Assessing the Clinical Efficacy and Effectiveness of Sentinel Lymph Node Biopsy Combined with Breast-Conserving Surgery for Early-Stage Breast Cancer

Objective:To analyze the impact of sentinel lymph node biopsy(SLNB)combined with breast-conserving surgery in the clinical treatment of early-stage breast cancer.Methods:80 patients with early-stage breast cancer admitted to the Second Department of Breast Surgery at Dezhou Second People’s Hospital from September 2020 to September 2022 were selected and randomly divided into a control group and an observation group using the random number table method,with 40 cases in each group.The control group underwent a modified radical mastectomy,while the observation group underwent SLNB combined with breast-conserving surgery.The surgical efficacy and prognosis between the two groups were compared.Results:The observation group exhibited shorter operation,hospitalization,and extubation times,as well as less intraoperative blood loss and drainage volume,all of which were significantly better than those in the control group(P<0.05).Additionally,the observation group demonstrated a higher rate of excellent breast cosmetology and quality of life,with lower complication incidence,significantly outperforming the control group(P<0.05).There was no statistical difference in the metastasis rate and recurrence rate between the two groups(P>0.05).Conclusion:The combination of SLNB and breast-conserving surgery proves highly effective for patients with early-stage breast cancer,presenting fewer complications and enhancing both breast cosmetic outcomes and quality of life.

Application of Ultimate Oncoplastic Surgery in Breast-Conserving Surgery

Objective To investigate the application of oncoplastic surgery in breast-conserving surgery.Methods We retrospectively analyzed the clinical data of 103 breast cancer patients who underwent breast-conserving surgery in the First Affiliated Hospital of Henan University.All the patients were female whose tumor volume-to-breast volume ratio was greater than 20%.Fifty-two patients were treated with oncoplastic breast-conversing surgery(observation group),and 51 patients were treated with traditional breast-conserving surgery(control group).The volume of resected tissue,subjective satisfaction with breast shape,objective score of breast shape,and follow-up were compared between the two groups.Results In the observation group,the weight of resected breast tissue was 64.2–172.1 g,with a median of 98.7 g.In the control group,the weight of resected breast tissue was 67.5–175.7 g,with a median of 102.3 g.After 12 months of follow-up,the subjective satisfaction rate and objective score of breast shape in the observation group were significantly better than those in the traditional breast-conserving surgery group(P<0.05).There was no recurrence,metastasis,or death in the two groups.There was no significant difference in postoperative complications between the two groups(P>0.05).Conclusion Oncoplastic breast-conserving surgery leads to better cosmetic results and a more satisfactory clinical results.

Application experience and research progress of different emerging technologies in plastic surgery

In the diagnosis and treatment of plastic surgery,there are structural processing problems,such as positioning,moving,and reconstructing complex threedimensional structures.Doctors operate according to their own experience,and the inability to accurately locate these structures is an important problem in plastic surgery.Emerging digital technologies such as virtual reality,augmented reality,and three-dimensional printing are widely used in the medical field,particularly in plastic surgery.This article reviews the development of these three technical concepts,introduces the technical elements and specific applications required in plastic surgery,summarizes the application status of the three technologies in plastic surgery,and summarizes prospects for future development.

First Reconstructive Plastic Surgery of the Perineum in a Hominin Pan paniscus (Bonobo) and Plea by a Plastic Surgeon for Surgery for the Benefit of All Hominins (Members of the Human Lineage)

We present, for the first time, the repair by plastic surgery procedures of a large loss of perineal substance in a bonobo (hominin Pan paniscus). A 20-year-old male bonobo living in captivity in the Lola Ya Bonobo Sanctuary in Kinshasa in the Democratic Republic of the Congo was attacked by another bonobo. It was a large perineal wound through which urine flowed, located between the penis and the testicles, taking part of the anterior and posterior urethra, the bladder, as well as the elements of the spermatic duct. To repair the large loss of perineal substance, a pedicled flap of scrotal skin was removed, and then turned over, cutaneous surface on the trench of the loss of bladder substance and the urethral lumen. The postoperative course was satisfactory with healing by the first intention of the surgical wound, despite the wild postoperative behavior of the patient (removal of the vesicourethral catheter and protective plaster). We observed in the short term an urethro-cutaneous fistula, left in natural healing. The reconstructive surgery procedures applied in humans can also be applied with satisfactory results in bonobos, a species in the process of extension and whose members are our closest cousins. The bonobo is genetically close to humans. Based on this first successful experience, we advocate for reconstructive plastic surgery for all hominins (members of the human lineage), if indicated.

Optimal timing for plastic surgical procedures for common congenital anomalies:A review

Apart from listening to the cry of a healthy newborn,it is the declaration by the attending paediatrician in the labour room that the child is normal which brings utmost joy to parents.The global incidence of children born with congenital anomalies has been reported to be 3%-6%with more than 90%of these occurring in low-and middle-income group countries.The exact percentages/total numbers of children requiring surgical treatment cannot be estimated for several reasons.These children are operated under several surgical disciplines,viz,paediatric-,plastic reconstructive,neuro-,cardiothoracic-,orthopaedic surgery etc.These conditions may be life-threatening,e.g.,trachea-oesophageal fistula,critical pulmonary stenosis,etc.and require immediate surgical intervention.Some,e.g.,hydrocephalus,may need intervention as soon as the patient is fit for surgery.Some,e.g.,patent ductus arteriosus need‘wait and watch’policy up to a certain age in the hope of spontaneous recovery.Another extremely important category is that of patients where the operative intervention is done based on their age.Almost all the congenital anomalies coming under care of a plastic surgeon are operated as elective surgery(many as multiple stages of correction)at appropriate ages.There are advantages and disadvantages of intervention at different ages.In this article,we present a review of optimal timings,along with reasoning,for surgery of many of the common congenital anomalies which are treated by plastic surgeons.Obstetricians,paediatricians and general practitioners/family physicians,who most often are the first ones to come across such children,must know to guide the parents appropriately and convincingly impress upon the them as to why their child should not be operated immediately and also the consequences of too soon or too late.

Breast-conserving surgery and combined therapy for women breast cancer: a report of 216 cases

Objective： To explore the therapeutic effect and associated techniques of breast-conserving therapy on patients with clinical stage Ⅰ and stage Ⅱ breast cancer. Methods： 216 female patients with breast cancer underwent breast-conserving therapy from December 1993 to October 2004. Their data were analyzed retrospectively. The breast-conserving therapy consisted of lumpectomy or quadrant removal of the breast, postoperative radiotherapy, chemotherapy and endocrine therapy. Of them, 209 patients underwent axillary lymph node dissection. Results： There were no operative complications. 216 patients were followed-up 3 to 147 months, the medial follow-up time was 78 months. The local recurrence rate was 1.85%. Two patients died and one of them was not related with breast cancer. Presence or absence of fibrosis, shape of breast, asymmetry, pigmentation and handle were taken into consideration for cosmetic evaluation by the patients and experienced breast surgeon. Breasts were scored cosmetically as excellent and good in 199 patients, the rate of satisfactory was 92.13%. Conclusion： Breast-conserving therapy for early breast cancer is e safe end effective therapy. It has less trauma end less complications and can also raise the quality of life in the patients. But we must obey the strict indications and reasonable techniques.

Clinical significance of S100A7 protein in predicting recurrence of breast cancer in patients undergoing breast-conserving surgery with radiotherapy

Objective To investigate the relationship between the expression of S100A7 protein and prediction of recurrence and prognosis of breast cancer in patients undergoing breast-conserving surgery combined with radiotherapy.Methods 349 samples of carcinoma tissue wax blocks were selected from January 2011 to January 2014 in Qingdao Central Hospital.All the patients had undergone breast-conserving surgery.We analyzed S100A7 expression in tumor tissue by immunohistochemical staining.Using univariate and multivariate analyses,we evaluated the relationship between S100A7 and clinical results,to explore independent risk factors for local regional recurrence(LRR).Results The positive expression of S100A7 in the recurrence group(66.7%)was significantly higher than in the non-recurrence group(38.4%),P=0.025.A log-rank test showed that high S100A7 expression was significantly correlated with 5-year regional recurrence free survival rate(RFS)(94.9%vs 89.5%,P=0.0408),distant metastasis free survival rate(DFS)(95.4%vs 83.5%,P<0.001),and overall survival rate(OS)(99.0%vs 92.5%,P=0.0011).Histological grade,vessel carcinoma embolus,lymph node metastasis,S100A7 expression,and tumor size were factors that influenced RFS.Multivariate analysis of the Cox proportional hazard model showed that high S100A7 expression was an independent risk factor that affected breast cancer RFS(HR=6.864,95%CI:1.575-29.915,P=0.01).Thus,we concluded that high S100A7 expression is associated with increased risk of LRR and distant metastasis of breast cancer after breast-conserving surgery and postoperative radiotherapy.S100A7 can be used as a molecular marker to screen for patients with high recurrence risk after breast-conserving surgery.

Whole breast ultrafractionation radiotherapy after breast-conserving surgery in early breast cancer: A single-center, prospective, observational study from China

Objective:This single-center,prospective,observational study was designed to investigate the toxicities,patient-reported outcome(PRO),and dosimetric analysis of whole breast ultrafractionation radiotherapy(RT)after breast-conserving surgery(BCS)in early breast cancer(BC).Patients and methods:Patients diagnosed with BC stage I,II and treated with BCS were enrolled.A dose of 26 Gray(Gy)in five fractions was prescribed to the whole breast and tumor bed.Clinical endpoints included toxicities,PRO,and dosimetric analysis.PRO was measured by the European Organization for Research and Treatment of Cancer general quality of life questionnaire(EORTC QLQ-C30)and the BC-specific questionnaire(EORTC QLQ-BR23)questionnaires.Results:Between January 2022 and June 2023,62 female patients were enrolled.The median age was 45 years.Most patients(83.9%)were diagnosed with pathological stage I disease.The median planning target volume(PTV)was 456.4 mL.The minimum,maximum,and mean doses,and D95(dose of PTV irradiated volume more than 95%)to PTV were 20.2,28.8,27.2,and 26.3 Gy,respectively.The median mean lung dose and percentage lung volume receiving 8 Gy(V8)were 3.6 Gy and 13.4%,respectively.The median mean heart dose,V1.5(percentage of organ volume irradiated with 1.5 Gy or higher),and V7(percentage of organ volume irradiated with 7 Gy or higher)were 0.6 Gy,6.8%,and 0.4%,respectively.Cosmetic effects before RT showed no obvious differences compared to that post RT.No toxicities of grade 3 or higher occurred.Five patients had asymptomatic radiation pneumonia(grade 1),and 12 patients had radiation dermatitis(grade 1).No factor was significantly related to radiation dermatitis or radiation pneumonia.For the EORTC QLQ-C30 and QLQ-BR23 questionnaires,all function and symptom scores before RT had no significant differences compared with that after RT,1−2 months after RT,and 3−4 months after RT.Ultrafractionation RT did not worsen PRO.The 1-year crude local control was 100%.Conclusion:Whole breast ultrafractionation RT after BCS in early BC has no severe toxicities and does not affect PRO.These results need to be further validated with a longer follow-up and a larger sample size.

Comparison of Plastic Surgery Training Programs Between Hong Kong and Shanghai

The field of plastic surgery has developed rapidly in the last couple of decades in Hong Kong and Shanghai,China.Both cities have their own educational system for training plastic surgeons.Their training programs differ in many ways,including the surgical exposure of undergraduate studies,the structure,curriculum,and operative requirements of residency training.In general,Hong Kong has a single pathway of residency training with more early clinical exposure in an undergraduate study.On the contrary,Shanghai has multiple pathways of residency training that are heavily emphasized in academic research.Both Hong Kong and Shanghai should complement each other to modify their plastic surgery training programs that will eventually benefit the field of plastic surgery education。

Body Image and Personality in Aesthetic Plastic Surgery: A Case-Control Study

Introduction: The amount of research on the relationship between plastic surgery and psychological features, such as personality disorders and indexes of body image dissatisfaction, has increased significantly in the last years. Aim: The aim of the present study was to examine these psychological features among Italian patients who underwent aesthetic plastic surgery, testing the mediating role of the mass media influence on the relationship between them and the choice of aesthetic plastic surgery. The Personality Diagnostic Questionnaire 4+ (PDQ-4+) and the Body Uneasiness Test (BUT) were administered to patients who underwent aesthetic plastic surgery (N = 111) and participants who had no history of aesthetic plastic surgical procedures (N = 149). Results: Results showed that aesthetic patients reported higher indexes of body image disturbance than controls. No significant differences between aesthetic participants and controls were found in all three cluster B personality disorders. Moreover, the effect of body image dissatisfaction on the choice to undergo aesthetic plastic surgery was partially mediated by the influence of mass media. Conclusions: In conclusion, the present study confirmed the importance of body dissatisfaction as a predictor of the choice to undergo aesthetic surgery and highlighted the influence of media messages regarding physical appearance.

Advances in Oncoplastic Breast Surgery

Evidence from six prospective,randomized trials has shown that breast-conserving surgery(BCS)is a safe alternative to mastectomy,and this led to a heightened interest in achieving and balancing local control and cosmetic outcome post-surgery.However,it is also becoming apparent that conventional BCS techniques may not produce cosmetically favorable results for patients who present with ill-defined or poorly situated breast tumors.Other factors that are commonly found in Chinese women,such as small-volume and denser breasts,also contribute to the difficulty in achieving an optimal cosmetic outcome post-surgery,thus necessitating the need for oncoplastic breast surgery techniques to be employed.This article serves as an overview of the recent advances and principles of oncoplastic breast surgery,as well as the use of autologous fat grafts to improve cosmetic results and eliminate remaining smaller deformities post-surgery.

The Relevant Roles of Plastic and Orthopedic Surgery in Hand Salvage

Over the recent past few years, there is a huge innovation in plastic surgery and orthopedic surgery through implantation of new techniques, which enabled a great level of success in hand salvage. Conditions such as trauma, tumor, sepsis, or vascular disease, may necessitate hand salvage. The most frequent argument among surgeon from different subspecialties (orthopedics, plastics, trauma, and vascular surgery) are characterized by in what way each one can do his own part of the salvage operation, be it bony fixation, revascularization, or soft-tissue coverage, but none of them is sure whether it should be endeavored. What is necessary in such clinical situations is an interdisciplinary team attitude led by individual or groups of clinicians who are conversant not only with their identifiable subspecialized skills but also with those of their coworkers and the consequences accompanying the joined efforts at hand salvage. The perception of orthoplastic surgery is based on such an indication, where the integrated skills and techniques of the orthopedic surgeon and reconstructive microsurgeon are performed in recital to direct efforts concerning hand salvage or choose against it when it is not designated. The current article reviews the roles of orthopedic and plastic surgery and how this team can deal with the existing techniques to improve outcomes in hand salvage surgery.

Historical Case Report: 45 Years of the First Plastic Surgery in Morbid Obese in Brazil and Their Weight Loss

Before the 70s, in Brazil, each city had its morbidly obese, considered as the “excessive fats”, in very small numbers if we compare it with the current percentage. There was no classification of the degree of obesity by the body mass index (BMI) as we have today. By chance, on a Saturday in June 1975, at the Outpatient Clinic of the 23rd Infirmary of Santa Casa da Misericórdia Hospital in Rio de Janeiro, arrived the patient I. S., 41 years old, 1.70 m tall, supported by her two children, weighing 210 kg in weight body. Knowing that bariatric surgery only appeared in the 1980s, before that, patients with morbid obesity were left to their own devices, with hypertension and diabetes. The patient I. S. was hospitalized for 3 years in our Plastic Surgery Service, having received nutritional monitoring, had sporadic discharges and undergone 9 reparative plastic surgeries. She was discharged weighing 71 kg, with self-esteem recovered and happy to start a new life, without hypertension and diabetes.

A Short Term Review of Operated Cases in the Plastic Surgery Unit at the Komfo Anokye Teaching Hospital, Kumasi, Ghana

Introduction: Surgical problems are of much disturbance to the world and should therefore be given serious attention. The prevalence of these surgical problems, has made plastic surgery become a broadly relevant and acceptable way for addressing problems like injuries, congenital anomalies, surgical infections and malignancies among others. Aim: This study is to quantify and characterize surgical procedures done in the plastic surgery theatre located in the new Accident and Emergency (A & E) Building of KATH. Materials and Methods: Data were obtained from the Operation Register/Theatre Books in the plastic surgery theatre at the A & E Centre on cases operated on from October 1, 2009 to September 30, 2012. Data entry, presentation and analysis were done using Statistical Package for the Social Sciences (SPSS) 20.0 version. Results: Adults formed the majority of patients who sought for plastic surgery with a percentage of 70.3%. The male patients also outnumbered the females recording (61.5%) out of the total number of patients. Most of the cases recorded were acquired cases (93.2%). Reconstructive surgery was the commonest operation performed (30%);in 53.8% cases general anaesthesia was used. Conclusion: Among all the procedures used reconstructive surgery was the commonest surgery performed in the unit and general anaesthesia was the most type of anaesthesia used for the operations.

Saudi Arabia, Breast Plastic Surgery, Breast Construction

In this review article, various preferences in breast plastic surgery particularly after breast cancer will be discussed in view of the diverse indications for the different construction procedures. The various conditions that necessitate the need for reconstruction are appraised, the important reconstructive procedures are discussed. The most important indications procedures discussed in this review include;Prophylactic subcutaneous mastectomy, Lumpectomy and Radiation, Modified Mastectomy with Axillary Sampling, Nipple reconstruction, and the contralateral breast. These procedures are discussed in view of plastic surgeon practice and patients acceptability in Saudi Arabia. Data from Saudi Arabia in particular was identified through searches of the EMBASE, and MEDLINE database, using the keywords: Saudi Arabia, breast plastic Surgery, breast reconstruction, autologous breast reconstruction, breast augmentation. Advances in prosthetic technologies and modifications in autologous flap techniques, and the development of novel tissue alternatives have allowed for sustained developments in breast reconstruction results. A variety of attitudes has been accessible for addressing the difficulties that endure after resection of breast cancer in Saudi Arabia. Patients should be educated to accept different process in this context.

Improving Confidence and Practical Skills in Plastic Surgery for Medical Students and Junior Doctors: A One-Day Session

Objectives: The current medical school curriculum offers scant exposure to plastic surgery. Medical students and junior doctors are often inadequately prepared for in-hospital placements which may impact on patient safety and quality of care. We aimed to deliver a one-day “hands-on” practical session on basic surgical skills and principles in plastic surgery, and to assess its effectiveness at improving confidence to the specialty among junior trainees. Methods: The one-day practical session covered knot tying, suturing, LA administration, skin lesion excision and local flaps, with short concurrent lectures on principles of plastic surgery. Self-assessment confidence scores were recorded before and after the course on seven domains: a) knowledge: wound assessment and management, suture selection, and concepts of flaps;b) practical skills: Handling of surgical instrument, suturing, LA administration, and skin lesion excision. Results: Thirty-five participants attended: Six core surgical trainees, fifteen foundation doctors, and fourteen medical students. The overall course satisfaction was 9.13/10. Self-assessment confidence scores in all domains significantly improved after the course (p < 0.0001). Suturing (58.6%) and skin lesion excision (74.5%) demonstrated the largest improvement. Qualitative feedback was extremely positive. Conclusions: The hands-on nature of the course offered participants great opportunities to acquire the necessary confidence and practical skills required for in-hospital placements. It is vital for students and doctors interested in a career in plastic surgery to prepare adequately for this diverse specialty, which is covered in limited depth in medical school. The need for more practical skills courses on plastic surgery for this demographic is intuitive.

Applying Bruce Lee’s Jeet Kune Do Combat Philosophy in Plastic &Reconstructive Surgery—7 Principles for Success

At first glance, it may appear that martial arts and surgery do not relate to each other at all. However, martial arts and surgery are all one on the path of knowledge and self discovery. Innovations are constantly being developed;some techniques stand the test of time while others are relegated to history. Martial arts and surgery have also branched out for example boxing, taekwondo, jujitsu and wrestling for martial arts whereas surgery has branched out to orthopaedics, paediatrics, cardiothoracic and neurosurgery to name a few. Some choose to specialize while others choose to be a generalist. Learning methodologies in martial arts and plastic surgery are similar. Martial arts students are the equivalent of surgical residents, and both have to enroll in a school that prepares them to be practitioners of their respective arts. In the last century, formal martial arts academies and surgical residency training programs have sprung up. The standards and entrance requirements vary from school to school as do training methodology and philosophical concepts. In this article, we seek to analyze Bruce Lee’s martial arts’ philosophy of Jeet Kune Do (JKD) and that how we can apply it to our personal path in Plastic & Reconstructive Surgery.

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.

Prospective application of poloxamer 188 in plastic surgery:A comprehensive review

An increasing number of researchers have demonstrated that poloxamer 188(P188)can be used as a pharmaceutical excipient for clinical applications.Its membrane-sealing effects and inherent biological activities make it an extremely promising agent for plastic surgery.In this review,we summarize the positive roles of P188 in autologous fat grafting,wound healing,and cartilage transplantation.These roles include improving the survival rate of fat grafts and chondrocytes,stimulating the metabolic activity of adipocytes,promoting wound healing,and contributing to cartilage formation.Although further research is still needed,it is clear that P188 has great potential and application value in the field of plastic surgery.

Patients Body Modeling:A Practical Theoretical Experience in Plastic Surgery

This research is an active pedagogical experience with surgeons who are specialized in reconstructive plastic surgery and nursing. The guiding questions were the statements of each Surgeon’s clients and what they think about them. Modeling the imaginary bodies of the patients and identify what they built in their minds, highlighting topics and the discussion about the practice made in clay modeling. Eight bodies were modeled, with six bodies with all the senses and two incomplete bodies with only the regions of the breasts and buttocks. It was concluded that there are diverse issues emerging such as gender, ethics, care, spirituality and dream as the fulfillment of the wishes of the patients. Where in the body can these surgeons act to improve the patients’ physical and quality of life? There is an important theme when we are generally welcoming women into an anamnesis that considers their body as a whole, but what is their expectation for each patient? This paper showed the importance of the preoperative evaluation of this whole, for the indication of repairs or contraindications of procedures that aim to improve the physical of the patients, with possible bodily surgical modifications as a form of modeling through liposuction, grafting or excision with lipectomy and withdrawal of excess skin to mitigate the effects of the transformations that deform the physical and end up harming the human relationship, especially women. This is a qualitative method showing the meanings of the bodies of the women represented in the modeling by the Surgeons. However, some surgeons stand out by the look of their practice, as greater sensitivity looking at the body as a whole, spiritual and emotional. They need to use their skills as surgical art and gift, to try to achieve a means, but not an end.