Breast reconstruction:Review of current autologous and implantbased techniques and long-term oncologic outcome

Implant-based reconstruction is the most common method of breast reconstruction.Autologous breast reconstruction is an indispensable option for breast reconstruction demanding keen microsurgical skills and robust anatomical understanding.The reconstructive choice is made by the patient after a discussion with the plastic surgeon covering all the available options.Advantages and disadvantages of each technique along with long-term oncologic outcome are reviewed.

Single Abscess as the First Manifestation of Breast ALK-Positive Anaplastic Large Cell Lymphoma in Pregnancy Without Breast Implants:A Case Report

Primary lymphoma involving the breast accounts for only 0.04-0.5%of malignant breast tumors,constituting 1-2%of all non-Hodgkin lymphomas(NHL).Here,we report a case of breast ALK-positive ALCL arising in a 21-year-old woman in pregnancy with single abscess as the first clinical manifestation.

A prospective study comparing endoscopic subcutaneous mastectomy plus immediate reconstruction with implants and breast conserving surgery for breast cancer

Background Breast conserving surgery （BCS） has been the standard surgical procedure for the treatment of early breast cancer. Endoscopic subcutaneous mastectomy （ESM） plus immediate reconstruction with implants is an emerging procedure. The objective of this prospective study was to evaluate the clinical outcomes of these two surgical procedures in our clinical setting. Methods From March 2004 to October 2007, 43 patients with breast cancer underwent ESM plus axillary lymph node dissection and immediate reconstruction with implants, while 54 patients underwent BCS. The clinical and pathological characteristics, surgical safety, and therapeutic effects were compared between the two groups. Results There were no significant differences in the age, clinical stage, histopathologic type of tumor, operative blood loss, postoperative drainage time, and postoperative complications between the two groups （P 〉0.05）. The postoperative complications were partial necrosis of the nipple and superficial skin flap in the ESM patients, and hydrops in the axilla and residual cavity in the BCS patients. There was no significant difference in the rate of satisfactory postoperative cosmetic outcomes between the ESM （88.4%, 38/43） and BCS （92.6%, 50/54） patients （P 〉0.05）. During follow-up of 6 months to 4 years, all patients treated with ESM were disease-free, but 3 patients who underwent BCS had metastasis or recurrence -- one of these patients died of multiple organ metastasis. Conclusions After considering the wide indications for use, high surgical safety, and favorable cosmetic outcomes, we conclude that ESM plus axillary lymph node dissection and immediate reconstruction with implants -- the new surgery of choice for breast cancer -- warrants serious consideration as the prospective next standard surgical procedure.

Use of the Scar Acceleration Method/Método de Aceleração Cicatricial—MAC®—in the Treatment of Capsular Contracture: Case Report

Capsular contracture is a frequent complication in the postoperative period of breast implantation. It usually accompanies the appearance of a firm breast that can progress to pain, distortion, and asymmetry of the breasts, requiring surgical revision. The present study is a case report. A 58-year-old woman with a medical diagnosis of capsular contracture of the right breast evidenced by ultrasound. She was referred to the physiotherapy clinic in October 2019 with an initial complaint of pain on palpation, swelling, and stiffness in her right breast. The patient was evaluated and the MACò method was used to treat capsular contracture. For this, 12 sessions of photodynamic therapy were carried out. The treatment included the use of LED by doping: red (300 s), violet (60 s) and blue (120 s), with the use of 1% methylene blue in target areas, three times a week. The patient had the beginning of symptoms’ remission in the fourth visit and total remission in the 12th visit. It was concluded that the use of photodynamic therapy using the MACò method showed improvement in signs and symptoms—the sensation of prosthesis stiffness in the lower and medial region, local temperature, and pain in the right breast. The patient was followed up after treatment and currently, she has no complaints. There was also no need for surgical intervention. In the present case report, the MACò method proved to be effective. Further research is suggested with a cohort of patients with capsular contracture, with randomization and evaluation of a larger number of patients with the referred method.

Cosmetic Breast Implants Linked to Suicide Risk

选注者言:本文信息极为丰富。首先,我们得知当今美国的三大整容外科是:eyelid surgery,breast reduction and nose reshaping。其次,文章告诉读者,去年(2002年)美国施行隆胸手术的妇女达25万之众;再次,就是本文的标题所言,要求进行隆胸手术的女性中的自杀者比例高于不要求隆胸者。而且,更值得注意的是:If women have a psychological problem and they are given breast implantsthey will still have that problem.(假如一个女性存在心理问题,而且进行了隆胸手术,她们的心理问题依旧存在。)

Application of ＂CD-4＂ Theory for Determining the Width of Implant in Breast Augmentation

Background：The determination of the width of the implant is the first key step to select shape and volume of the implant in breast augmentation.The aim of this study was to introduce a new method to determine the width of the implant （W） and explain the reasons to do so in details.Methods：From January 2006 to June 2014,the authors have found and applied ＂CD-4＂ theory to determine the width of breast implant （W） in dual plane Ⅰ or Ⅱ breast augmentation cases through transaxillary or periareolar incision for 560 patients.＂CD＂ is defined as the curved distance on skin from the midline of the sternal bone to the anterior axillary line （AAL） on the lateral chest wall through the horizontal level on inferior mammary fold.W =CD-4 （or 3.5） cm.Results：The 560 patients used both round and anatomic implants with W from 10.5 cm to 12.5 cm.Their CDs are from 14.5 cm to 17 cm.About 78％ of the patients have got followed up from 1 month to 5 years postoperatively.Except for four patients who got unilateral capsular contractions,all the other patients are satisfied with their nature new breast shapes and volumes.Their new intermammary cleavages without bras are between 1 cm and 2.5 cm,and lateral borders of the breast are on the area of the AAL.Conclusions：W （width of the implant） =CD-4 （cm） when doing dual plan Ⅰ or Ⅱ breast augmentation.For the very thin patient,4 should be 3.5.