Objective: By observing the treatment and nursing care of a patient with Grade IV capsular contracture following breast cancer expander implantation and subsequent Stage II reconstruction, we aim to analyze the reason...Objective: By observing the treatment and nursing care of a patient with Grade IV capsular contracture following breast cancer expander implantation and subsequent Stage II reconstruction, we aim to analyze the reasons for the formation of capsular contracture after Stage I expander implantation and prevent its recurrence following Stage II reconstruction. Methods: In May 2020, the patient noticed an increase in the size of a breast mass. In August, she underwent AC-THP neoadjuvant chemotherapy, followed by a “right breast-conserving nipple-areolar subglandular excision + right axillary lymph node dissection + expander implantation” surgery in November 2020. Radiation therapy began in January 2021. During radiation therapy, the patient experienced severe breast hardening, distortion, tenderness, and was diagnosed with Grade IV capsular contracture. To relieve the capsular contracture, the patient underwent a “contracted capsule incision and release procedure + removal of the right breast expander + right breast implantation” surgery in July 2021. Postoperatively, measures were taken to prevent incision infection, emphasizing aseptic techniques, ensuring smooth negative pressure drainage, reducing skin flap tension, monitoring skin flap blood supply, actively preventing subcutaneous effusion and hematoma, and applying appropriate compression dressings. Results: The patient was discharged after the removal of the drainage tube. During the postoperative follow-up at 3 and 6 months, there was no recurrence of capsular contracture, and the breast appeared full, upright, and relatively soft. There were no complications such as hematoma, infection, breast implant rupture, breast sagging, or displacement. The patient had a good outcome without additional financial or surgical burdens. Conclusion: The occurrence of Grade IV capsular contracture in the patient is generally related to infection after Stage I expander implantation, improper compression dressing, excessive saline injection causing content infiltration, and radiation therapy. Therefore, it is recommended to enhance the intraoperative and postoperative prophylactic use of antibiotics after Stage I expander implantation. Intermittent saline injection after surgery, with the amount of saline gradually increasing rather than filling all at once, is advisable. This helps the breast tissue gradually adapt to expansion, reducing the risk of capsular contracture. Postoperatively, patients should be instructed to wear pressure garments and breast elastic bandages while intensifying breast monitoring during radiation therapy and increasing postoperative follow-up.展开更多
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 anat...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.展开更多
We hypothesize that a cylinder implant made of multilayer Poly-lactic-co-glycolic-acid (PLGA) membrane can be a method for controlled and extended drug release. We fashioned a multilayer cylindrical implant termed STI...We hypothesize that a cylinder implant made of multilayer Poly-lactic-co-glycolic-acid (PLGA) membrane can be a method for controlled and extended drug release. We fashioned a multilayer cylindrical implant termed STID100 that released doxorubicin for 3 weeks in an orthotopic 4T1 breast cancer model in Balb/C mice. This implant starts as a thin doxorubicin-embedded PLGA membrane, and is then rolled into a cylinder containing an air gap between the membrane layers. Its controlled sustained release delivered 2× the amount of the intravenous (IV) equivalent of doxorubicin, inhibited the primary tumor, and prevented lung metastasis. Importantly it did not cause weight loss, splenomegaly, or cardiac toxicity vs systemically administrated doxorubicin. This favorable safety profile is further substantiated by the finding of no detectable plasma doxorubicin in multiple time points during the 3-week period, and low tumor doxorubicin concentration. The implant system delivered to the specification of an ideal pharmacological paradigm might offer a better coverage of the local tumor, significantly preventing metastatic spread with less drug toxicity to many vital organs, compared to the traditional pharmacology of IV route. The profile of STID made it an attractive therapeutic alternative in metastatic tumor prevention, pain management and many other diverse clinical scenarios.展开更多
Motiva Implants®(Establishment Labs Holdings Inc., NY, USA) contains a RFID micro transponder RFID(RT) (RT = registered trademark) known as Q Inside Safety Technology which provides an added safety feature emb...Motiva Implants®(Establishment Labs Holdings Inc., NY, USA) contains a RFID micro transponder RFID(RT) (RT = registered trademark) known as Q Inside Safety Technology which provides an added safety feature embedded in the shell of the Motiva breast implant [1] [2]. Because this RFID micro transponder has Ferric components, a concern over breast MRI imaging susceptibility artifact has arisen. Among breast images, a single high risk breast cancer patient was imaged at our institution (January 2018). All breast imaging modalities were used to determine if this high risk patient had a recurrence of her cancer or any new breast cancer. The MRI showed a susceptibility artifact on the posterior margin of the implant but breast ultrasound showed no abnormalities in the area of the susceptibility artifact. By using high risk screening including Mammography, Tomosynthesis, Breast Ultrasound and Breast MRI, an adequate survey of the high risk patient was completed [3]. Our high risk clinic examined the patient and the imaging results and came to the following conclusion: This patient showed no evidence of recurrent cancer and no new masses were identified. The conclusion was BIRADS 2 benign: normal findings post-mastectomy and implants. Recommendation was for routine high risk screening at yearly interval.展开更多
Objectives: A recent entry into the silicone gel-filled breast implant market from Motiva Implants (Establishment Labs Holdings Inc., NY, USA) contains a radio frequency identification device micro-transponder (RFID-M...Objectives: A recent entry into the silicone gel-filled breast implant market from Motiva Implants (Establishment Labs Holdings Inc., NY, USA) contains a radio frequency identification device micro-transponder (RFID-M), known as the Q Inside Safety Technology, as an added safety feature embedded in the shell of its breast implant. This RFID-M device allows for the rapid unique identification of the implant. Concern for imaging voids due to the presence of the RFID device during MRI screening scans have arisen given its metallic components. Our investigation aims to determine whether the Q Inside Safety Technology RFID-M device in the Motiva Implants Limits the visualization of breast tissue in conventional breast imaging modalities. Methods: Seven patients with Motiva Implants were referred to dedicated diagnostic breast imaging centers for evaluation of their prostheses and surrounding breast parenchyma between January and May 2018. Imaging indications included routine evaluation of implant integrity, evaluation of significant breast symptoms, oncologic follow-up, and breast cancer screenings. Results: Under mammography, the Motiva Implants have a similar contour and mobility to other commonly used implants. The RFID-M is not visible and produces no artifact, allowing for proper visualization and screening of all visualized parenchymal tissues. Under ultrasound, the Motiva Implants are well-visualized in all patients. The RFID-M was not visible in vivo. No related ultrasound artifact was apparent within the lumen or behind the implant as shown in Figure 2(a). Five patients received MRI. The breast parenchyma and axillae were well-visualized in all 5 patients. The RFID-M was found to produce a “butterfly-shaped” susceptibility artifact that projects into the lumen of the breast implant and causes image distortion in some of the surrounding soft tissues and chest wall posterior to the implant. Conclusion: Aside from making its presence evident inside the implant, the Q Inside Safety Technology RFID-M does not interfere with the mammographic or sonographic exam, its results, or any consequent diagnosis made via their analysis. In the same respect using optimized MRI sequences to evaluate patients we were able to obtain satisfactory visualization of breast tissue in patients with the new Motiva Implants, and recommend using optimized study protocols for both early cancer detection and assessment of the implant’s integrity.展开更多
Introduction: breast implants have been used to correct the size and the form of a breast in post-mastectomy breast reconstruction, for correcting congenital defects and deformities or for purely aesthetic breast aug...Introduction: breast implants have been used to correct the size and the form of a breast in post-mastectomy breast reconstruction, for correcting congenital defects and deformities or for purely aesthetic breast augmentation. Silicone breast implants were introduced in the 1960s. They are non without complications, like rupture is or silicone gel bleeding. Materials and methods: the authors present the case of 50 patients, aged 45-55, who presented to our attention after 15 (+ 5) years of the application of silicone breast implant for the appearance of lumps under the skin in the armpit area. These were palpable, painless except on palpation. The patients reported burning in the affected area, but no other symptoms. Results: considering the presence in each of them of silicone implants, and assuming a possible allergic basis, the authors performed a patch test series S1DAPA produced by F.I.R.M.A Spa, Firenze, ultrasound and MR and blood tests. In all patients the allergy test (patch test) were negative, ultrasound and MR have shown that no hearing was damaged or broken. Blood test showed no abnormalities. Discussion: comparing the authors' study with other similar works in the literature, they noted that the reported cases of hypersensitivity type 4 silicone prosthesis was not only initially accompanied by specific symptoms such as urticaria and blistering, but mostly it was found to be a net positive patch test. The absence of urticaria, the low values of lgE and total negativity of patch test confirmed the purely inflammatory nature of the lesions in our patients.展开更多
Breast cancer is the most common malignancy and the most frequently diagnosed cancer in women worldwide.In China,the incidence rate of breast cancer among women has been showing an upward trend and is higher in urban ...Breast cancer is the most common malignancy and the most frequently diagnosed cancer in women worldwide.In China,the incidence rate of breast cancer among women has been showing an upward trend and is higher in urban areas.Decades of clinical research have made considerable progress,which is attributable to improved mastectomy and maintenance of a well-perfused skin flap after mastectomy.An in-depth insight into the nature of breast cancer will contribute to reduced overall mortality and prolonged survival.In China,there is an increasing awareness of the importance of breast reconstruction in improving quality of life(QoL)and life expectancy.There has been progress in breast reconstruction surgical procedures due to demand from women.Clinicians should be aware that breast reconstruction is not only a medical problem but also a surgical problem.In the following sections,we present the epitome of advances in implant-based breast reconstruction.展开更多
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...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.展开更多
The aim of the study was to show significant differences regarding postoperative complications and outcomes using three different Acellular Dermal Matrices (ADM), namely Epiflex<span style="white-space:nowrap;...The aim of the study was to show significant differences regarding postoperative complications and outcomes using three different Acellular Dermal Matrices (ADM), namely Epiflex<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span>, Strattice<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> and Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span>, in immediate implant-based subpectoral breast reconstruction cases. <strong>Background:</strong> The use of Acellular Dermal Matrices for implant-based breast reconstruction cases continues to evolve. There is a wide variety of products which differ significantly in their biological features. It remains unclear if and how these differences manifest in clinical practice. <strong>Methods:</strong> 82 cases of primary breast reconstruction in the Department of Plastic and Aesthetic Surgery of HELIOS Clinics Schwerin, Germany between 2010 and 2018 were analyzed. 25 patients received Strattice<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> acellular dermal matrix (SADM), 22 cases Epiflex<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> acellular dermal matrix (EADM) and the remaining 35 cases Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> acellular dermal matrix (BADM). The mean follow-up was 1.8 years. Cases were analyzed regarding minor or major complications and rate of capsular contracture grade III or IV (Baker Classification). <strong>Results:</strong> The overall complication rate was 34.1% for all groups (SADM = 40%, EADM = 50%, BADM = 20%, p-value = 0.051). Of all cases, 6 patients underwent implant exchange or secondary autologous reconstruction due to capsular contracture (7.3%). The mean time between revision due to capsular contracture and reconstruction was 35.8 ± 14.4 months. 50% of patients, who developed capsular contracture, received postoperative radiation. Mean hospitalization time was 8.2 ± 3 days (SADM = 8 ± 3.2 days, EADM = 10 ± 2.8 days, BADM = 6 ± 1.3 days). There were no significant differences between all three groups for demographics, overall complication rate or capsular contracture. However, patients receiving Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> matrix showed significantly fewer minor complications (p-value = 0.01). Moreover, patients receiving Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> ADM showed a significantly lower time of hospitalization (p < 0.001). <strong>Conclusion:</strong> No significant differences regarding the overall complication rate were found between the three groups. Different biological features of ADM showed a weak influence on overall results. However, patients receiving Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> ADM showed significantly lower minor complication rates and hospitalization time. In addition, these matrices showed a trend towards lower capsular contracture rates. The low rate of capsular contracture hints at possible advantages of ADM-use in direct-to-implant cases.展开更多
目的:探讨三维扫描成像在单侧假体乳房重建术前评估中的应用价值。方法:回顾性分析2018年1月-2021年9月于笔者科室行假体乳房重建术的15例单侧乳房萎缩或缺陷患者临床资料,所有患者术前均行三维扫描成像,得到术前乳房容量差异评估(Preop...目的:探讨三维扫描成像在单侧假体乳房重建术前评估中的应用价值。方法:回顾性分析2018年1月-2021年9月于笔者科室行假体乳房重建术的15例单侧乳房萎缩或缺陷患者临床资料,所有患者术前均行三维扫描成像,得到术前乳房容量差异评估(Preoperative assessment of breast volume difference,PABVD),依据该结果得出最接近的乳房假体容量,记为预计假体容量(Predicted prosthesis volume,PPV);术中剥离腔隙后,将圆形扩张器置入腔隙,注水评估容量差异,即为术中乳房容量差异评估(Intraoperative assessment of breast volume difference,IABVD),以IABVD参考选择最为相近的假体容量,记为实际假体容量(Actual prosthesis volume,APV),置入假体后,重建乳房下皱襞。术后给予止痛泵镇痛、抗瘢痕综合治疗。统计学分析数据,并对患者术后并发症、医患沟通满意度及手术效果满意度进行随访。结果:PABVD为(181.6±39.0)ml,IABVD为(178.6±36.4)ml,两者比较差异无统计学意义(P>0.05),PPV与APV吻合率达93.33%(14/15),PABVD与APV有较强关联性(P<0.05)。术后随访3~6个月,再造乳房形态自然、挺拔,双侧较对称,切口瘢痕位于新的乳房下皱襞处,术后均无明显瘢痕增生、包膜挛缩、感染等并发症,医患沟通良好,患者对手术效果满意。结论:三维扫描成像能够精确获取乳房的外在轮廓,并在术前对乳房容量差异进行可靠评估,有利于医患之间良好沟通,同时对于手术规划及预选假体有重要参考价值。展开更多
目的探讨不同入路行双平面假体隆乳术的效果。方法回顾性分析2020年1月—2023年1月新乡市中心医院收治的629例行双平面假体隆乳术患者的临床资料,按其手术入路的不同将其分为2组,其中经乳晕入路行手术的329例患者纳入对照组,经腋窝入路...目的探讨不同入路行双平面假体隆乳术的效果。方法回顾性分析2020年1月—2023年1月新乡市中心医院收治的629例行双平面假体隆乳术患者的临床资料,按其手术入路的不同将其分为2组,其中经乳晕入路行手术的329例患者纳入对照组,经腋窝入路行手术的300例患者纳入观察组,术后均随访6个月。对比2组手术相关指标、乳房形态变化、隆胸效果、并发症。结果观察组切口愈合时间[(7.30±1.25)d]短于对照组[(9.21±1.69)d],并发症发生率(1.67%)低于对照组(4.86%),差异有统计学意义(P<0.05)。2组术中出血量、手术时间、住院时间、术后数字评分法(numeric rating scale,NRS)评分、隆胸效果相比,差异无统计学意义(P>0.05)。术前、术后2组乳头-乳房下皱襞的经皮距离(nipple to inframammaryfold,N-IMF)、胸骨切迹-乳头距离(sternal notch to nipple,S-N)、乳头-正中线距离(nipple to midline,N-M)、乳房总体积相比,差异无统计学意义(P>0.05)。结论经乳晕入路、经腋窝入路行双平面假体隆乳术均能够取得优良的隆胸效果,但经腋窝入路行手术更能够促进切口愈合,降低并发症发生率。文章的研究结果为临床后期选择双平面假体隆乳术的入路提供了借鉴内容,具有一定的运用价值。展开更多
文摘Objective: By observing the treatment and nursing care of a patient with Grade IV capsular contracture following breast cancer expander implantation and subsequent Stage II reconstruction, we aim to analyze the reasons for the formation of capsular contracture after Stage I expander implantation and prevent its recurrence following Stage II reconstruction. Methods: In May 2020, the patient noticed an increase in the size of a breast mass. In August, she underwent AC-THP neoadjuvant chemotherapy, followed by a “right breast-conserving nipple-areolar subglandular excision + right axillary lymph node dissection + expander implantation” surgery in November 2020. Radiation therapy began in January 2021. During radiation therapy, the patient experienced severe breast hardening, distortion, tenderness, and was diagnosed with Grade IV capsular contracture. To relieve the capsular contracture, the patient underwent a “contracted capsule incision and release procedure + removal of the right breast expander + right breast implantation” surgery in July 2021. Postoperatively, measures were taken to prevent incision infection, emphasizing aseptic techniques, ensuring smooth negative pressure drainage, reducing skin flap tension, monitoring skin flap blood supply, actively preventing subcutaneous effusion and hematoma, and applying appropriate compression dressings. Results: The patient was discharged after the removal of the drainage tube. During the postoperative follow-up at 3 and 6 months, there was no recurrence of capsular contracture, and the breast appeared full, upright, and relatively soft. There were no complications such as hematoma, infection, breast implant rupture, breast sagging, or displacement. The patient had a good outcome without additional financial or surgical burdens. Conclusion: The occurrence of Grade IV capsular contracture in the patient is generally related to infection after Stage I expander implantation, improper compression dressing, excessive saline injection causing content infiltration, and radiation therapy. Therefore, it is recommended to enhance the intraoperative and postoperative prophylactic use of antibiotics after Stage I expander implantation. Intermittent saline injection after surgery, with the amount of saline gradually increasing rather than filling all at once, is advisable. This helps the breast tissue gradually adapt to expansion, reducing the risk of capsular contracture. Postoperatively, patients should be instructed to wear pressure garments and breast elastic bandages while intensifying breast monitoring during radiation therapy and increasing postoperative follow-up.
文摘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.
文摘We hypothesize that a cylinder implant made of multilayer Poly-lactic-co-glycolic-acid (PLGA) membrane can be a method for controlled and extended drug release. We fashioned a multilayer cylindrical implant termed STID100 that released doxorubicin for 3 weeks in an orthotopic 4T1 breast cancer model in Balb/C mice. This implant starts as a thin doxorubicin-embedded PLGA membrane, and is then rolled into a cylinder containing an air gap between the membrane layers. Its controlled sustained release delivered 2× the amount of the intravenous (IV) equivalent of doxorubicin, inhibited the primary tumor, and prevented lung metastasis. Importantly it did not cause weight loss, splenomegaly, or cardiac toxicity vs systemically administrated doxorubicin. This favorable safety profile is further substantiated by the finding of no detectable plasma doxorubicin in multiple time points during the 3-week period, and low tumor doxorubicin concentration. The implant system delivered to the specification of an ideal pharmacological paradigm might offer a better coverage of the local tumor, significantly preventing metastatic spread with less drug toxicity to many vital organs, compared to the traditional pharmacology of IV route. The profile of STID made it an attractive therapeutic alternative in metastatic tumor prevention, pain management and many other diverse clinical scenarios.
文摘Motiva Implants®(Establishment Labs Holdings Inc., NY, USA) contains a RFID micro transponder RFID(RT) (RT = registered trademark) known as Q Inside Safety Technology which provides an added safety feature embedded in the shell of the Motiva breast implant [1] [2]. Because this RFID micro transponder has Ferric components, a concern over breast MRI imaging susceptibility artifact has arisen. Among breast images, a single high risk breast cancer patient was imaged at our institution (January 2018). All breast imaging modalities were used to determine if this high risk patient had a recurrence of her cancer or any new breast cancer. The MRI showed a susceptibility artifact on the posterior margin of the implant but breast ultrasound showed no abnormalities in the area of the susceptibility artifact. By using high risk screening including Mammography, Tomosynthesis, Breast Ultrasound and Breast MRI, an adequate survey of the high risk patient was completed [3]. Our high risk clinic examined the patient and the imaging results and came to the following conclusion: This patient showed no evidence of recurrent cancer and no new masses were identified. The conclusion was BIRADS 2 benign: normal findings post-mastectomy and implants. Recommendation was for routine high risk screening at yearly interval.
文摘Objectives: A recent entry into the silicone gel-filled breast implant market from Motiva Implants (Establishment Labs Holdings Inc., NY, USA) contains a radio frequency identification device micro-transponder (RFID-M), known as the Q Inside Safety Technology, as an added safety feature embedded in the shell of its breast implant. This RFID-M device allows for the rapid unique identification of the implant. Concern for imaging voids due to the presence of the RFID device during MRI screening scans have arisen given its metallic components. Our investigation aims to determine whether the Q Inside Safety Technology RFID-M device in the Motiva Implants Limits the visualization of breast tissue in conventional breast imaging modalities. Methods: Seven patients with Motiva Implants were referred to dedicated diagnostic breast imaging centers for evaluation of their prostheses and surrounding breast parenchyma between January and May 2018. Imaging indications included routine evaluation of implant integrity, evaluation of significant breast symptoms, oncologic follow-up, and breast cancer screenings. Results: Under mammography, the Motiva Implants have a similar contour and mobility to other commonly used implants. The RFID-M is not visible and produces no artifact, allowing for proper visualization and screening of all visualized parenchymal tissues. Under ultrasound, the Motiva Implants are well-visualized in all patients. The RFID-M was not visible in vivo. No related ultrasound artifact was apparent within the lumen or behind the implant as shown in Figure 2(a). Five patients received MRI. The breast parenchyma and axillae were well-visualized in all 5 patients. The RFID-M was found to produce a “butterfly-shaped” susceptibility artifact that projects into the lumen of the breast implant and causes image distortion in some of the surrounding soft tissues and chest wall posterior to the implant. Conclusion: Aside from making its presence evident inside the implant, the Q Inside Safety Technology RFID-M does not interfere with the mammographic or sonographic exam, its results, or any consequent diagnosis made via their analysis. In the same respect using optimized MRI sequences to evaluate patients we were able to obtain satisfactory visualization of breast tissue in patients with the new Motiva Implants, and recommend using optimized study protocols for both early cancer detection and assessment of the implant’s integrity.
文摘Introduction: breast implants have been used to correct the size and the form of a breast in post-mastectomy breast reconstruction, for correcting congenital defects and deformities or for purely aesthetic breast augmentation. Silicone breast implants were introduced in the 1960s. They are non without complications, like rupture is or silicone gel bleeding. Materials and methods: the authors present the case of 50 patients, aged 45-55, who presented to our attention after 15 (+ 5) years of the application of silicone breast implant for the appearance of lumps under the skin in the armpit area. These were palpable, painless except on palpation. The patients reported burning in the affected area, but no other symptoms. Results: considering the presence in each of them of silicone implants, and assuming a possible allergic basis, the authors performed a patch test series S1DAPA produced by F.I.R.M.A Spa, Firenze, ultrasound and MR and blood tests. In all patients the allergy test (patch test) were negative, ultrasound and MR have shown that no hearing was damaged or broken. Blood test showed no abnormalities. Discussion: comparing the authors' study with other similar works in the literature, they noted that the reported cases of hypersensitivity type 4 silicone prosthesis was not only initially accompanied by specific symptoms such as urticaria and blistering, but mostly it was found to be a net positive patch test. The absence of urticaria, the low values of lgE and total negativity of patch test confirmed the purely inflammatory nature of the lesions in our patients.
文摘Breast cancer is the most common malignancy and the most frequently diagnosed cancer in women worldwide.In China,the incidence rate of breast cancer among women has been showing an upward trend and is higher in urban areas.Decades of clinical research have made considerable progress,which is attributable to improved mastectomy and maintenance of a well-perfused skin flap after mastectomy.An in-depth insight into the nature of breast cancer will contribute to reduced overall mortality and prolonged survival.In China,there is an increasing awareness of the importance of breast reconstruction in improving quality of life(QoL)and life expectancy.There has been progress in breast reconstruction surgical procedures due to demand from women.Clinicians should be aware that breast reconstruction is not only a medical problem but also a surgical problem.In the following sections,we present the epitome of advances in implant-based breast reconstruction.
文摘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.
文摘The aim of the study was to show significant differences regarding postoperative complications and outcomes using three different Acellular Dermal Matrices (ADM), namely Epiflex<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span>, Strattice<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> and Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span>, in immediate implant-based subpectoral breast reconstruction cases. <strong>Background:</strong> The use of Acellular Dermal Matrices for implant-based breast reconstruction cases continues to evolve. There is a wide variety of products which differ significantly in their biological features. It remains unclear if and how these differences manifest in clinical practice. <strong>Methods:</strong> 82 cases of primary breast reconstruction in the Department of Plastic and Aesthetic Surgery of HELIOS Clinics Schwerin, Germany between 2010 and 2018 were analyzed. 25 patients received Strattice<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> acellular dermal matrix (SADM), 22 cases Epiflex<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> acellular dermal matrix (EADM) and the remaining 35 cases Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> acellular dermal matrix (BADM). The mean follow-up was 1.8 years. Cases were analyzed regarding minor or major complications and rate of capsular contracture grade III or IV (Baker Classification). <strong>Results:</strong> The overall complication rate was 34.1% for all groups (SADM = 40%, EADM = 50%, BADM = 20%, p-value = 0.051). Of all cases, 6 patients underwent implant exchange or secondary autologous reconstruction due to capsular contracture (7.3%). The mean time between revision due to capsular contracture and reconstruction was 35.8 ± 14.4 months. 50% of patients, who developed capsular contracture, received postoperative radiation. Mean hospitalization time was 8.2 ± 3 days (SADM = 8 ± 3.2 days, EADM = 10 ± 2.8 days, BADM = 6 ± 1.3 days). There were no significant differences between all three groups for demographics, overall complication rate or capsular contracture. However, patients receiving Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> matrix showed significantly fewer minor complications (p-value = 0.01). Moreover, patients receiving Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> ADM showed a significantly lower time of hospitalization (p < 0.001). <strong>Conclusion:</strong> No significant differences regarding the overall complication rate were found between the three groups. Different biological features of ADM showed a weak influence on overall results. However, patients receiving Braxon<span style="white-space:nowrap;"><span style="white-space:nowrap;"><sup>®</sup></span></span> ADM showed significantly lower minor complication rates and hospitalization time. In addition, these matrices showed a trend towards lower capsular contracture rates. The low rate of capsular contracture hints at possible advantages of ADM-use in direct-to-implant cases.
文摘目的:探讨三维扫描成像在单侧假体乳房重建术前评估中的应用价值。方法:回顾性分析2018年1月-2021年9月于笔者科室行假体乳房重建术的15例单侧乳房萎缩或缺陷患者临床资料,所有患者术前均行三维扫描成像,得到术前乳房容量差异评估(Preoperative assessment of breast volume difference,PABVD),依据该结果得出最接近的乳房假体容量,记为预计假体容量(Predicted prosthesis volume,PPV);术中剥离腔隙后,将圆形扩张器置入腔隙,注水评估容量差异,即为术中乳房容量差异评估(Intraoperative assessment of breast volume difference,IABVD),以IABVD参考选择最为相近的假体容量,记为实际假体容量(Actual prosthesis volume,APV),置入假体后,重建乳房下皱襞。术后给予止痛泵镇痛、抗瘢痕综合治疗。统计学分析数据,并对患者术后并发症、医患沟通满意度及手术效果满意度进行随访。结果:PABVD为(181.6±39.0)ml,IABVD为(178.6±36.4)ml,两者比较差异无统计学意义(P>0.05),PPV与APV吻合率达93.33%(14/15),PABVD与APV有较强关联性(P<0.05)。术后随访3~6个月,再造乳房形态自然、挺拔,双侧较对称,切口瘢痕位于新的乳房下皱襞处,术后均无明显瘢痕增生、包膜挛缩、感染等并发症,医患沟通良好,患者对手术效果满意。结论:三维扫描成像能够精确获取乳房的外在轮廓,并在术前对乳房容量差异进行可靠评估,有利于医患之间良好沟通,同时对于手术规划及预选假体有重要参考价值。
文摘目的探讨不同入路行双平面假体隆乳术的效果。方法回顾性分析2020年1月—2023年1月新乡市中心医院收治的629例行双平面假体隆乳术患者的临床资料,按其手术入路的不同将其分为2组,其中经乳晕入路行手术的329例患者纳入对照组,经腋窝入路行手术的300例患者纳入观察组,术后均随访6个月。对比2组手术相关指标、乳房形态变化、隆胸效果、并发症。结果观察组切口愈合时间[(7.30±1.25)d]短于对照组[(9.21±1.69)d],并发症发生率(1.67%)低于对照组(4.86%),差异有统计学意义(P<0.05)。2组术中出血量、手术时间、住院时间、术后数字评分法(numeric rating scale,NRS)评分、隆胸效果相比,差异无统计学意义(P>0.05)。术前、术后2组乳头-乳房下皱襞的经皮距离(nipple to inframammaryfold,N-IMF)、胸骨切迹-乳头距离(sternal notch to nipple,S-N)、乳头-正中线距离(nipple to midline,N-M)、乳房总体积相比,差异无统计学意义(P>0.05)。结论经乳晕入路、经腋窝入路行双平面假体隆乳术均能够取得优良的隆胸效果,但经腋窝入路行手术更能够促进切口愈合,降低并发症发生率。文章的研究结果为临床后期选择双平面假体隆乳术的入路提供了借鉴内容,具有一定的运用价值。