Excess Breast Research Articles

Evaluation of Lactobacillus Sakei Probiotic Supernatant’s Effectiveness in Promoting Apoptosis and Decreasing Breast Cancer MCF-7 Cancerous Cells through Modulation of Bax and Bcl2 Genes

Introduction: Accumulating evidence has revealed that inducing apoptosis is an important strategy to control excessive breast cancer cell proliferation. In this study, the supernatant effect of the probiotic strain of Lactobacillus Sakei on Expression Level of Apoptosis-Related Genes (Bax/Bcl2) in Breast Cancer Cell Line (MCF-7) was investigated. Methods: In the experimental study, MCF-7 breast cancer cells were cultured in DMEM medium with 10% bovine serum. The cells were treated in 1, 2, 3, 4 and 5 mg/ml concentrations of sakei supernatant and incubated at 24, 48 and 72 hours. The MTT assay was used to measure cytotoxicity effect according to kit manufacturer's protocol in all three incubation times. MCF-7 cells with concentration of sakei supernatant at IC50 point (5 mg / ml) to examine the expression of genes Bax and Bcl2 were incubated for 72 hours. Real-Time PCR was performed to analyze the changes in the expression of Bax and Bcl2 genes. Results: The results of this study indicated that bioavailability of MCF-7 cell line reached the lowest value at concentration of 5 mg/ml compared to the control group. In addition, MCF-7 cell line treatment with Lactobacillus sakei supernatant at a dose of 5 mg/ml and 72 h incubation time, showed significantly increased expression of BAX (p-value= 0.0033) and significantly decreased expression of BCL-2 (p-value= 0.0278). Conclusion: The results indicate that Lactobacillus sakei supernatant can reduce the bioavailability of breast cancer cells by inducing apoptosis pathway.

Vertical Scar Reduction Mammaplasty Using the Superomedial-Based Pedicle Technique in Gigantomastia.

Breast reduction surgery has witnessed significant advancements in recent years; however, it continues to pose challenges for both surgeons and patients when dealing with cases involving excessive breast volume and severe breast ptosis. This study aimed to assess the aesthetic outcomes and the impact on the quality of life, as measured by the BREAST-Q questionnaire, in patients with gigantomastia and severe breast ptosis who underwent reduction mammaplasty using the superomedial-based pedicle technique. We present a retrospective series comprising 84 patients who underwent reduction mammoplasty utilizing the superomedial pedicle technique. The surgical resections exceeded 1 kg per breast, with a mean resection weight of 1506.58 g (right breast) and 1500.32 g (left breast). The preoperative mean suprasternal notch to nipple distance measured 40.50 cm (right breast) and 40.38 cm (left breast). Postoperatively, the patients were followed up for a minimum of 6 months. Both preoperative and postoperative BREAST-Q surveys were administered to the participants, and scores were analyzed using descriptive statistics. Complications were observed in 3 patients (3.57%), characterized by partial loss of the areola, which resolved spontaneously over time. Additionally, 2 cases of hematoma and 2 instances of minor delayed wound healing were reported. All patients expressed satisfaction with their aesthetic outcomes, as they achieved a natural breast shape and minimal scarring, along with symptomatic relief. The superomedial pedicle reduction mammaplasty technique has demonstrated its ability to produce satisfactory aesthetic outcomes and long-term benefits in patients with excessively large breasts. Careful patient selection and postoperative management are vital for achieving optimal results. Further investigations involving larger sample sizes and longer follow-up periods are warranted to validate our findings. IV.

The articulated dual-supply pedicle for reduction mammoplasty.

Breast reduction surgery achieves symptomatic relief and improved quality of life for patients with excessive breast enlargement. Reduction mammoplasty has evolved over the last century with the introduction of multiple new pedicles and skin excision patterns utilizing the ample blood supply of the breasts. The superior pedicle is a relatively safe technique in small resections, while the superomedial pedicle, supplied by the internal mammary perforators, serves as a proper alternative in broader resections. We aim to introduce the dual-supply pedicle technique, taking advantage of the two efficient workhorse pedicles-the superior and superomedial. A retrospective study of 48 bilateral reduction mammoplasty patients operated over a 2-year period between 2017 and 2019 by a single surgeon (Y.W). Patient characteristics and postoperative outcome data were collected and evaluated. The novel surgical technique showed compatibility with different types of patients and breasts, forming excellent aesthetic outcomes. Complication rates were comparable or lower than previously published series. Major complications requiring revision surgery were encountered in 2 patients (2.08%) and minor complications in 11 patients (11.5%); 4 moderate surgical wound dehiscence, 6 minor surgical wound dehiscence and 1 fat necrosis. The Dual-Supply Pedicle Reduction Mammoplasty is a safe, reproducible technique, with a short learning curve, excellent aesthetical results, and an acceptable complication rate. Level of Evidence is Level III.

Severe Bilateral Breast Hypertrophy in a Pregnant Patient: A Case Report

Background: Bilateral breast hypertrophy, ranging from mild to severe, can lead to various complications, including pain, ulceration, infection, and psychological distress. Swift surgical intervention is often necessary to address the mechanical and psychological challenges associated with excessive breast weight. While treatment approaches for this condition are debated, recent advancements favor surgical strategies like mastectomies with reconstruction to improve clinical and psychological outcomes. We present a unique case of bilateral breast hypertrophy successfully managed through breast amputation and NAC (nipple-areolar complex) graft using wise patterns incision mammoplasty. Case Presentation: This report details the case of a 30-year-old female with hypothyroidism and lupus who experienced significant bilateral breast enlargement during her second pregnancy. The patient faced pain, hyperpigmentation, and limited mobility, along with abnormal laboratory findings. Bilateral reduction mammoplasty (breast amputation) was performed, leading to successful outcomes and improved quality of life for both the patient and her newborn. Follow-up assessments showed no recurrence or complications postoperatively. Conclusion:This case highlights the challenges of managing breast hypertrophy in pregnant patients with autoimmune conditions. Early recognition and multidisciplinary management are crucial in such cases. The positive results of the interventions underscore the importance of timely and comprehensive care for patients facing similar conditions.

Abstract 5207: Hypermethylation of SOX17 is an important epigenetic mark in Afro-Brazilian breast cancers

Abstract Afro-Brazilian women suffer from higher excess breast cancer mortality after adjusting for age, level of education and stage at diagnosis. Limited studies have researched disease characteristics in this population, which can benefit from the identification of molecular markers that can provide an insight into who is at greater risk of mortality. Epigenetic biomarkers represent the combined effect of environmental and genetic factors. Particularly DNA methylation biomarkers can be valuable as biomarkers of breast cancer risk and prognosis. While studies in other populations have identified DNA methylation biomarkers associated with breast cancer and its clinicopathological outcomes, research on Brazilian cohorts has been limited in scope and focused on women of European descent. The goal of this work was to determine the epigenetic makeup of breast cancer in Brazilian women of African descent. To identify epigenetic biomarkers in Brazilian women who self-identified as Black or Brown, we conducted a case-series analysis investigating DNA methylation patterns in tumor (T) and adjacent non-tumor (NT) tissue. For this, we used the Illumina EPIC (850k) arrays to carry out DNA methylation profiling in 48 frozen tissue paired T and NT samples of breast cancer patients treated at the National Cancer Institute Breast Cancer Hospital in Rio de Janeiro, Brazil. We identified a total of 7,749 probes with Benjamini-Hochberg adjusted p-value < 0.0001 and differences between T and NT tissue above |0.3|. Of these, 5,976 or 77.12% had lower DNA methylation in T when compared to NT tissue; while 1,773 (22.88%) had higher DNA methylation. These were used to identify 21 differentially methylated regions (DMRs) that contained a minimum of seven cg sites, a mean difference larger than |0.2| and a maximum difference above |0.4|. DMRs were mostly (12) hypermethylated in T, and included PCDHGA, NKAPL, ZKSCAN4, SPAG6, CA3, DPP6, RGS22, NXPH1, ANK3, OTX2, SOX17, and CDO1. We used pyrosequencing to validate the levels of SOX17 in eighty-eight tumor and non-adjacent tumor tissue DNAs. We found SOX17 to be hypermethylated in T (44.5±19.1% vs 10.2±10.6, p<0.0001). Differences in DNA methylation in T and NT tissue we still observed by race/ethnicity categories, 43.9±18.6% vs 11.0.±13.2% (p<0.0001) for Brown, and 45.1±20.7% vs 8.8±3.0% for Black women (p<0.0001), respectively. Similarly to previously reported, SOX17 hypermethylation was found to be associated with Luminal A and B molecular subtypes (p<0.0001). To our knowledge, this is the first study to use a discovery approach to identify epigenetic biomarkers in Black and Brown Brazilian women. Our findings confirming previously reported data on SOX17 hypermethylation in breast cancer are encouraging. We expect to validate other epigenetic markers unique to this population that can ultimately aid in the molecular characterization of Brazilian breast cancers. Citation Format: Lissette Delgado-Cruzata, Diego J. Gomes de Paula, Jennifer G. Vieira, André L. Christianes, Tatiana Simao, Leonor B. Gusmao, Luis Felipe Ribeiro Pinto, Sheila Coelho Soares Lima. Hypermethylation of SOX17 is an important epigenetic mark in Afro-Brazilian breast cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5207.

Abstract IA035: Narrowing disparities in breast cancer: A multi-level perspective

Abstract Seminar Abstract: Despite improvements in breast cancer detection and treatment, racial disparities in breast cancer outcomes persist. In the United States, particularly the southeastern region, Black women are more likely to experience breast cancer-related mortality than any other race or ethnic group—regardless of subtype, age, or socioeconomic status. The drivers of disparities are likely multifactoral and include interacting factors (e.g., tumor, treatment, patient, and neighborhood characteristics) that contribute to race differences in breast cancer-specific mortality. Emerging data suggest that the excess breast cancer mortality experienced by Black women is linked to broader systems of oppression that impact everything from access and quality of care to tumor aggressiveness and treatment response—the imprints of which may be detectable in tumor biology. Comprehensive, multi-level approaches to addressing disparities will aid the identification of causal and contributing factors, moving us beyond merely documenting differences to creating action-oriented models aimed at achieving equitable cancer care within the social contexts of the communities affected. Citation Format: Lauren E. McCullough. Narrowing disparities in breast cancer: A multi-level perspective [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr IA035.

Combined superior and inferior dermoglandular flaps for projection enhancement in giantic breast amputation and free nipple areola graft

Giantomastia has been a pathological condition in which excised breast tissue weighs more than1.5 kg per breast or when breast weight surpasses three percent of body weight. epidermis & Cooper's ligaments, which support breast tissue, expand as a result of breasts becoming heavier & larger, which causes breast ptosis. Numerous methods for correcting gigantomastia have been discovered. amputation for decreased studied cases who complain of gigantomastia & severe ptosis (space among nipple & inframammary fold exceeds twenty-five cm) are only eligible for mammaplasty with free nipple-areola grafting. purpose of that surgery is to achieve breast shape size that is acceptable while also relieving pain & suffering brought on by excessive breast tissue hypertrophy. flat, boxy breasts with poor projection is the main drawback of that treatment. Several flaps, including superior, inferior, medial, superomedial,& lateral-based flaps combined with wise-pattern skin excision, are employed to address this drawback.

The effect of various natural growth regulatory substances and the origin of stem cuttings on the vegetative growth of white jasmine (Jasminum sambac L.)

Jasmine is a native plant of the archipelago in Indonesia. Jasmine (Jasminum sambac L.) is a plant that has many ingredients, including as an ornamental plant, the chemical content of jasmine flowers, namely indole, benzyl, livalyacetat, is believed to be able to treat diseases such as headaches, shortness of breath, fever, excess breast milk and eye pain. Shallot extract is one of the natural growth regulators, namely the auxin group which contains indole and naphthalene compounds which function to stimulate the development of adventitious root meristems. Bean sprouts are one type of vegetable that is commonly used for consumption, easy to obtain, has economic value, and does not have toxic compounds. Bean sprout extract contains growth regulators, namely auxins and cytokinins. Based on the research results, it was found that the concentrations of various natural growth regulators were significantly different with respect to the number of shoots, shoot length, and number of leaves. The best treatment of natural growth regulators was found in shallot extract 50% (Z2). The type of cutting material differed significantly with the number of shoots, shoot length, and number of leaves. The best cutting material treatment was found in the middle of the branch (B2).

A rare case of gigantomastia caused by pseudoangiomatous stromal hyperplasia

Gigantomastia is a rare pathologic condition characterized by an excessive and abnormal breast hypertrophy. To date, there is no exact definition or classification of this disease. Pathogenesis still unclear. The purpose of this article is to present a case of extreme and disabling gigantomastia caused by pseudoangiomatous stromal hyperplasia, one of the rarest etiology of gigantomastia.

Low Rates of Early Detection Drive Excess Breast Cancer Mortality

Low Rates of Early Detection Drive Excess Breast Cancer Mortality

Abstract 5516: Identifying DNA methylation biomarkers in Brazilian women of African descent

Abstract Breast cancer is the most common cancer, and the leading cause of cancer-related deaths in Brazilian women. Studies have shown that in Brazil while breast cancer mortality has increased in the last decade for all women, mortality in women of African descent has doubled. A recent study showed that Afro-Brazilian women suffer from higher excess breast cancer mortality even after adjusting for extent of disease, year of diagnosis, age and socioeconomic status, which suggests biological factors also contribute to the differences in the clinicopathological make-up of the disease in women in this group. DNA methylation biomarkers, representing a combination of genetic and non-genetic factors, have the potential to be especially valuable when considering the combined contribution of the environment and genetics in breast cancer etiology. Several groups have found differences in DNA methylation levels associated with race and ethnicity in breast cancer. In addition, research has shown that women of different races/ethnicities with similar breast cancer tumor subtypes have distinct DNA methylation patterns. To explore further the association between race, ancestry and DNA methylation, we conducted a study in paired tumor and non-tumor tissue samples of forty-eight Brazilian women who self-identified as Black or Brown and were treated at National Cancer Institute Breast Cancer Hospital in Rio de Janeiro, Brazil. We carried out a DNA methylation profiling analysis using Illumina EPIC (850k) arrays in bisulfite converted DNA originally extracted from frozen tissue samples. A total of 739,883 differentially methylated probes (DMP) were identified, of which a large proportion 6,241 (78.4%) were hypomethylated. Lower DNA methylation was more common on intragenic regions and gene bodies, while hypermethylation was more commonly found on the promoter regions. DNA methylation was often higher in non-tumor than tumor samples. Among our top hits we found genes previously associated with estrogen receptor negative tumor types, CDH4, CERK, PROX1 and ADHFE1, and with high risk of breast cancer mortality (ST6GAL1, LYN, TFF1 and BMP3). A DPM enrichment pathway analysis predicted effects in known signaling pathways and transcriptional misregulation. We are currently analyzing the associations between the top differentially methylated regions with ancestry informative markers, and the clinicopathological characteristics of disease, to gain a better understanding of the role of DNA methylation marks in this population. This study adds to our current knowledge on epigenetics marks that will ultimately help us address mortality due to this disease in this population. Citation Format: Lissette Delgado-Cruzata, Diego J. Gomes de Paula, Jennifer Vieira Gomes, Tatiana A. Simão, Leonor Gusmão, Luis Felipe Ribeiro Pinto, Sheila C. Soares-Lima. Identifying DNA methylation biomarkers in Brazilian women of African descent. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5516.

Donation of women's milk to the neonatology department at the Androva hospital in Mahajanga

Background: The functioning of a milk bank begins with the donation of milk from women donors. The objective of our study was to describe the demographic profile of mothers who donate milk and their practice of donating milk in the neonatology department at the hospital Center Androva Mahajanga. Methods: This is a prospective, descriptive study over a 7-month period, from August 2019 to February 2020. Were included all healthy breastfeeding women who agreed to donate excess breast milk. Results: The participation rate of breastfeeding women in milk donation was 6.6%. Vaginal delivery was the most common (85.9%). The majority had no knowledge about milk donation (83.8%). Manual breast pumping was the most used (43.8%). The average total amount of milk collected by a mother from the beginning to the end of the donation was 613 ml. The average duration of donation by a mother was 6.4 days. Conclusions: The participation and knowledge of mothers on the donation of women's milk was low, although it can improve the survival of newborns.

Estimating Excess Mortality Due to Prostate, Breast, and Uterus Cancer during the COVID-19 Pandemic in Peru: A Time Series Analysis.

During the COVID-19 pandemic, most of the deaths in Peru were related to COVID-19; however, cancer deaths have also been exacerbated in the first months of the pandemic. Despite this, excess mortalities of prostate, breast, and uterus cancer are not available by age group and region from January to December 2020. Therefore, we estimated the excess deaths and excess death rates (per 100,000 habitants) due to prostate, breast, and uterus cancer in 25 Peruvian regions. We did a time series analysis. Prostate, breast, and uterus cancer death data for 25 Peruvian regions were retrieved during the COVID-19 pandemic in 2020, as well as data for up to 3 years prior (2017-2019) from the Sistema Informatico Nacional de Defunciones at the Ministry of Health of Peru. Deaths in 2020 were defined as observed deaths. The expected deaths (in 2020) were estimated using the average deaths over 3 preceding years (2017, 2018 and 2019). Excess mortality was calculated as the difference between observed mortality and expected mortality in 2020. We estimated that the number of excess deaths and the excess death rates due to prostate, breast, and uterus cancer were 610 deaths (55%; 12.8 deaths per 100,000 men), 443 deaths (43%; 6 deaths per 100,000 women), and 154 deaths (25%; 2 deaths per 100,000 women), respectively. Excess numbers of deaths and excess death rates due to prostate and breast cancer increased with age. These excess deaths were higher in men aged ≥ 80 years (596 deaths (64%) and 150 deaths per 100,000 men) and women aged 70-79 years (229 deaths (58%) and 15 deaths per 100,000 women), respectively. In summary, during the COVID-19 pandemic, there were excess prostate and breast cancer mortalities in 2020 in Peru, while excess uterus cancer mortalities were low. Age-stratified excess death rates for prostate cancer and breast cancer were higher in men ≥ 80 years and in women ≥ 70 years, respectively.

Breast cancer treatment disparities in patients with severe mental illness: A systematic review and meta-analysis.

The incidence and mortality rates of breast cancer in individuals with pre-existing severe mental illness (SMI), such as schizophrenia, bipolar disorder, and major depression, are higher than in the general population. Reduced screening is one factor but there is less information on possible barriers to subsequent treatment following diagnosis. We undertook a systematic review and meta-analysis on access to guideline-appropriate care following a diagnosis of breast cancer in people with SMI including the receipt of surgery, endocrine, chemo- or radiotherapy. We searched for full-text articles indexed by PubMed, EMBASE, PsycInfo and CINAHL that compared breast cancer treatment in those with and without pre-existing SMI. Study designs included population-based cohort or case-control studies. There were 13 studies included in the review, of which 4 contributed adjusted outcomes to the meta-analyses. People with SMI had a reduced likelihood of guideline-appropriate care (RR=0.83, 95% CI=0.77-0.90). Meta-analyses were not possible for the other outcomes but in adjusted results from a single study, people with SMI had longer wait-times to receiving guideline-appropriate care. The results for specific outcomes such as surgery, hormone, radio- or chemotherapy were mixed, possibly because results were largely unadjusted for age, comorbidities, or cancer stage. People with SMI receive less and/or delayed guideline-appropriate care for breast cancer than the general population. The reasons for this disparity warrant further investigation, as does the extent to which differences in treatment access or quality contribute to excess breast cancer mortality in people with SMI.

Translational Potential of Fluorescence Polarization for Breast Cancer Cytopathology.

Breast cancer is the most common malignancy in women. The standard of care for diagnosis involves invasive core needle biopsy followed by time-consuming histopathological evaluation. A rapid, accurate, and minimally invasive method to diagnose breast cancer would be invaluable. Therefore, this clinical study investigated the fluorescence polarization (Fpol) of the cytological stain methylene blue (MB) for the quantitative detection of breast cancer in fine needle aspiration (FNA) specimens. Cancerous, benign, and normal cells were aspirated from excess breast tissues immediately following surgery. The cells were stained in aqueous MB solution (0.05 mg/mL) and imaged using multimodal confocal microscopy. The system provided MB Fpol and fluorescence emission images of the cells. Results from optical imaging were compared to clinical histopathology. In total, we imaged and analyzed 3808 cells from 44 breast FNAs. Fpol images displayed quantitative contrast between cancerous and noncancerous cells, whereas fluorescence emission images showed the morphological features comparable to cytology. Statistical analysis demonstrated that MB Fpol is significantly higher (p < 0.0001) in malignant vs. benign/normal cells. It also revealed a correlation between MB Fpol values and tumor grade. The results indicate that MB Fpol could provide a reliable, quantitative diagnostic marker for breast cancer at the cellular level.

Retrospective Evaluation of Complications in Patients Who Underwent Breast Reduction Surgery without Drains: No Drain, No Pain!

Aim: In women, breast reduction surgery is performed due to macromastia, i.e., excessive breast size, regardless of age, and is the most effective method for eliminating problems such as dermatitis and malodor under breasts, as well as pain in the musculoskeletal system. Breast reduction surgery is a frequently performed and relatively safe procedure to defer above mentioned symptoms of patients. To contribute the establishment of standards that will ensure maximum patient comfort and minimum complications risk in the follow-up of breast reduction surgery is the main output of this study. For that reason, complications and their associations in this patient group has been compared with the previous studies. Material and Methods: Demographic and surgical record of all women who underwent bilateral breast reduction surgery without liposuction performed by the same surgeon without the use of drains were evaluated retrospectively. Approval of the local ethics committee has been received prior of the study (decision number 10/24). Hence, types of complications and their percentages, statistics related to their age and patients’ surgical measurements has been analyzed statistically. Results: Breast reduction surgery was performed with the superomedial pedicle technique in 22 of the patients and the free nipple graft technique in 9. Early complications were seen in three (1.82%) of the total of 62 breasts that were operated on. There was no statistical correlation between the amount of reduction or nipple elevation level with complications. Conclusion: The use of no drains in breast reduction surgery did not increase postoperative complications when compared to literature, and it also provided a more comfortable follow-up process for both the patient and the surgeon.

Breast cancer risk among thyroid cancer survivors and the role of I-131 treatment.

Female thyroid cancer survivors are more likely to have a higher risk of breast cancer compared to the general population, and the underlying causes are yet to be understood. The potential role of I-131 treatment on this association remains controversial. We pooled individual data of women who were treated for differentiated thyroid cancer from 1934 to 2005 in France, Italy and Sweden. Standardized incidence ratios (SIRs) for breast cancer were estimated by comparison with age, sex and calendar-year expected values of the general population in each country. We estimated breast cancer risk in relation to I-131 treatment using time-dependent Poisson models. Of 8475 women (mean age at diagnosis: 45 years, range 2-90 years), 335 were diagnosed with breast cancer [SIR = 1.52, 95% confidence interval (CI): 1.36-1.69] during a median follow-up time of 12.7 years since diagnosis. Overall, breast cancer risk did not differ between women treated or not with I-131 (relative risk=1.07, 95% CI 0.84-1.35). However, breast cancer risk increased with increasing cumulative I-131 activity, without significant departure from linearity (excess relative risk per 100 mCi=17%, 95% CI: 2% to 38%). The higher risk associated with a cumulative I-131 activity of ≥100 mCi and ≥400 mCi was translated into 4 (95% CI -4 to 13) and 42 (95% CI -8 to 93) excess breast cancer cases per 10,000 person-years, respectively. An elevated risk was observed for the highest cumulative administered activity (>=400 mCi), and a significant dose-dependent association was observed among thyroid cancer survivors who were treated with I-131. However, overall, I-131 treatment might only explain partly the increase in breast cancer risk among female thyroid cancer survivors.

How to do the Pisces mastectomy for female-to-male top surgery

Gender-affirming mastectomy ('top surgery') is one of the most commonly requested and performed procedures in the transgender and non-binary population. The goal of female-to-male (FtM) surgery is to treat gender dysphoria by creating an aesthetically pleasing male chest, achieved by removing excess breast tissue and skin, and repositioning and resizing the nipple-areola complex. We present a modification of the double-incision, mastectomy with free nipple graft (DIFNG) technique that we have called the ‘Pisces’ mastectomy as it is common for fish to exhibit gender fluidity. With some imagination, the skin excision could also be considered fish-shaped. This technique achieves the goals of surgery, provides good access for haemostasis and decreases the need for revision surgery by adequate removal of ‘dog ears’ medially and laterally.

Human Milk Sharing in the United States: A Scoping Review.

Background: Human milk is the optimal form of infant nutrition. If mother's own milk is unavailable, families may seek alternative sources of human milk through milk sharing, despite potential health and safety risks with this practice. Objective: The purpose of this scoping review was to synthesize the current literature on human milk sharing in the United States to help health care professionals better understand how families may use this practice for infant nutrition. Methods: A systematic search was conducted in June 2021 using Ovid MEDLINE, Embase, CINAHL, ProQuest Central, Web of Science, and Google Scholar. Articles were included if the primary outcome was milk sharing, excluding milk banks and preterm hospitalized infants. Results were limited to studies conducted in the United States and published in English after January 1, 2000. Results: From 2,124 articles, 34 met inclusion criteria and were reviewed. Study designs were largely observational (30/34), and participants were predominantly white, married, and middle-income women experiencing lactation problems or in possession of excess breast milk. Milk sharing, not for profit, was often facilitated through the internet but exchanged in person. Conversely, for-profit milk sharing often involved shipping and studies found evidence of milk contamination. No studies documented infant harm. Conclusions: There is limited research on the milk quality and relative risks of milk sharing, and no research on clinical outcomes in infants fed shared milk. Clinicians have opportunities to engage in open conversations about this practice to guide risk mitigation, however, research on recipient infant outcomes are urgently needed to inform best practices.

Change in effectiveness of mammography screening with decreasing breast cancer mortality: a population-based study.

BackgroundReductions in breast cancer mortality observed over the last three decades are partly due to improved patient management, which may erode the benefit-harm balance of mammography screening.MethodsWe estimated the numbers of women needed to invite (NNI) to prevent one breast cancer death within 10 years. Four scenarios of screening effectiveness (5–20% mortality reduction) were applied on 10,580 breast cancer deaths among Norwegian women aged 50–75 years from 1986 to 2016. We used three scenarios of overdiagnosis (10–40% excess breast cancers during screening period) for estimating ratios of numbers of overdiagnosed breast cancers for each breast cancer death prevented.ResultsUnder the base case scenario of 20% breast cancer mortality reduction and 20% overdiagnosis, the NNI rose from 731 (95% CI: 644–830) women in 1996 to 1364 (95% CI: 1181–1577) women in 2016, while the number of women with overdiagnosed cancer for each breast cancer death prevented rose from 3.2 in 1996 to 5.4 in 2016. For a mortality reduction of 8.7%, the ratio of overdiagnosed breast cancers per breast cancer death prevented rose from 7.4 in 1996 to 14.0 in 2016. For a mortality reduction of 5%, the ratio rose from 12.8 in 1996 to 25.2 in 2016.ConclusionsDue to increasingly potent therapeutic modalities, the benefit in terms of reduced breast cancer mortality declines while the harms, including overdiagnosis, are unaffected. Future improvements in breast cancer patient management will further deteriorate the benefit–harm ratio of screening.