Breast cancer-related lymphedema: Symptoms, diagnosis, risk reduction, and management

The global burden of breast cancer continues to increase largely because of the aging and growth of the world population. More than 1.38 million women worldwide were estimated to be diagnosed with breast cancer in 2008, accounting for 23% of all diagnosed cancers in women. Given that the 5-year survival rate for breast cancer is now 90%, experiencing breast cancer is ultimately about quality of life. Women treated for breast cancer are facing a life-time risk of developing lymphedema, a chronic condition that occurs in up to 40% of this population and negatively affects breast cancer survivors' quality of life. This review offers an insightful understanding of the condition by providing clinically relevant and evidence based knowledge regarding lymphedema symptoms, diagnosis, risk reduction, and management with the intent to inform health care professionals so that they might be better equipped to care for patients.

Immediate Nipple Reconstruct!on Following Breast Reduction

Necrosis of nipple-areola complex is one of the major complications of breast reduction in gigatomastia.Wie present a case study of a 32-year-old patient with severe gigantomastia,who required an immediate nipple reconstruction during breast reduction.The final reconstruction was satisfactory.No complications were observed within three months postoperatively.

Current aspects of therapeutic reduction mammaplasty for immediate early breast cancer management: An update

Breast-conservation surgery(BCS) is established as a safe surgical treatment for most patients with early breast cancer. Recently, advances in oncoplastic techniques are capable of preserving the breast form and quality of life. Although most BCS defects can be managed with primary closure, the aesthetic outcome may be unpredictable. Among technical options, therapeutic reduction mammaplasty(TRM) remains a useful procedure since the BCS defect can be repaired and the preoperative appearance can be improved, resulting in more proportional breasts. As a consequence of rich breast tissue vascularization, the greater part of reduction techniques have based their planning on preserving the pedicle of the nipple-areola complex after tumor removal. Reliable circulation and improvement of a conical shape to the breast are commonly described in TRM reconstructions. With an immediate approach, the surgical process is smooth since both procedures can be carried out in one operative setting. Additionally,it permits wider excision of the tumor, with a superior mean volume of the specimen and potentially reduces the incidence of margin involvement. Regardless of the fact that there is no consensus concerning the best TRM technique, the criteria is determined by the surgeon's experience, the extent/location of glandular tissue resection and the size of the defect in relation to the size of the remaining breast. The main advantages of the technique utilized should include reproducibility, low interference with the oncological treatment and long-term results. The success of the procedure depends on patient selection, coordinated planning and careful intra-operative management.

Two Crossed Dermal Flaps for Prevention of Bottoming out after Breast Reduction

Introduction: Breast reduction is one of the most prevalent plastic surgery procedures in Syria and the world, bottoming out on the other hand is one of the most happened disadvantages after breast reduction with inferior pedicle technique. Different techniques were used to prevent this deformity after inferior pedicle. In this study we tried to prevent bottoming out by using two crossed dermal flaps suspending the inferior pedicle to the periosteum of the 2nd rib. Methods and materials: 32 patients had breast reduction surgery using inferior pedicle technique at Almowassat University Hospital in Damascus. We divide them into 2 groups, 16 patients each. First group we used crossed dermal flaps with the inferior pedicle and the second group was without these flaps, the dermal flaps had a base on the side of the inferior pedicle base, crossed anterior to it in the middle point between the lower edge of the areola and the IMF and then sutured to the periosteum of the 2nd rib on each side. Results: Preoperatively, the average distance between the inframammary fold and areola was 14.5 cm (range, 11 - 18 cm) in the first group without dermal flaps and 14 cm in the second group with dermal flaps. The average amount of breast parenchymal resection was 790 g (range, 140 - 1600 g). The average distance between the inframammary fold and the lower border of the areola was 8.5 cm (range, 7.5 - 9 cm) on the postoperative first-year measurements in the group with flaps and 10.2 cm (8.6 - 11.4 cm) in the other group. Conclusion: Inferior pedicle suspension using crossed dermal flaps has a real role in preventing bottoming out, without using any allogenic or alloplastic materials, making it one of the considered ways in preventing bottoming after breast reduction.

The Effects of Moufarrege Total Posterior Pedicle Reduction Mammaplasty on Breast Cancer Incidence

Introduction: The Moufarrege total posterior pedicle breast reduction involves complete denudation of the breast offering free access to all breast quadrants. This allows a total resection of the upper outer quadrant which is most implicated in breast cancer. The objective was to assess the postoperative incidence of breast cancer in the cohort of women who underwent the Moufarrege technique. Methods: Retrospective chart review was performed for patients operated on between 1981 and 1997, and a written questionnaire was sent to all patients in 2008. Patients were asked about the date of their last mammogram and any diagnosis of breast cancer. Expected numbers of cancers were calculated from rates in the general population. Age standardization at the time of surgery was done and the incidence of breast cancer was calculated in relation to age at time of surgery and age at last follow-up. Results were presented as standardized incidence ratios (SIR) with their corresponding 95% confidence interval (CI). Results: We included 924 patients. The response rate was 60.38% (n = 558). Mean patient age at the time of the surgery was 32.8 years (14 to 82). Mean resection weight was 620 grs per breast (250 - 1600). Breast cancer was significantly reduced by nearly 64 percent in patients who responded to our questionnaire and were aged 35 years or more at the time of surgery ([SIR] = 0.36;95 % [CI] 0.09 - 0.93). No difference in breast cancer incidence was observed in patients aged less than 25 years at the time of the surgery. Conclusion: The Moufarrege Total Posterior Pedicle breast reduction is a reliable and safe procedure that may offer a superior breast cancer risk reduction based on the results of our retrospective chart review and patient questionnaire.

The Combination of Three Techniques for Breast Reduction: A Series of Ten Consecutive Cases

There is continuing controversy regarding the most effective and safest technique for breast reduction surgery. This case series describes our experience with a breast reduction approach that combines three techniques aimed at addressing three different aspects of breast reduction: skin reduction, shaping, and nipple areolar complex shaping. We assessed the perioperative course and postoperative outcomes (for a mean of 19 months) of 10 consecutive women who underwent breast reduction surgery involving a combination of three techniques: “inverted T” skin reduction, modified Hall-Findley supero-medial pedicle for glandular reduction, and inferior de-epithelialized flap (modified “Foustanos” flap) for molding and improved shaping of the breast. The final bra cup size was C or D in all patients. The overall results were graded as excellent in four patients and very good in six patients. Each patient was completely satisfied with her surgery. Six patients developed venous congestion of the nipple areolar complex, which resolved within 24 - 48 hours after surgery. Two patients had uneventful delayed wound healing in the vertical scar of the inverted T pattern. There was a 100% nipple areolar complex survival rate. No patient had a major adverse event, permanently altered nipple areolar complex sensitivity, or bottoming out of the lower pole. None required revision surgery. This case series confirms our expectations that the solution to questions about breast reduction methods may depend on melding different techniques into a single procedure. The combination of techniques herein described was both effective and safe. Level of Evidence: Level IV, therapeutic study.

Versatility of therapeutic reduction mammoplasty in oncoplastic breast conserving surgery

Oncoplastic breast conserving surgery is the gold standard approach for the surgical treatment of early breast cancer. There is a well defined technique named "therapeutic mammoplasty" which is characterized for using a reduction mammaplasty technique to treat breast cancer conservatively. In our current practice, "therapeutic mammoplasty" or therapeutic reduction mammaplasty is our favorite oncoplastic breast conserving approach which it used in almost half of our patients. This technique is very versatile allows us the resection of tumors located in all breast quadrants of patients with moderate-to large-sized breasts. We describe a series of 57 patients who were treated using a therapeutic reduction mammaplasty. All surgical procedures were carried out by one comprehensive breast surgeon who planned and designed the surgery performing both oncologic and reconstructive procedures. Surgical margins were insufficient in eight patients(14%). Nine patients(15.8%) had a complication in early postoperative period and in one of them adjuvant radiotherapy was delayed four months due to a wound dehiscence. The rate of synchronous contralateral symmetrization was 31.6%. Our conclusion is that reduction mammaplasty is a useful and safe skill to treat breast cancer conservatively playing a very important role therefore it must be situated in the priority of learning objectives.

Reduction Mammaplasty as a Treatment Option for Early Breast Cancer

Background: Although reduction mammaplasty is a well-known technique for cosmetic purposes, there are few previous reports regarding its application and clinical outcome following conservative breast surgery reconstruction. Mammaplasty combined with breast conservation surgery is an effective treatment of early breast cancer, and leads to better overall results and superior quality of life in patients with previous macromastia or ptosis. Our aim is to analyze both the aesthetic and oncologic outcome of reduction mammaplasty combined with conservative breast surgery reconstruction. Patient and Methods: 25 patients with stage 1 or 2 breast cancer, with a tumor size not more than 3 cmin its greatest dimension, were operated upon by quadrantectomy, and bilateral reduction mammaplasty. Oncologic data on tumor size, location, and axillary lymph node, were assessed, and accordingly the design of the pedicle was chosen. Reconstructed breast and opposite breast reduction were evaluated. Results: Of the total 50 breast reductions techniques, 35 (70 percent) were superomedial pedicle, 4 (8 percent) were superior, 3 (6 percent) were superolateral, and 8 (16 percent) were inferior. The cosmetic result was considered to be good or very good in 18 cases, satisfactory in 6 cases, and poor in 1 case. There were no other complications as regard nipple areola ischemia, heamatoma, seroma, wound problems, fat necrosis, or recurrence in any of the cases. Conclusion: By adding breast reduction and other plastic surgery techniques to breast conservation, patients have the opportunity for an improved cosmetic outcome and overall improved quality of life. Although the combined approach between the oncologic surgeon and the plastic surgeon requires more preoperative planning and intraoperative care, the concept can reduce deformities, favor the oncologic treatment, and optimize the aesthetic outcome in most early-stage cancer patients.

Breast Reduction Complications

Background: Breast reduction surgery is increasing in popularity, with so many techniques all around the world, and the community’s knowledge of the details of this procedure increases thanks to the Internet and easy access to information, which increases breast reduction reviews for plastic surgery clinics. Reduction mammaplasty is an established and effective technique to treat symptomatic macromastia. Variable rates of complications have been reported, and there is a continued need for better outcome assessment studies. Aim: The purpose of this study was to identify the complications occurred during the first year of breast reduction surgery. Materials and Methods: A prospective study over a 1-year period from October 2018 to October 2019, that included 32 patients who underwent breast reduction surgery using the same technique (inferior pedicle and inverted T scar) in the Department of Plastic Surgery at Al-Mouassat University Hospital, Damascus, Syria. Patients were followed through a whole year after surgery and complications that occurred were recorded. Results: Complications that occurred in 14 patients (43%), and, and were more common in patients with larger breasts and worse symptoms before surgery. The most common complication was delayed wound healing, and it was associated with breast volume before surgery and with smoking. In general, the most relevant factor influencing the incidence of complications was the weight of the resected breast tissue, which is mainly related to the size of the breast before surgery. Conclusion: The weight of the resected breast tissue was the most important factor influencing the occurrence of complications after breast reduction surgery. The most prevalent complication was delayed wound healing and it was associated with the weight of the removed tissue.

Dermatomal Somatosensory Evoked Potentials: An Indicator of Improvement of Breast Sensibility after Reduction Mammaplasty

Introduction: Many women think about reduction mammaplasty for different reasons. The effect of surgery on the beast sensibility is one of the greatest concerns after reconstructive reductive breast surgery through its affect on patient’s social life and psychological health. The dermatomal somatosensory evoked potential (D-SEP) is a new method to quantitatively evaluate breast sensibility. Patients and Methods: Twenty-five women enrolled in this study presenting with breast enlargement, underwent mammary reduction by using the inferior pyramidal breast reduction technique using the same operative technique described by Robbins with some modifications. All D-SEP amplitudes and latencies were calculated preoperatively and then were reassessed six and twelve months post-surgery in each breast. Result: The results revealed that there is a significant difference in the D-SEP latency pre- and post-operatively. The statistically significant decrease in latency and the breast size demonstrated indicates that the sensibility improved after breast reduction surgery both at six and twelve months. There is also a significant increase in the D-SEP amplitude pre- and post-operatively. The negative and statistically significant increase in amplitude with the decrease in breast size demonstrated indicates that the sensibility improved after breast reduction surgery both at six and twelve months. Conclusion: This study concluded that breast sensibility will improve after breast reduction as indicated by significant reduction of D-SEP latencies and increase of its amplitudes. Our results confirm an inverse relationship between breast size and sensibility, with improvement in sensibility after breast reduction.

A New Technique for Mastopexy and Reduction Mammaplasty: The Rolling Bilateral Flap Technique

Background: Numerous techniques have been proposed as “gold standard” for mastopexy, as for reduction mammaplasty. The quality of the breast parenchyma should be a primary factor in selecting the most appropriate technique for an individual case. Objective: The article describes a simple technique that can be used either for mastopexy or for reduction mammaplasty, giving optimal breast shape and position. It is appropriate for patients having some degree of ptosis, and especially for those in whom the glandular component of the breast predominates. Methods: The technique entails elevating the entire dome of the breast, rolling it under, and then stitching the two halves of the breast parenchyma together (lateral and medial dermoglandular flaps), while the upper pedicle (a third dermoglandular flap) bearing the nipple areolar complex (NAC) severed from the two inferior flaps is attached as a cap. The result is a new and attractive shape of the underlying supporting “barrel”. The technique can be performed with the T scar or the vertical scar approach. Results: The procedure was applied for various indications on 45 patients aged 20 - 62 years. Good results were only achieved in 36 women with predominant glandular component. Nine patients with fatty breasts achieved unsatisfactory results (6 with T scar, 3 with vertical scar) and very poor breast projection. Conclusions: The best-suited candidates for the proposed technique for mastopexy or reduction mammaplasty are women in whom the glandular component of the breast predominates. This simple technique, applicable with either inverted T scar or vertical scar approaches, carries very low morbidity, affording an attractive profile, long-lasting results, and conserving the patient’s ability to breast feed.

Central/Inferior Pedicle Technique for Reduction Mammaplasty: A Systematic Review

Background: Intention of reduction mammoplasty is to minimize the breast volume and maintain supply of blood and innervations to NAC (nipple-areola-complex), to lift NAC to higher position in mound of breast using any reliable technique like central pedicle technique. Methods: This research selected and observed 15 patients who underwent central pedicle technique for mammaplasty of breast reduction. Age criterium included for this research is 18 years to 60 years for 5 years from Chinese patients. In addition to these, this study systematically reviewed about central pedicle technique for 25 years. Papers were selected from 1996 to 2021. Results: Using central pedicle technique, shape and projection of breast were reduced. Such changes of measurements showed that postoperative technique leads to long-term satisfactory impact. Conclusion: Central pedicle technique was found to be best, reliable and safe technique for reduction mammaplasty. Reduction mammaplasty is used for reducing the ptotic and large breasts. It provides more satisfactory and good aesthetic outcomes. Majority of patients do not have any complications postoperative. Complications rate is minimal when central pedicle technique is used for reduction mammaplasty. Patients with ptotic and large breasts would have huge advantage postoperative.

Upper Footprint Dependent Nipple Position to Avoid High-Riding Nipple after Reduction Mammoplasty

Introduction: High-riding nipple following reduction mammoplasty is a challenging problem for the plastic surgeons. To avoid such problem, many methods have been described for marking the correct nipple position but still controversial. We aimed in this study to present our experience in preventing excessive nipple elevation after reduction mammoplasty by using the upper footprint to set the new nipple position. Material and Methods: From March 2019 to March 2022, 25 female patients at a mean age of 38.3 years were included in this prospective study. They underwent reduction mammoplasty with inverted T scar and a combination of inferior pedicle and Würinger’s septum techniques. Resection weights, pre- and postoperative anthropometric measures were recorded. All patients were photographed at the follow-up visits and evaluated for complications if any, the nipple-areola complex (NAC) sensation, and subjective patient satisfaction using “The Breast Evaluation Questionnaire”. Results: The mean preoperative midclavicular point to nipple distance was 37.40 and 37.18 cm for the right and left breasts, respectively. The mean resection weight was 1270 and 1242 g from the right and left sides, respectively. None of our patients experienced NAC necrosis, while 2 breasts had minor wound dehiscence treated conservatively. After a mean follow-up period of 12 months, the NAC descended by an average of 1.40 cm, the distance from the IMF to nipple had an average increase of 2.24 cm, and all of patients were satisfied with the esthetic outcomes and convinced with their breast shape. Conclusion: The upper footprint dependent nipple position seems to have a real role in preventing high-riding nipple after breast reduction in hypertrophic and gigantomastic breasts. Moreover, it can be applied easily and allow for more satisfying outcomes than other methods for setting the new nipple position.

Evaluation of Inferior Pedicle Therapeutic Mammoplasty as a Primary Procedure for Upper Quadrants Early Breast Cancer

Background: The treatment of breast cancer in large breast patients represents a great challenge to both surgical oncologist and radiation oncologist. The aim of this study is to evaluate the outcome of inferior pedicle therapeutic mammoplasty in large-breasted patients with upper quadrants early breast cancer. Methods: Thirty five large-breasted patients with early breast cancer were included in this study. Simultaneous bilateral inferior pedicle therapeutic mammoplasty was performed. Results: The age of the patients is ranged from 36 to 61 (median 46) years and tumour size is ranged from one to three and half cm. The weight of tissue removed is ranged from 350 gm to 780 gm and the tumour safety margins are ranged from three to eight cm. Wound dehiscence was the commonest post operative complications and six patients were affected (17.6%). The cosmetic outcome was excellent in 22 patients (64.5%), nine patients (26.5%) showed good results, two patients (6%) were satisfactory and one patient (3%) showed poor result. The follow up period is ranged from 6 to 42 months with one case (3%) of systemic metastasis. Conclusion: Inferior pedicle therapeutic reduction mammoplasty for upper quadrants early breast cancer in large breasted women is a surgically and oncologically safe procedure, and it carries a satisfactory aesthetic outcome.

A Long Term Review of Surgically Treated Enlarged Breasts

Introduction: Breast hypertrophy (excessive enlargement of breast), a condition though rare, is well pronounced in some females. Surgery either by reduction mammaplasty or sub-cutaneous mastectomy is often employed in treatment of this condition. Aim: This study seeks to find out the long term level of satisfaction of the surgery on these persons after about 10 - 12 years after treatment. Materials and Methods: From January 1994 to December 2000, the Komfo Anokye Teaching Hospital (KATH) carried out surgeries on 43 females who presented with several degrees of breast hypertrophy. Patients were asked to answer questionnaires on their condition pre-operatively and post-operatively during the long term review process. Results: Thirty-four (79.1%) patients out of the 43 were available for the review with the patients stating there was much (100%) improvement in terms of the pain they felt in the neck, upper and lower back regions. There was no re-occurrence of the condition in any of the patients;29 (85.3%) stated they were satisfied and that their new breast size(s) was/were excellent for them. Conclusion: The pre-operative complications experienced by these patients were resolved hence this surgical procedure was good and the quality of life of these persons had been improved.

A Novel Treatment Optimization System and Top Gene Identification via Machine Learning with Application on Breast Cancer

Traditional treatment selection of cancers mainly relies on clinical observations and doctor’s judgment, but most outcomes can hardly be predicted. Through Genomics Topology, we use 272 breast cancer patients’ clinical and gene information as an example to propose a treatment optimization and top gene identification system. This study faces certain challenges such as collinearity and the Curse of Dimensionality within data, so by the idea of Analysis of Variance (ANOVA), Principal Component Analysis (PCA) is implemented to resolve this issue. Several genes, for example, SLC40A1 and ACADSB, are found to be both statistically significant and biological-studies supported;the model developed can precisely predict breast cancer mortality, recurrence time, and survival time, with an average MSE of 3.697, accuracy rate of 88.97%, and F1 score of 0.911. The result and methodology used in this study provide a channel for people to further look into the more precise prediction of other cancer outcomes through machine learning and assist in the discovery of targetable pathways for next-generation cancer treatment methods.

Oncoplastic Breast Surgery Using Spindle Shaped-Partial Mastectomy for Early Breast Cancer in the Upper Quadrant Area

Background: Oncoplastic surgery is becoming more common, however, only several reports have been published in Japan. We report the results of simple oncoplastic surgery for Japanese patients with early breast cancer in the upper quadrant area. Methods: In seven patients with a past history of breast-feeding and ptotic breasts, we performed oncoplastic surgery involving partial mastectomy and the resection of excess skin and parenchymal tissue. Results: None of the patients received a contralateral operation to produce symmetrical breasts. The width of the resected excess skin tissue ranged from 20 to 50 mm, with the mean width being 30 mm, and its length ranged from 50 to 90, with the mean length being 77 mm. The width of the resected gland tissue ranged from 40 to 65 mm, with the mean width being 53 mm, and its length ranged from 70 to 100 mm, with the mean length being 97 mm. The cosmetic results were excellent. Conclusions: Oncoplastic surgery using spindle shaped-resection was successfully performed in patients with upper quadrant lesions, and the cosmetic results were excellent.

乳房整形美容术后早期疼痛的临床特征研究

目的调查三类乳房整形美容手术后早期患者疼痛的临床特征,为优化疼痛管理方案提供依据。方法收集2021年11月至2022年8月收治的72例行隆乳术、乳房缩小成形术、乳房悬吊术的患者资料,于术后1 d、2 d、3 d分别记录疼痛水平(数字疼痛评分、修订版面部表情疼痛评估法)、疼痛部位、伴随症状、用药情况,分析疼痛的临床特征。结果术后1~3 d的疼痛水平总体呈现下降趋势。隆乳术后的患者疼痛水平最高,持续处于中等疼痛水平,疼痛部位以腋下(68.60%)、乳房上方(49%)居多;乳房缩小成形术、乳房悬吊术后患者的疼痛部位以乳房下缘(33.30%)、乳晕(33.30%)和乳房外侧(26.70%)为主,部分位置的双侧乳房疼痛发生率不一致。多数患者不伴有其他症状。58.33%的患者在术后1 d使用1种药物镇痛,37.5%的患者在术后2 d使用2种及以上药物镇痛,76.39%的患者在术后3 d无需使用药物。结论隆乳术后患者的早期疼痛值得重点关注,疼痛发生位置主要与切口、引流留置、假体植入、血肿发生有关。在评估疼痛时应关注双侧乳房疼痛的区域特征,识别疼痛原因,尽早发现并预防血肿。镇痛药物的选择应避免同机制药物的叠加使用,实施多模式镇痛,联合非药物干预措施,共同管理疼痛及药物不良反应。

身心语言程式学理论结合正念减压疗法对乳腺癌患者焦虑抑郁情绪、生活质量的影响

目的:探讨身心语言程式学理论结合正念减压疗法对乳腺癌患者焦虑抑郁情绪、生活质量的影响。方法:将150例乳腺癌患者随机纳入A组和B组,两组分别采用常规护理措施与身心语言程式学理论结合正念减压疗法的护理措施,比较两组患者干预前、后焦虑抑郁情绪、生活质量变化情况。结果:干预后,B组焦虑自评量表(SAS)、抑郁自评量表(SDS)评分、中文版压力知觉量表(CPSS)评分低于A组(t=13.908,15.554,5.580;P<0.05),癌症患者生活质量评定量表(EORTC QLQ-C30)各维度评分均高于A组(t=8.036,6.762,6.219,6.371,19.460,7.711;P<0.05)。结论:采用身心语言程式学理论结合正念减压疗法对乳腺癌患者进行干预可有效缓解焦虑抑郁情绪,减轻压力,提高生活质量。

乳腺浸润性上皮病背景下原位癌9例临床病理特征分析

目的探讨在乳腺浸润性上皮病(IE)背景下原位癌的组织病理学、免疫组织化学染色特征,讨论其诊断与鉴别诊断。方法收集9例IE背景下原位癌,采用自动免疫组织化学仪检测雌激素受体(ER)、孕激素受体(PR)、人表皮生长因子受体2(HER-2)、Ki-67等项目。结果9例均为中老年女性,影像表现为多发性结节;镜下表现为:上皮增生旺盛,形成不规则的上皮巢,缺乏小叶结构特征,形成浸润样形态,可以累及周围脂肪组织及神经被膜;肌上皮均存在,但在硬化性区域,肌上皮减少。结论IE背景下发生原位癌出现缺乏小叶结构的特征时,类似浸润样形态,容易过诊断为浸润性癌。同时,癌灶常较广,建议扩切或乳腺单纯切除,同时要考虑双侧乳腺癌可能性。