nevus syndrome (BNS).
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19
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Rooi A, Botha A, Ndobe E, Nel M. Severe gestational gigantomastia: management challenges. S AFR J SURG 2021; 59:195a-195c. [PMID: 34889547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Gestational gigantomastia is rare and characterised by rapid and disproportionate enlargement of the breast during pregnancy. It often requires surgical removal of more than 1500 g of breast tissue. Of the 50 case reports published worldwide, not one was in South African literature. This unusual case report is of a female presenting with gigantomastia at five weeks gestational age. The patient was multiparous and decided to terminate the pregnancy due to the physical and emotional effects of the large, pendulous breasts. Management included breast reduction and free nipple grafting in a staged approach. The complications are briefly outlined. Despite rare presentation, patient satisfaction was achieved.
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Affiliation(s)
- A Rooi
- Department of Surgery, Division of Plastic and Reconstruction Surgery, University of the Witwatersrand, South Africa and Department of Surgery, Helen Joseph Hospital, South Africa
| | - A Botha
- Department of Surgery, Division of Plastic and Reconstruction Surgery, University of the Witwatersrand, South Africa and Department of Surgery, Chris Hani Baragwanath Academic Hospital, South Africa
| | - E Ndobe
- Department of Surgery, Division of Plastic and Reconstruction Surgery, University of the Witwatersrand, South Africa and Department of Surgery, Chris Hani Baragwanath Academic Hospital, South Africa
| | - M Nel
- Department of Surgery, Division of Plastic and Reconstruction Surgery, University of the Witwatersrand, South Africa
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20
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Crittenden TA, Watson DI, Ratcliffe J, Dean NR. Interpreting Differences in BREAST-Q Scores following Reduction Mammaplasty: Minimal Important Difference. Plast Reconstr Surg 2021; 148:331e-332e. [PMID: 34233344 DOI: 10.1097/prs.0000000000008147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Tamara A Crittenden
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, College of Medicine and Public Health, Flinders University
| | - David I Watson
- College of Medicine and Public Health, Flinders University
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University
| | - Nicola R Dean
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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21
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Hall-Findlay EJ. Commentary on: Frequency of Headaches in Macromastia Patients and Relief After Reduction Mammoplasty. Aesthet Surg J 2021; 41:NP327-NP328. [PMID: 33515447 DOI: 10.1093/asj/sjaa299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Caro C, Freude W, Florek A, Morgenstern S, Boeer B, Roehm C, Hahn M, Marx M. Simultaneous correction of a pectus excavatum with tubular breast deformity using a custom-made silicone implant. Arch Gynecol Obstet 2021; 303:1025-1037. [PMID: 33389096 DOI: 10.1007/s00404-020-05898-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
Pectus excavatum (PE) is one of the most common congenital deformities of the thorax and is characterized by a depressed sternum with reduction of the antero-posterior thoracic diameter. Although the majority of patients with PE have no physiologic limitations, it is often associated with psychological problems influencing the patients' quality of life. Surgical treatment options show particular variation with regard to invasiveness and morbidity of the respective procedures. Surgical treatment using a custom-made silicone implant represents a less invasive alternative for patients without further accompanying physical symptoms. This article describes the simultaneous correction of a PE combined with tubular breast deformity using this minimally invasive technique.
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Affiliation(s)
- C Caro
- Department of Plastic, Reconstructive and Breast Surgery, Elbland Hospital Radebeul, Radebeul, Germany
| | - W Freude
- Department of Plastic, Reconstructive and Breast Surgery, Elbland Hospital Radebeul, Radebeul, Germany
| | - A Florek
- Department of Plastic, Reconstructive and Breast Surgery, Elbland Hospital Radebeul, Radebeul, Germany
| | - S Morgenstern
- Department of Plastic, Reconstructive and Breast Surgery, Elbland Hospital Radebeul, Radebeul, Germany
| | - B Boeer
- Department of Women's Health, University of Tübingen, Tübingen, Germany
| | - C Roehm
- Department of Women's Health, University of Tübingen, Tübingen, Germany
| | - M Hahn
- Department of Women's Health, University of Tübingen, Tübingen, Germany
| | - M Marx
- Department of Plastic, Reconstructive and Breast Surgery, Elbland Hospital Radebeul, Radebeul, Germany.
- Department of Women's Health, University of Tübingen, Tübingen, Germany.
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23
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Vishwanath S, Pellegrini B, Parker E, Earnest A, Kalbasi S, Gartoulla P, Elder E, Farrell G, Moore C, Cooter RD, Ahern S, McNeil JJ, Hopper I. Breast Device Surgery in Australia: Early Results from the Australian Breast Device Registry. J Plast Reconstr Aesthet Surg 2021; 74:2719-2730. [PMID: 33931327 DOI: 10.1016/j.bjps.2021.03.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 03/03/2021] [Accepted: 03/13/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Australian Breast Device Registry (ABDR) is a clinical quality registry designed to monitor the performance of breast devices; and the quality and safety of breast device surgery. OBJECTIVE To report on breast device surgery characteristics across Australia. METHODS Participants were registered patients in the ABDR from 2012 to 2018. Results are described using percentages, mean and median. Revision rates were calculated using survival analysis methods. RESULTS A total of 37,603 patients were registered and had undergone reconstruction (post-cancer 15.1%, risk-reducing mastectomy 3.4% and developmental deformity 2.4%) or cosmetic augmentation (74.7%) procedures. The majority of breast implant devices were silicone filled with textured surface (reconstruction 74.0% and augmentation 64.0%). Sub-pectoral plane was the most common for both reconstruction (60.1%) and augmentation (76.6%) procedures. For reconstruction surgery, the most common surgical incision was previous mastectomy scar (44.0%) and inframammary (31.8%), and for augmentation, it was inframammary (83.4%). Intraoperative/postoperative antibiotic usage for reconstruction was 85.8% and augmentation was 89.4%. Revision incidence due to complication at 12 months post-cancer reconstruction was 5.1%, risk-reducing reconstruction 5.7% and developmental deformity implants 4.5%. Revision incidence due to complication at 12 months after augmentation procedure was 1.1%. Patient-reported outcome measures (PROMs) indicate high levels of satisfaction at 1 year for augmentation and reconstruction procedures. CONCLUSION We report on early data from the ABDR and reflect on the uptake of the registry by surgeons and patients. The registry also benefits from international collaborative approaches to addressing challenges and is committed to facilitate international post-market surveillance.
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Affiliation(s)
- Swarna Vishwanath
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Breanna Pellegrini
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Emily Parker
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Saeid Kalbasi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Pragya Gartoulla
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Elisabeth Elder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Westmead Breast Cancer Institute, Australia; University of Sydney, Sydney, Australia; Breast Surgeons of Australia & New Zealand, Australia
| | - Gillian Farrell
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Cabrini Hospital - Brighton, Australia; Peter McCallum Cancer Centre, Melbourne, Australia; Australian Society of Plastic Surgeons, Australia
| | - Colin Moore
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Australasian College of Cosmetic Surgery, Australia
| | - Rodney D Cooter
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ingrid Hopper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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de Vasconcelos Gaspar A, Melo L, Geraldes F, Belo J, Águas F. Breast pathology in adolescence. Breast Dis 2021; 40:269-274. [PMID: 34120893 DOI: 10.3233/bd-201043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Description of breast pathology in adolescents. METHODS A retrospective descriptive study of adolescents who were referred to the Gynecology consultation of a tertiary pediatric hospital for suspected breast pathology, in the period from the 1st June 2011 to the 30th December 2018. RESULTS One hundred and two female adolescents (11 to 18 years old) with suspected breast pathology were referred (6% of the motives for consultation), with confirmation in 58 (56.9%), who were included in the study. The reasons for referral were breast masses (66%), anomalies in breast size or symmetry (29%) and infection (5%). Of breast masses, the most frequent diagnosis was fibroadenoma (76%), followed by fibro-cystic pathology (18%). In most cases, a conservative approach was chosen, with clinical and imaging surveillance. Surgery was required in 29% of these cases. Anomalies in breast size and symmetry were observed in 17 adolescents. Two adolescents were submitted to symmetrization, after 18 years of age. Infectious and inflammatory pathology occurred in three cases: two mastitis and one retroareolar cyst. The approach consisted mainly of antibiotherapy. There were no cases of malignant breast disease. CONCLUSION Lumps or breast masses are the most frequent breast pathology in adolescence, and in the majority of cases surveillance was recommended, as they are a mere sign of hormonal oscillations at this age. Objective examination and/or breast ultrasound are usually enough to make the diagnosis. The approach must be mainly conservative, since malignancy is extremely rare in this age group.
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Affiliation(s)
| | - Luís Melo
- Serviço de Ginecologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Fernanda Geraldes
- Serviço de Ginecologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Joana Belo
- Serviço de Ginecologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Fernanda Águas
- Serviço de Ginecologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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25
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Restifo RJ. The Pedicled Robertson Mammaplasty: Minimization of Complications in Obese Patients With Extreme Macromastia. Aesthet Surg J 2020; 40:NP666-NP675. [PMID: 32173731 DOI: 10.1093/asj/sjaa073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Breast reduction for extreme macromastia in obese patients is a potentially high-risk endeavor. Free nipple grafting as well as a variety of pedicled techniques have been advocated for large reductions in obese patients, but the number of different approaches suggests that no single method is ideal. This paper suggests the Robertson Mammaplasty, an inferior pedicle technique characterized by a curvilinear skin extension onto the pedicle, as a potentially favorable approach to this clinical situation. OBJECTIVES The author sought to determine the safety of the Pedicled Robertson Mammaplasty for extreme macromastia in obese patients. METHODS The records of a single surgeon's practice over a 15-year period were retrospectively reviewed. Inclusion criteria were a Robertson Mammaplasty performed with a >3000-g total resection and a patient weight at least 20% above ideal body weight. Records were reviewed for patient characteristics, operative times, and complications. RESULTS The review yielded 34 bilateral reduction patients that met inclusion criteria. The mean resection weight was 1859.2 g per breast, the mean body mass index was 36.4 kg/m2, and the mean sternal notch-to-nipple distance was 41.4 cm. Mean operative time was 122 minutes. There were no cases of nipple necrosis and no major complications that required reoperation under general anesthesia. A total 26.4% of patients had minor complications that required either local wound care or small office procedures, and 4.4% received small revisions under local anesthesia. CONCLUSIONS The Pedicled Robertson Mammaplasty is a fast and safe operation that yields good aesthetic results and a relative minimum of complications in the high-risk group of obese patients with extreme macromastia. LEVEL OF EVIDENCE: 4
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Simões da Silva J, Alves Teixeira P, Rosmaninho MT. Tuberous Breast. ACTA MEDICA PORT 2020; 33:767. [PMID: 32975511 DOI: 10.20344/amp.12348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 07/10/2019] [Indexed: 11/20/2022]
Affiliation(s)
- Joana Simões da Silva
- Unidade de Saúde Familiar Águeda Mais Saúde. Agrupamento Centro de Saúde do Baixo Vouga. Águeda. Portugal
| | - Paula Alves Teixeira
- Unidade de Saúde Familiar Águeda Mais Saúde. Agrupamento Centro de Saúde do Baixo Vouga. Águeda. Portugal
| | - Maria Teresa Rosmaninho
- Unidade de Saúde Familiar Águeda Mais Saúde. Agrupamento Centro de Saúde do Baixo Vouga. Águeda. Portugal
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Otsuki Y, Ueda K, Nuri T, Satoh C, Maekawa R, Yoshiura KI. EEC-LM-ADULT syndrome caused by R319H mutation in TP63 with ectrodactyly, syndactyly, and teeth anomaly: A case report. Medicine (Baltimore) 2020; 99:e22816. [PMID: 33126320 PMCID: PMC7598809 DOI: 10.1097/md.0000000000022816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Ectrodactyly ectodermal dysplasia-cleft lip/palate (EEC) syndrome, limb-mammary syndrome (LMS), and acro-dermato-ungual-lacrimal-tooth (ADULT) syndrome are caused by a TP63 gene disorder and have similar features. In the present article, a R319H mutation in TP63 is reported, and the correlation between genotype and phenotype is discussed based on the current case and previous literature. PATIENT CONCERNS A 13-year-old Japanese boy had ectrodactyly in the right hand and left foot and syndactyly in the left and right foot, and tooth shape abnormalities. DIAGNOSES Peripheral blood samples were obtained, and mutation analysis was performed. A heterozygous G>A transition at cDNA position 956 of the TP63 gene was found. The patient was diagnosed with ELA (EEC/LM/ADULT) syndrome based on his clinical features and mutation analysis results. INTERVENTIONS The patient underwent surgery to correct the left foot malformation at 1 year of age and the right foot syndactyly at 11 years of age. OUTCOMES No complications were observed after the first and second operations. He can walk comfortably after them, and no additional interventions will be planned in him. We continued to follow up with him up to the present. LESSONS The concept of ELA syndrome, which is the original concept of combining 3 syndromes (EEC syndrome/LMS/ADULT syndrome) into a unique clinical entity, can help clinicians to better understand TP63-related syndromes and improve the differential diagnosis of these syndromes.
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Affiliation(s)
- Yuki Otsuki
- Department of Plastic and Reconstructive Surgery, Osaka Medical College, Osaka
| | - Koichi Ueda
- Department of Plastic and Reconstructive Surgery, Osaka Medical College, Osaka
| | - Takashi Nuri
- Department of Plastic and Reconstructive Surgery, Osaka Medical College, Osaka
| | - Chisei Satoh
- Department of Human Genetics, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryuta Maekawa
- Department of Human Genetics, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Koh-ichiro Yoshiura
- Department of Human Genetics, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Bustos SS, Molinar V, Kuruoglu D, Cespedes-Gomez O, Sharaf BA, Martinez-Jorge J, Manrique OJ, Tran NV, Nguyen MDT. Inferior pedicle breast reduction and long nipple-to-inframammary fold distance: How long is safe? J Plast Reconstr Aesthet Surg 2020; 74:495-503. [PMID: 33127349 DOI: 10.1016/j.bjps.2020.08.123] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Free nipple grafting indications in breast reduction surgery are outdated. Safety of inferior pedicle technique for large resections and long pedicles has not been clearly defined. We evaluated patients who underwent inferior pedicle reduction mammoplasty to define the safety constraints of the inferior pedicle. METHODS A retrospective review of patients who underwent inferior pedicle reduction mammoplasty due to symptomatic macromastia at Mayo Clinic over a six-year period was conducted. Patients with prior breast surgeries were excluded. Demographics, breast measurements, and surgical outcomes were collected. Univariate and multivariate analyses were performed to assess for predictors of necrosis. RESULTS Overall, 288 patients (576 breasts) underwent inferior pedicle breast reduction from 2014 to 2019. The mean sternal notch-to-nipple (SNN) distance was 31.5 cm (standard deviation[SD]:4.2; range[r]:16-48), and the mean nipple-to-inframammary fold (N-IMF) distance was 14.8 cm (SD:4.0; r:7.5-27). The mean resection weight was 699.6 g (SD:310.4; r:125-2,385). The median follow-up was 3.9 months (interquartile range[IQR]:2.8-9.0). The overall skin or nipple areolar complex necrosis rate was 2.1%; the overall complication rate was 14.8%. On multivariate analysis, overall necrosis was not found to be associated with the N-IMF distance (adjusted odds ratio[aOR]:1.05, 95%-CI 0.88-1.16). Resection weight was statistically associated with an increased risk of overall necrosis (aOR:1.003, 95%-CI 1.001-1.005), adjusting for N-IMF and SNN distances. CONCLUSION Inferior pedicle breast reduction offers low risk of necrosis and can be safely performed in patients regardless of the N-IMF distance. No association was found between N-IMF distance and overall necrosis in our cohort, including lengths >15 cm. However, large resections could increase the risk of necrosis.
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Affiliation(s)
- Samyd S Bustos
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States; Center for Regenerative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Vanessa Molinar
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Doga Kuruoglu
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Omar Cespedes-Gomez
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Basel A Sharaf
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Jorys Martinez-Jorge
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Oscar J Manrique
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Nho V Tran
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States
| | - Minh-Doan T Nguyen
- Division of Plastic and Reconstructive Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
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Das L, Rai A, Vaiphei K, Garg A, Mohsina S, Bhansali A, Dutta P, Tripathy S. Idiopathic gigantomastia: newer mechanistic insights implicating the paracrine milieu. Endocrine 2019; 66:166-177. [PMID: 31502211 DOI: 10.1007/s12020-019-02065-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/20/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Gigantomastia refers to pathological breast enlargement usually occurring in the peripubertal or peripartum period. Idiopathic gigantomastia, however, is a rare entity with hypotheses citing local expression of hormones and growth factors in causing this disease, none of which have been systemically analysed. The purpose of this study was to delve deeper into the mechanistic pathways causing this condition. METHODS Herein, we describe three patients of idiopathic gigantomastia, all of whom had had normal puberty and uneventful pregnancies. Further, one of the patients had postmenopausal gigantomastia which is extremely rare, with only four cases described in the literature. Serum markers of autoimmunity, incriminated hormones and growth factors analysed, were normal in all the cases. Breast tissue specimens were subjected to histopathological examination and immunohistochemistry for ER, PR and Her-2-Neu. Quantitative immunofluorescence for aromatase, IGF2, EGFR, TGF-β, PDGFR-α, β, IGF1 and PTHrP was also performed. RESULTS Of these, the tissue expression of aromatase, IGF2, EGFR, TGF-β, PDGFR-α and β were found to be upregulated, whereas IGF1 and PTHrP were comparable to normal breast. CONCLUSION This observation that paracrine overexpression of these factors is responsible for the pathogenesis of apparently idiopathic gigantomastia may have therapeutic ramifications in the future for patients with this debilitating condition.
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Affiliation(s)
- Liza Das
- Department of Endocrinology, PGIMER, Chandigarh, India
| | - Ashutosh Rai
- Department of Translational and Regenerative Medicine, PGIMER, Chandigarh, India
| | - Kim Vaiphei
- Department of Pathology, PGIMER, Chandigarh, India
| | - Akhil Garg
- Department of Plastic surgery, PGIMER, Chandigarh, India
| | - Subair Mohsina
- Department of Plastic surgery, PGIMER, Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, PGIMER, Chandigarh, India
| | - Pinaki Dutta
- Department of Endocrinology, PGIMER, Chandigarh, India.
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Modarressi T, Levine MA, Khan AN. Response to Letter to the Editor: "Gestational Gigantomastia Complicated by PTHrP-Mediated Hypercalcemia". J Clin Endocrinol Metab 2019; 104:5100-5101. [PMID: 30977835 DOI: 10.1210/jc.2019-00820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 02/13/2023]
Affiliation(s)
- Taher Modarressi
- Diabetes & Endocrine Associates of Hunterdon, Flemington, New Jersey
| | - Michael A Levine
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amna N Khan
- Department of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Section of Endocrinology, Philadelphia VA Medical Center, Philadelphia, Pennsylvania
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Zongo N, Yaméogo SLC, Zamané H, Tiemtoré S, Zida M, Sanou A, Ouédraogo C, Lompo OM. [Oncoplasty by the Thorek technique for lower quadrant cancers in a condition of gigantomastia]. ACTA ACUST UNITED AC 2019; 47:650-654. [PMID: 31386918 DOI: 10.1016/j.gofs.2019.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Describe our experience of Oncoplasty according to Thorek in gigantomastia with hard and less plastic breasts and a major ptosis. METHODOLOGY Thirteen cases of breast carcinoma on gigantomastia operated using the Thorek technique between 2014 and 2019 in Burkina Faso were analyzed retrospectively. The operative indications, technique and results were considered. Breast Q was used to assess patient satisfaction. RESULTS The indication of oncoplasty by the Thorek's technique was breast lower quadrants carcinoma, associated with a major ptosis, gigantomastia. There was a consequence on the spine in 9 over 13 cases. The breasts were hard and less plastic, making the other breast reduction techniques difficult. This technique helped remove the carcinoma, reduce the volume of the breast and address the ptosis. The patients were satisfied with the volume of the remaining breasts and their aesthetic look. The resection margins were safe. Two cases of aerolar dyschromia were noticed. CONCLUSION The Thorek technique remains an alternative concerning tumours on gigantomastia, with hard and less plastic breasts and a major ptosis. The results combine carcinological and aesthetic requirements.
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Affiliation(s)
- N Zongo
- Service de chirurgie viscérale, CHU Yalgado Ouédraogo (CHUYO), 03 BP : 7022, Ouagadougou 03, Burkina Faso.
| | - S L C Yaméogo
- Service de chirurgie viscérale, CHU Blaise Compaoré (CHUBC), Ouagadougou, Burkina Faso.
| | - H Zamané
- Service de gynécologie-obstétrique, CHUYO, Ouagadougou, Burkina Faso
| | - S Tiemtoré
- Service de gynécologie-obstétrique, CHUYO, Ouagadougou, Burkina Faso
| | - M Zida
- Service de chirurgie viscérale, CHU Yalgado Ouédraogo (CHUYO), 03 BP : 7022, Ouagadougou 03, Burkina Faso.
| | - A Sanou
- Service de chirurgie viscérale, CHU Blaise Compaoré (CHUBC), Ouagadougou, Burkina Faso.
| | - C Ouédraogo
- Service de gynécologie-obstétrique, CHUYO, Ouagadougou, Burkina Faso.
| | - O M Lompo
- Anatomie pathologique, CHUYO, Ouagadougou, Burkina Faso.
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Winter EM, Appelman-Dijkstra NM. Letter to the Editor: "Gestational Gigantomastia Complicated by PTHrP-Mediated Hypercalcemia". J Clin Endocrinol Metab 2019; 104:1440. [PMID: 30541082 DOI: 10.1210/jc.2018-02287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/06/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Elizabeth M Winter
- Center for Bone Quality, Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
| | - Natasha M Appelman-Dijkstra
- Center for Bone Quality, Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, Netherlands
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Cruz NI. Breast Asymmetry in Women Requesting Plastic Surgery of the Breast. P R Health Sci J 2018; 37:230-238. [PMID: 30548060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Breast asymmetries have a high prevalence among women requesting breast augmentation. However, the prevalence of breast asymmetries in women undergoing other types of breast surgeries is not known. METHODS The breast measurements of consecutively women evaluated for plastic surgery of the breast, but without prior breast surgery, were prospectively recorded in a plastic surgery database. They were classified into three groups according to the presenting breast problem: hypoplastic breasts, macromastia, and ptotic breasts. Comparisons were made between the right and left side of each patient regarding the symmetry of the nipple-areola complex (size and position), breast mound, and chest wall. RESULTS The breast measurements of 304 women were analyzed. The mean age was 35 ± 12 years. The study population was distributed in the following manner: 126 hypoplastic breast cases, 100 macromastia cases, and 78 ptotic breast cases. Asymmetry of the position of the nipple-areola complex was found in 54%, 59%, and 56% of the groups, respectively. Asymmetry of the breast mound volume was found in 41%, 47%, and 44% of the groups. Asymmetry of the chest wall was present in 12%, 11%, and 10% of the groups, respectively. Overall, we found that 91% of the cases had at least one type of breast asymmetry. Prevalence of asymmetry was not different (p>0.05) among the groups, but the magnitude was larger in macromastia. CONCLUSION Breast asymmetries were detected in the majority of women and the prevalence was similar across the different groups, however the magnitude was greater in hypertrophic breasts.
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Affiliation(s)
- Norma I Cruz
- Department of Surgery, Div. of Plastic Surgery, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR
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Bucaria V, Elia R, Maruccia M, Annoscia P, Boccuzzi A, Giudice G. Why Choose the Septum-Supero-Medial (SSM)-Based Mammaplasty in Patients with Severe Breast Ptosis: An Anatomical Point of View. Aesthetic Plast Surg 2018; 42:1439-1446. [PMID: 29987488 DOI: 10.1007/s00266-018-1189-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
Nipple-areola complex (NAC) loss is one of the most devastating complications of mastopexy or breast reduction, and it requires revisional procedures with poor aesthetic outcome. In high-risk patients, a free nipple graft could be a choice, but it is associated with the same aesthetic concerns for both patients and surgeons. We report our experience with the septum-supero-medial-based mammaplasty to treat 22 patients with severe breast ptosis (nipple-to-sternal-notch distance > 40 cm). No NAC loss was observed. The study highlights surgical technical details and discusses anatomical considerations to justify the successful result. 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)
- V Bucaria
- Division of Plastic and Reconstructive Surgery, Mater Dei Hospital, 10 v. Samuel F Hahnemann, 70125, Bari, Italy
| | - R Elia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.
| | - M Maruccia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - P Annoscia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - A Boccuzzi
- Division of Plastic and Reconstructive Surgery, Mater Dei Hospital, 10 v. Samuel F Hahnemann, 70125, Bari, Italy
| | - G Giudice
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
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Modarressi T, Levine MA, Tchou J, Khan AN. Gestational Gigantomastia Complicated by PTHrP-Mediated Hypercalcemia. J Clin Endocrinol Metab 2018; 103:3124-3130. [PMID: 30032172 DOI: 10.1210/jc.2018-01181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/12/2018] [Indexed: 02/13/2023]
Abstract
CONTEXT Gestational gigantomastia is an uncommon condition characterized by abnormal and excessive growth of breast tissue during an otherwise uncomplicated pregnancy. Gestational gigantomastia may be accompanied by hypercalcemia, which in some cases has been associated with elevated serum levels of PTHrP. The source of the PTHrP in these cases has been suggested to be the enlarged breasts. OBJECTIVE To describe the rapid resolution of hypercalcemia and normalization of serum PTHrP after elective termination of pregnancy, indicating that the placenta was the source of the PTHrP. DESIGN A retrospective analysis of clinical and biochemical data over a 2-year interval and review of literature. SETTING An academic medical center. PATIENT A 33-year-old G8P4 female who presented at week 8 of pregnancy with gestational gigantomastia and subsequently developed marked hypercalcemia at week 13. Serum levels of PTH were suppressed but circulating PTHrP was elevated. There was no history of hypercalcemia or significant breast growth during previous pregnancies. INTERVENTION Hypercalcemia was poorly responsive to IV saline, prednisone, calcitonin, and cinacalcet. She requested termination of pregnancy at week 20. RESULTS Serum levels of calcium, PTH, and PTHrP normalized within 48 hours of termination of pregnancy. CONCLUSION The rapid resolution of hypercalcemia after termination of pregnancy, despite persistent gigantomastia, provides evidence for a pathologic role of the placenta in the excess production of PTHrP, possibly through an as yet uncharacterized placenta-breast hormonal axis.
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Affiliation(s)
- Taher Modarressi
- Department of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael A Levine
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Julia Tchou
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amna N Khan
- Department of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Section of Endocrinology, Philadelphia VA Medical Center, Philadelphia, Pennsylvania
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Rosen KV, Gunnarsson GL, Gramkow C, Sørensen JA, Thomsen JB. [Fat grafting of the breast]. Ugeskr Laeger 2018; 180:V10170758. [PMID: 30064621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
An increasing amount of evidence supports the benefits of fat grafting for breast augmentation, correction following breast-conserving surgery, breast reconstructions as well as correction of tuberous, hypoplastic and asymmetrical breasts. The aim of fat grafting is to create a breast with an aesthetic, natural appearance. In this review, we describe the most common indications for fat grafting of the breast and give an overview of the techniques in use as well as their associated risks and future perspectives.
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Ron O, Inbal A, Arad E, Zaretski A, Leshem D, Yanko R, Gur E, Barnea Y. Superomedial Pedicle Vertical Scar Breast Reduction: Objective and Subjective Assessment of Breast Symmetry and Aesthetics. Aesthetic Plast Surg 2018; 42:639-647. [PMID: 29218474 DOI: 10.1007/s00266-017-1015-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 10/20/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The superomedial vertical scar breast reduction (SVBR) described by Hall-Findlay is gaining popularity among surgeons worldwide. The aim of this study was to evaluate its long-term aesthetic outcome, the extent of quality of life improvement and the factors that influence patient satisfaction and reviewers' evaluation of aesthetic/surgical outcome. METHODS In this historical prospective study, we included women who underwent SVBR at least one year prior to enrollment and responded to a quality of life questionnaire. Their breasts were photographed, measured and evaluated by the plastic surgery staff. RESULTS A total of 40 patients responded to the questionnaire, and the breasts of 31 of them were measured and photographed. All 31 patients had good breast symmetry according to objective breast measurements. There was a clear correlation between the patients' and the reviewers' scores of breast symmetry, scar appearance and breast shape (r = 0.4-0.65, r = 0.432-0.495 and r = 0.335-0.403, respectively). The factor that most influenced reviewers' and patients' satisfaction with the overall aesthetic outcome was the breast-to-body proportion. CONCLUSIONS The proportions between the breast size and the patient's body habitus are pivotal to patient satisfaction and should be taken into consideration when planning a reduction mammaplasty. The SVBR technique for breast reduction provided good cosmetic outcome and symmetry over a long-term follow-up. 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)
- Ofir Ron
- Breast Reconstruction Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St, 6423906, Tel-Aviv, Israel
| | - Amir Inbal
- Breast Reconstruction Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St, 6423906, Tel-Aviv, Israel
| | - Ehud Arad
- Breast Reconstruction Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St, 6423906, Tel-Aviv, Israel
| | - Arik Zaretski
- Breast Reconstruction Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St, 6423906, Tel-Aviv, Israel
| | - David Leshem
- Breast Reconstruction Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St, 6423906, Tel-Aviv, Israel
| | - Ravit Yanko
- Breast Reconstruction Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St, 6423906, Tel-Aviv, Israel
| | - Eyal Gur
- Breast Reconstruction Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St, 6423906, Tel-Aviv, Israel
| | - Yoav Barnea
- Breast Reconstruction Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St, 6423906, Tel-Aviv, Israel.
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Abstract
OBJECTIVE This study aims to make a bibliometric analysis of the studies on breast reduction (BR) between the years 1980 and 2016 and identify important studies through trend topics as well as active authors, countries, universities, scientific journals, and citation and co-citation analyses about BR. BACKGROUND Although BR looks like one of the cosmetic surgeries performed in order to restore the woman's appearance, in fact it is a reconstructive surgery that eliminates back pain, stance disorder, headache, shoulder pain, back and cervical disk hernia, difficulty in breathing, hollowness caused by bra straps, hygiene problems under breasts (e.g., rash or fungal infections), and limitations in some daily activities. However, the related literature has little information about the publications on this issue. METHODS Bibliometric analysis was performed by downloading all the documents published between 1980 and 2016 from Thomson Reuters Web of Science (WoS; Thomson Reuters, New York, NY, USA), using the keywords including "breast reduction", "gigantomastia", "reduction mammaplasty", and "reduction mammoplasty". RESULTS There was a total of 1427 publications in the WoS database. Of these publications, 869 (60.90%) were research articles. The top three research areas of these publications were surgery with 1178 (82.55%) publications, oncology with 78 (5.47%) publications, and obstetrics gynecology with 67 (4.70%) publications. The top three countries that contributed to the literature most were the USA (515), England (147), and Turkey (83), respectively; the top university that contributed most was Harvard University, and the top two authors who contributed most were Drew PJ and Iwuagwu OC (13; 0.91%). The top-cited publication was "A Simplified Vertical Reduction Mammaplasty: Shortening the Learning Curve" written by Hall-Findlay, EJ in 1999. The journals with top numbers of publications were Plastic and Reconstructive Surgery (483; 33.85%), Annals of Plastic Surgery (164; 11.50%) and Aesthetic Plastic Surgery (147; 10.30%) respectively. CONCLUSION Despite the fact that the BR literature is contributed by developed countries, developing countries, particularly Turkey and Brazil, also had significant contributions to the literature. 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)
- Ümran Muslu
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Hitit University, Çorum, Turkey.
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Abstract
AIM Although breast reduction surgery plays an invaluable role in the correction of macromastia, it almost always results in a breast lacking in upper pole fullness and/or roundness. We present a technique of breast reduction combined with augmentation termed "reductive augmentation" to solve this problem. The technique is also extremely useful for correcting breast asymmetry, as well as revising significant pseudoptosis in the patient who has previously undergone breast augmentation with or without mastopexy. METHODS An evolution of techniques has been used to create a breast with more upper pole fullness and anterior projection in those patients desiring a more round, higher-profile appearance. Reductive augmentation is a one-stage procedure in which a breast augmentation is immediately followed by a modified superomedial pedicle breast reduction. Often, the excision of breast tissue is greater than would normally be performed with breast reduction alone. RESULTS Thirty-five patients underwent reductive augmentation, of which 12 were primary surgeries and 23 were revisions. There was an average tissue removal of 255 and 227 g, respectively, per breast for the primary and revision groups. Six of the reductive augmentations were performed for gross asymmetry. Fourteen patients had a previous mastopexy, and 3 patients had a previous breast reduction. The average follow-up was 26 months. CONCLUSIONS Reductive augmentation is an effective one-stage method for achieving a more round-appearing breast with upper pole fullness both in primary breast reduction candidates and in revisionary breast surgery. This technique can also be applied to those patients with significant asymmetry. 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)
- Paul E Chasan
- Ranch and Coast Plastic Surgery, 1431 Camino del Mar, Del Mar, CA, 92014, USA.
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40
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Bukhari SS, Manan H, Khan MM, Raza SS. Resolution Of Gestational Gigantomastia With Termination Of Pregnancy. J Ayub Med Coll Abbottabad 2018; 30:298-300. [PMID: 29938441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Less than 100 cases of gestational gigantomastia have been described in literature. The aetiology and risk factors are not well-established. Various treatments have been used with some consensus. We present the case of a 47-year-old female who presented to us with bilateral gigantomastia in her 16th week of gestation. She had massively enlarged breasts which were very painful. Relevant laboratory investigations were normal. An incisional biopsy done prior to, and two trucut samples at presentation to us, showed normal breast tissue proliferation. In the absence of adequate pain control, it was decided to electively terminate the pregnancy and give a trial of tamoxifen. She made a rapid recovery following termination without requiring the use of tamoxifen.
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Affiliation(s)
| | - Haris Manan
- Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Mah Muneer Khan
- Department of Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Syed Shahmeer Raza
- Department of Surgery, Hayatabad Medical Complex, Hayatabad-Peshawar, Pakistan
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Cabral IV, da Silva Garcia E, Sobrinho RN, Pinto NLL, Juliano Y, Veiga-Filho J, Ferreira LM, Veiga DF. Use of the BREAST-Q™ Survey in the Prospective Evaluation of Reduction Mammaplasty Outcomes. Aesthetic Plast Surg 2018; 42:388-395. [PMID: 29124379 DOI: 10.1007/s00266-017-1009-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/18/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION BREAST-Q™ is a patient-reported outcomes survey instrument with a specific module that evaluates breast reduction surgery. It allows assessment of patient's satisfaction with received treatment and evaluates the impact of surgery on different aspects of the patient's quality of life. This article aims to assess the satisfaction and quality of life of patients who underwent reduction mammaplasty. MATERIALS AND METHODS Women aged between 18 and 60 years, with a body mass index ranging from 19 to 30 kg/m2, who were already scheduled for reduction mammaplasty, were included in the study. The Brazilian version of the BREAST-Q™ Reduction/Mastopexy Module (preoperative 1.0 and postoperative 1.0 versions) was self-applied preoperatively and 1 and 6 months after the operation. RESULTS One hundred and seven patients were included in the study and completed the 6-month follow-up. The median age was 33 years, and the median preoperative body mass index was 25 kg/m2. The superomedial pedicle was used in 96.3% of the cases, and the total median weight of the resected breast was 1115 g. There was a significant improvement in the scores of the scales: Psychosocial well-being, Sexual well-being, Physical well-being, and Satisfaction with the breasts compared to the preoperative assessment (p < 0.0001). The scales Satisfaction with the NAC and Satisfaction with the outcome, available only in the postoperative version, demonstrated high satisfaction rates at the two postoperative periods evaluated. CONCLUSION Reduction mammaplasty improved the quality of life and provided high levels of patient satisfaction with outcomes 1 and 6 months postoperatively. 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)
- Isaias Vieira Cabral
- Division of Plastic Surgery, Department of Surgery, Universidade do Vale do Sapucaí, Pouso Alegre, MG, Brazil
| | - Edgard da Silva Garcia
- Division of Plastic Surgery, Department of Surgery, Universidade do Vale do Sapucaí, Pouso Alegre, MG, Brazil
| | | | - Natália Lana Larcher Pinto
- Division of Plastic Surgery, Department of Surgery, Universidade do Vale do Sapucaí, Pouso Alegre, MG, Brazil
| | - Yara Juliano
- Department of Bioestatistics, Universidade do Vale do Sapucaí, Pouso Alegre, MG, Brazil
- Department of Bioestatistics, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Joel Veiga-Filho
- Division of Plastic Surgery, Department of Surgery, Universidade do Vale do Sapucaí, Pouso Alegre, MG, Brazil
| | - Lydia Masako Ferreira
- Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Daniela Francescato Veiga
- Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
- Division of Plastic Surgery, Department of Surgery, Universidade do Vale do Sapucaí, Av. Prefeito Tuany Toledo, 470, Pouso Alegre, MG, CEP 37550-000, Brazil.
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Abstract
We present the case of a 20-year-old woman, primigravida with 24 weeks of amenorrhoea due to pregnancy. She came with symptoms of rapidly increasing size of both the breasts since 8 weeks. On examination, both breasts were grossly enlarged, right more than left, with the level of the nipples reaching beyond the level of the umbilicus. Breast circumference was measured to be 72 cm on the right, and left breast was 66 cm. No palpable lumps in both breasts. No axillary lymphadenopathy noted. Hormonal studies were found to be within the normal range. The pregnancy was terminated due to pre-eclampsia. The patient opted for regular follow-up and observation. While regularly following up, the size of both breasts was observed to gradually reduce to a circumference of 40 cm on the right and 30 cm on the left.
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Affiliation(s)
- Dharini
- Department of General Surgery, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Tejas Venkataram
- Department of General Surgery, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
| | - Sumanth Raghuprakash
- Department of General Surgery, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
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43
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Elmelegy NG, Sadaka MS, Hegazy AM, Abdeldaim DE. Treatment of Gigantomastia Using a Medial-Lateral Bipedicle Reduction Mammoplasty: The Role of Doppler-Assisted Preoperative Perforator Identification. Aesthetic Plast Surg 2018; 42:73-79. [PMID: 29273932 DOI: 10.1007/s00266-017-1049-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/30/2017] [Indexed: 11/29/2022]
Abstract
The purpose of this study is to introduce a breast reduction technique designed to reduce the incidence of postoperative nipple-areola complex ischemia and necrosis following reduction mammoplasty, while at the same time allowing all the other goals of breast reduction to be realized. This is achieved through preoperative detection of perforating vessels supplying the nipple-areola complex using a hand-held Doppler. The horizontally based parenchymal pedicle is designed to include these perforators whether originating from the internal mammary artery, lateral thoracic artery or both. This technique provides freedom in pedicle shaping and fixation to the pectoral fascia to achieve the best breast contour. The study included 50 patients equally divided into two groups: the study group (using preoperative Doppler for detection of perforators) and control group (without preoperative Doppler). The average body mass index of our patients was 32.4 and 29.8 for study and control groups, respectively. The average suprasternal notch to nipple distance was 40.8 cm in the study group and 38.9 cm in the control group. In all cases of the study group, both medial and lateral pedicles were used each of them containing one perforator. The average resection weight per side was 1433.6 g for the study group and 1173.2 g for the control group. None of the study group cases experienced NAC necrosis, while four cases of the control group experienced NAC necrosis (3 partial and 1 total). The horizontally based parenchymal pedicle constructed with the aid of preoperative perforator identification with a Doppler is an effective technique for breast reduction that results in a very low rate of postoperative ischemia and necrosis of the nipple-areola complex. 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)
| | - Mohamed Saad Sadaka
- Plastic and Reconstructive Surgery Department, Tanta University, Tanta, Egypt
| | - Ahmed M Hegazy
- Plastic and Reconstructive Surgery Department, Tanta University, Tanta, Egypt.
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45
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Zimman OA, Butto CD, Rostagno R, Rostagno C. Volumetric Mammogram Assessment: A Helpful Tool in the Treatment of Breast Asymmetries. Aesthetic Plast Surg 2017; 41:1261-1274. [PMID: 28779406 DOI: 10.1007/s00266-017-0940-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 07/05/2017] [Indexed: 11/30/2022]
Abstract
The surgical approach to breast asymmetry depends on several factors, including the surgeon's experience, the anatomy of the patient, and several methods that may help to choose a technique and define the size of the implant or the amount of breast tissue to be excised. The aim of this study is to assist in evaluation of breast volumes with the Quantra™ software application, intended for use with Hologic™ digital mammography systems. Twenty-eight women were studied with full-field digital mammography (FFDM) with the Quantra™ software application, for use with Hologic™ digital mammography systems preoperatively. The case diagnoses were as follows: breast hypertrophy, ptosis, hypoplasia, and reconstruction, and the surgeries included breast reduction, mastopexy, mastopexy and breast reduction, mastoplasty and breast augmentation, breast augmentation, and immediate or delayed breast reconstruction. Patients were evaluated from 6 to 18 months after surgery. Volumetric mammogram studies help to decide the amount of tissue to be excised, the size of the implants, and the combination of both. The results of this study were evaluated by surgeons and patients and found to be highly satisfactory. The use of full-field digital mammography with adequate software should be considered as another tool to assist in making decisions regarding the correction of breast asymmetries. 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)
- Oscar A Zimman
- Centro Zimman de Cirugía Plástica and Division of Plastic Surgery, Hospital de Clínicas, University of Buenos Aires, Juncal 2437, 1A, (1425), Buenos Aires, Argentina.
| | - Carlos D Butto
- Division of Plastic Surgery, Hospital de Clínicas, University of Buenos Aires, Buenos Aires, Argentina
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Kelahmetoglu O, Firinciogullari R, Yagmur C, Yildiz K, Guneren E. Combination of Würinger's Horizontal Septum and Inferior Pedicle Techniques to Increase Nipple-Areolar Complex Viability During Breast Reduction Surgery. Aesthetic Plast Surg 2017; 41:1311-1317. [PMID: 28698934 DOI: 10.1007/s00266-017-0933-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/22/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Breast reduction techniques depend on the vascularity of the pedicle. Preserving vascularity of the nipple-areolar complex (NAC) is mandatory for reduction mammoplasties, as the NAC is the most important aesthetic and functional unit of the breast. The inferior pedicle technique is the most common method for breast reduction; however, pedicle length may increase after using this technique and cause problems related to NAC viability in gigantomastic and hypertrophic breasts. In this study, we present our technical approach to preserve NAC viability by combining Würinger's horizontal septum and inferior pedicle techniques. METHODS This study included 60 women (mean age 39.71 ± 10.52 years) who underwent a breast reduction combining Würinger's horizontal septum and inferior pedicle procedures from April 2012 to January 2016. All patients were marked preoperatively in a standing upright position using a prefabricated Wise-pattern template. The base of the pedicle was marked at the level of the inframammary ridge at a width of 8 cm. RESULTS The patients were followed up for a mean of 5.6 ± 3.3 months. The resection weights of the right and left sides were 1406 ± 566 and 1340 ± 563 g, respectively. Venous insufficiency was encountered in five cases (8.3%) and caused partial NAC necrosis in one case (1.6%). No cases of total NAC necrosis were encountered. Fifteen breasts (12.5%) were described as gigantomastic (resection weight >2000 g). CONCLUSIONS This combined method may promote safer and more satisfying outcomes from inferior pedicle breast reduction. 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)
- Osman Kelahmetoglu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty, Bezmialem Vakif University, Adnan Menderes Bulvarı, Fatih/Istanbul, Turkey.
| | - Remzi Firinciogullari
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ozel Ege Şehir Hastanesi, Izmir, Turkey
| | - Caglayan Yagmur
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Kemalettin Yildiz
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty, Bezmialem Vakif University, Adnan Menderes Bulvarı, Fatih/Istanbul, Turkey
| | - Ethem Guneren
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical Faculty, Bezmialem Vakif University, Adnan Menderes Bulvarı, Fatih/Istanbul, Turkey
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Demir CY, Sultanoglu Y, Kocak OF, Ersoz ME. Inferior Pedicle Reduction Mammoplasty with or without Tourniquet: A Comparative Study. Aesthetic Plast Surg 2017; 41:1024-1030. [PMID: 28536929 DOI: 10.1007/s00266-017-0895-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/07/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the perioperative findings of inferior pedicle reduction mammoplasty (IPRM) performed with or without a tourniquet. METHODS This study was carried out in the plastic and reconstructive surgery department at a tertiary care center on a total of 42 consecutive women scheduled for IPRM. Patients in Group I (n = 21) underwent surgery using a tourniquet, whereas patients in Group II (n = 21) were operated on without a tourniquet. Levels of hemoglobin (Hb), hematocrit (Hct), Hct/Hb ratio, and platelet counts were noted preoperatively and on postoperative 24th and 48th h. Numbers of surgical pads and gauze sponges completely used and dripping with blood were recorded. Duration of operation, the amount of breast tissue excised on both sides, and fluid collected in hemovac drains on 48th h after operation were documented. RESULTS In Group I, the operative time was significantly shorter (p < 0.001), and numbers of gauze sponges and surgical pads were fewer (p < 0.001 for both). Hemoglobin levels were significantly higher in Group I on postoperative 24th (p = 0.002) and 48th h (p = 0.007). Similarly, hematocrit levels in Group I were higher than those of Group II on postoperative 24th (p = 0.004) and 48th h (p = 0.009). CONCLUSION We determined that use of a tourniquet significantly reduced the operative time and blood loss during IPRM. Therefore, our preliminary results support that tourniquet usage is practical and safe, and it may also improve the cost-effectiveness of the procedure. LEVEL OF EVIDENCE III 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)
- Canser Yilmaz Demir
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey.
| | - Yılmaz Sultanoglu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey
| | - Omer Faruk Kocak
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey
| | - Muhammet Eren Ersoz
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey
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Klinger M, Klinger F, Giannasi S, Veronesi A, Bandi V, Banzatti B, Catania B, Vinci V, Lisa A, Cornegliani G, Giaccone M, Caviggioli F, Maione L. Stenotic Breast Malformation and Its Reconstructive Surgical Correction: A New Concept From Minor Deformity to Tuberous Breast. Aesthetic Plast Surg 2017; 41:1068-1077. [PMID: 28593490 DOI: 10.1007/s00266-017-0903-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 04/25/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Several classification systems have been reported to define the spectrum of tuberous breast deformity, and a range of surgical techniques has been described. In this paper, we proposed a new classification including tuberous breast and minor deformity based on stenosis type, glandular trophism and ptosis adapting surgical planning to different breast types. METHODS A total of 246 patients meeting our definition for stenotic breasts asking for surgery were analyzed in this study. We considered eight different types of stenotic breasts analyzing anatomical presentations, and we then proposed eight key-point maneuvers, finalized to the correction of different breast deformities and their possible association according to the stenotic breast type. Results have been evaluated by a group of three surgeons and by patients. In addition, we evaluated the complication incidence in terms of re-intervention rate. RESULTS Following our classification eight different groups were distinguished. For each one we reported the prevalence and the surgical procedure adopted. Results evaluated by the surgeon group reported a mean aesthetic outcome of 8.2 (range 5-10), whereas patients reported a mean value of 7.9 (range 6-10). During a follow-up period with a mean of 16 months we observed a 4.9% re-intervention rate. CONCLUSIONS We believe this new classification to be very complete in evaluating breast shape, including most of the breast evaluable features. Our results confirmed the suitability of the approach for appropriate preoperative planning, thus improving the global surgical outcome. 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)
- Marco Klinger
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
| | - Francesco Klinger
- Reconstructive and Aesthetic Plastic Surgery School, MultiMedica Holding S.P.A., Plastic Surgery Unit, University of Milan, Sesto San Giovanni, Milan, Italy
| | - Silvia Giannasi
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Alessandra Veronesi
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Valeria Bandi
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Barbara Banzatti
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Barbara Catania
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Valeriano Vinci
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Andrea Lisa
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Guido Cornegliani
- Reconstructive and Aesthetic Plastic Surgery School, MultiMedica Holding S.P.A., Plastic Surgery Unit, University of Milan, Sesto San Giovanni, Milan, Italy
| | - Micol Giaccone
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Plastic Surgery Unit, Humanitas Clinical and Research Center, University of Milan, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Fabio Caviggioli
- Reconstructive and Aesthetic Plastic Surgery School, MultiMedica Holding S.P.A., Plastic Surgery Unit, University of Milan, Sesto San Giovanni, Milan, Italy
| | - Luca Maione
- Clinica San Carlo, Plastic Surgery Unit, Via Ospedale 21, 20037, Paderno Dugnano, Milan, Italy
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Inbal A, Gur E, Lemelman BT, Barsuk D, Menes T, Leshem D, Barnea Y. Optimizing Patient Selection for Direct-to-Implant Immediate Breast Reconstruction Using Wise-Pattern Skin-Reducing Mastectomy in Large and Ptotic Breasts. Aesthetic Plast Surg 2017; 41:1058-1067. [PMID: 28593488 DOI: 10.1007/s00266-017-0899-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 05/07/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Immediate breast reconstruction in large and ptotic breasts is challenging, often requiring skin-reducing procedures. The Wise-pattern skin-reducing mastectomy (WPSRM) technique provides reliable one-stage implant coverage using the pectoralis muscle and a de-epithelialized inferiorly based dermal flap. However, de-vascularization may result in mastectomy skin flap necrosis. We aimed to critically evaluate and isolate patients at high risk of complications using this procedure. METHODS We retrospectively reviewed consecutive patients undergoing WPSRM by the senior author from January 2008 to December 2011. Data collected included patient demographics, breast cancer staging, smoking, preoperative radiation, chemotherapy, BMI, mastectomy weight, implant size and type. We analyzed their effect on complications, revisions and failure rate. RESULTS Fifty-nine WPSRMs were performed in 39 patients with a minimum of 12-month follow-up. Complications occurred in 43.75% patients and 34.88% breasts. Multivariate statistical analysis revealed that age (p = 0.093) and BMI (p = 0.631) were not significant risk factors as opposed to previously published data. Mastectomy weight was significantly associated with major complications requiring secondary surgery (odds ratio per 100 g of breast tissue was 1.18; 95% CI 1.01-1.39; p = 0.036) as 90.5% of our complications occurred in those patients with mastectomy weight exceeding 700 g. Complications were reduced twofold when selecting a Becker adjustable implant over a silicone one for these higher mastectomy weights. CONCLUSION WPSRM was found to be associated with an increased complication rate in patients with high mastectomy weights and immediate reconstruction with silicone implants. We propose an algorithm offering better patient selection for this technique in immediate breast reconstruction. 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)
- Amir Inbal
- Department of Plastic Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA.
| | - Eyal Gur
- Department of Plastic Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Benjamin T Lemelman
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Daphna Barsuk
- Breast Health Center Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tehilla Menes
- Breast Health Center Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David Leshem
- Department of Plastic Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yoav Barnea
- Department of Plastic Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Breast Health Center Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Zhou M, Jin M, Wang L, Pan LJ. Pregnancy-associated gigantomastia recurrence and ectopic breast after reduction mammaplasty: A case report. Cancer Biomark 2017; 20:225-229. [PMID: 28869443 DOI: 10.3233/cbm-160450] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It has been reported that majority of cases of gigantomastia, also known as breast hypertrophy and macromastia, occur during either pregnancy or puberty. Gigantomastia is a rare disorder that does not have a clear etiology or well-established risk factors. We present a 26-year-old female patient who appeared to have pregnancy-associated gigantomastia recurrence, large accessory breast and, ectopic breast tissue at external genital three years after bilateral breast reduction surgery. The patient successively underwent bilateral mastectomy and vulvar tumor resection. Breast hypertrophy and progenital ectopic breast were pathologically confirmed. This the first case of gigantomastia reported worldwide.
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