History Of Breast Surgery Research Articles

Is Background Parenchymal Enhancement in Breast Magnetic Resonance Imaging Associated with Breast Cancer?

Background: Background parenchymal enhancement (BPE) in breast magnetic resonance imaging (MRI) potentially correlates with breast cancer (BC). Thus, BPE may be used for BC risk stratification and for monitoring chemo-prevention. Objectives: We aimed to investigate the BPE patterns in benign and malignant breast lesions and in pre-menopausal and post-menopausal women. Methods: In 2017, 128 consecutive pre-menopausal or post-menopausal patients underwent breast MRI with different indications were examined. Subjects with the history of breast surgery, radiotherapy, or chemotherapy were excluded. A 1.5 Tesla device was used with the same protocol, and a blinded radiologist visually assessed and categorized breast BPE as minimal, mild, moderate, and marked. We used frequency distribution, mean, and standard deviation to report the findings. Comparing age or BPE in categorical variables, we appropriately used ANOVA, or Chi-square and Fisher’s exact tests. Results: The mean (± standard deviation) age was 42.43 (± 10.82) years, and 89 (69.5%) patients were hormonally active. Eighteen (14.1%), 55 (43.0%), 41 (32.0%), and 14 (10.9%) patients were classified as having minimal, mild, moderate, and marked BPE, respectively. Age did not change among BPE levels (P = 0.197). Prevalence of moderate and marked BPE was higher in pre-menopausal women. BPE was not associated with breast lesion histopathology (P value = 0.857) in pre-menopausal or post-menopausal women (P = 0.790, and 0.840, respectively). Conclusions: BPE is a measure of breast tissue hormonal activity, and it is not correlated with histopathological diagnosis of breast lesion in both pre-menopausal and post-menopausal women. The data of this study do not support the use of BPE for BC risk estimation.

Impact on Clinical Management of After-Hours Emergent or Urgent Breast Ultrasonography in Patients with Clinically Suspected Breast Abscesses.

Newly diagnosed breast abscesses are generally treated as a medical emergency that may necessitate immediate interventional treatment. At our institution, there is no in-house after-hours coverage for breast ultrasonography. We could find no peer-reviewed studies on the cost-effectiveness or clinical management impact of on-call ultrasound technologist coverage for imaging of breast abscesses. The purposes of this study were to determine the incidence of breast abscess in patients with clinical findings highly suggestive of abscess, identify clinical factors associated with breast abscess in such patients, and determine the impact of after-hours emergent or urgent breast ultrasonography on the clinical management of breast abscesses in both outpatients and inpatients. We retrospectively reviewed 100 after-hours breast ultrasound studies performed at our tertiary care center from 2011 to 2015 for evaluation of a suspected breast abscess. Only 26% of our patients with clinically suspected abscess ultimately had a confirmed abscess. Factors associated with breast abscess were a palpable abnormality and a history of breast surgery within the eight weeks before presentation. After-hours diagnosis of an abscess was associated with after-hours clinical intervention. Of the 74 patients in whom after-hours ultrasound imaging showed no evidence of abscess, only three patients underwent after-hours drainage. Our findings support overnight and weekend breast ultrasound coverage in large tertiary care centers.

Breast Cancer and Reconstruction: Normative Data for Interpreting the BREAST-Q.

The BREAST-Q is a patient-reported outcome instrument used to evaluate outcomes in patients undergoing breast cancer surgery and reconstruction. Normative values for the BREAST-Q breast cancer modules have not been established, limiting data interpretation. Participants were recruited by means of the Army of Women, an online community of women (with and without breast cancer), to complete Mastectomy, Breast Conserving Therapy, and Reconstruction preoperative BREAST-Q scales. Inclusion criteria were women aged 18 years or older without a history of breast surgery or breast cancer. Analysis included descriptive statistics, a linear multivariate regression, and a comparison of the generated normative data to previously published BREAST-Q findings. The BREAST-Q was completed by 1201 women. The mean patient age was 54 ± 13 years, mean body mass index 26 ± 6 kg/m, and 38 percent (n = 455) had a bra cup size of D or greater. Mean ± SD scores for BREAST-Q scales were as follows: Satisfaction with Breasts (58 ± 18), Psychosocial Well-being (71 ± 18), Sexual Well-being (56 ± 18), Physical Well-being-Chest (93 ± 11), and Physical Well-being Abdomen (78 ± 20). Women with a body mass index of 30 kg/m or greater, cup size of D or greater, age younger than 40 years, and annual income less than $40,000 reported lower scores. Comparing normative scores to published data in breast cancer patients, Satisfaction with Breasts scores were higher after autologous reconstruction and lower after mastectomy; Sexual Well-being scores were lower after mastectomy and breast conserving therapy; and Physical Well-being Chest scores were lower after mastectomy, breast conserving therapy, and reconstruction. These are the first published normative scores for the BREAST-Q breast cancer modules and provide a clinical reference point for the interpretation of data.

Imaging Features Associated With Posttraumatic Breast Neuromas.

The aim of this study is to review the clinical and imaging features of patients with a histopathologic diagnosis of posttraumatic breast neuromas. We report eight biopsy-proven posttraumatic neuromas in six patients with a history of breast surgery. Mammographic, sonographic, and breast MRI examinations were reviewed according to the BI-RADS lexicon. In addition, the tail sign, a specific sign known to be associated with neuromas in other parts of the body, was assessed. Mammographic, MRI, and sonographic examinations were performed in three, four and all six patients, respectively. The neuromas were occult on the three mammograms performed but all of them were identified on ultrasound as hypoechoic masses with parallel orientation; seven of the eight neuromas (87.5%) had an oval shape with circumscribed margins. Strain elastography performed for two patients (three neuromas) showed benign features (benign elasticity scores and fat-to-lesion ratio). Half of the masses showed a tail sign (focal thickening of the nerve adjacent to posttraumatic neuroma, similar to the dural tail sign). Of five lesions investigated by MRI, two were occult on MRI. The remaining three were visible as isointense foci on T1-weighted images, with a benign type 1 enhancement curve. In patients who underwent breast surgery, a mass with benign features raises the possibility of a neuroma. Although the tail sign was present in half of the posttraumatic neuromas, imaging-guided biopsy remains the standard of care.

P-1468 - Determining hopelessness in women diagnosed with fibrocystic change

Hope is individual's most valuable resource which lead to deal with difficult situations. One of the experiences that a woman can feel hopelessness is to be diagnosed with a breast lesion which they can have fear of escalation to breast cancer. The aim of this study is to determine hopelessness and the influencing factors in women diagnosed with fibrocystic change. The sample of this sectional study consisted of 69 women chosen by random sampling from those presenting at General Surgery Clinic and who volunteered to participate in the study. The data were collected using the information from mostly containing questions on sociodemographic characteristics and Beck Hopelessness Scale (BHS). The mean BHS score was 6.1 ± 4.6. The hopelessness level was found to be related to age, marriage status, number of children, earlier breast control and family history. Women who had children, were in reproductive period and those who admitted for the first time suffered more hopelessness. However, BHS scores of women admitted for control with a previously negative result, women without a family history and those whose close acquaintances had no history of breast surgery were very low. Also, althought breast cancer is more commen in older ages, in this study BHS score was found negatively related to age. We found some sociodemographic characteristics to influence hopelessness in women diagnosed with fibrocystic changes. We believe it is important for treatment success to take these influencing factors into account for individuals presenting at Breast Clinics.

Evaluation of the Determinants for Acceptance of Antenatal Clinical Breast Examination in Taiwan

Antenatal clinical breast examinations (ANCBEs) performed by physicians or nurses during prenatal care visits are recommended by the Department of Health in Taiwan. This study aimed to assess the level of acceptance of ANCBE in Taiwan and the determinants associated with behavior toward them. This was a clinic-based study conducted from 30 November 2008 to 30 April 2009 by using a structured questionnaire for 492 pregnant women. Only 2.8% of the patients received ANCBE, and 95.9% were not aware of the availability of ANCBE. History of breast surgery and awareness of ANCBE availability were significantly associated with receiving ANCBE (P < .001). Furthermore, multiparity was statistically different for the awareness of ANCBE availability (P = .04). Acceptance of ANCBE was determined by personal history of breast surgery and awareness of ANCBE availability.

A comparison of three methods for nonpalpable breast cancer excision

Aims To evaluate the efficacy of three methods of breast-conserving surgery (BCS) for nonpalpable invasive breast cancer in obtaining adequate resection margins and volumes of resection. Materials and methods A total of 201 consecutive patients undergoing BCS for nonpalpable invasive breast cancer between January 2006 and 2009 in four affiliated institutions was retrospectively analysed. Patients with pre-operatively diagnosed primary or associated ductal carcinoma in situ (DCIS), multifocal disease, or a history of breast surgery or neo-adjuvant treatment were excluded from the study. The resections were guided by wire localisation (WL), ultrasound (US), or radio-guided occult lesion localisation (ROLL). The pathology reports were reviewed to determine oncological margin status, as well as tumour and surgical specimen sizes. The optimal resection volume (ORV), defined as the spherical tumour volume with an added 1.0-cm margin, and the total resection volume (TRV), defined as the corresponding ellipsoid, were calculated. By dividing the TRV by the ORV, a calculated resection ratio (CRR) was determined to indicate the excess tissue resection. Results Of all 201 excisions, 117 (58%) were guided by WL, 52 (26%) by US, and 32 (16%) by ROLL. The rate of focally positive and positive margins for invasive carcinoma was significantly lower in the US group ( N = 2 (3.7%)) compared to the WL ( N = 25 (21.3%)) and ROLL ( N = 8 (25%)) groups ( p = 0.023). The median CRRs were 3.2 (US), 2.8 (WL) and 3.8 (ROLL) (WL versus ROLL, p < 0.05), representing a median excess tissue resection of 3.1 times the optimal resection volume. Conclusion US-guided BCS for nonpalpable invasive breast cancer was more accurate than WL- and ROLL-guided surgery because it optimised the surgeon’s ability to obtain adequate margins. The excision volumes were large in all excision groups, especially in the ROLL group.

Endogenous factors influencing the development of cancer in women with the syndrome of the operated breast.

e12064 Background: It is known that the presence of syndrome operated breast significantly increases risk of cancer in this organ. However, not all women, who had a history of breast surgery at the non-neoplastic diseases, develops breast cancer. The objectives of our study was to reliably identify significant factors influencing the development of breast cancer among women with the syndrome of the operated breast. Methods: The study is based on data on 505 women in history, who had a surgical trauma of breast over the non–neoplastic pathologies. In 73 of them (14.5%), subsequently, detected breast cancer. In both groups were analyzed more than 40 endo- and exogeneous factors. Processing of the results was performed using modern methods of biomedical statistics, the definition of relative risk (RR). Statistically significant differences taken at p < 0.05. Results: Among the endogenous endocrine factors, high relative risk (RR = 2.82 [1.59-4.98]) detected in women with the presence of the factor of obesity, with is 5.1 times higher than in patients with normal weight (RR = 0.55 [0.35-0.86]). In analyzing the factors of the reproductive late (after 35 years) increase in birth 6.0 times the risk of breast cancer - RR = 2.47 (1.03- 5.88); (RR at birth to 35 years = 0.41 [0.16-0.96]). At the beginning of menarche after 15 years of RR of 4.0 times higher (RR = 2.39 [1.27- 4.50]), than before 15 years. The presence of hyperplastic processes of internal female genital organs significantly increases the risk of breast cancer in 2.6 times. In the presence of this factor RR = 1.62 (1.02-2.56) in the absence - RR = 0.62 (0.38-0.97). In the analysis of other endogenous factors (mastitis, thyroid disease and others) significantly significant difference has been received. Conclusions: As endogenous factors as obesity, the reproductive late (after 35 years), the beginning of menarche after 15 years, the presence of hyperplastic processes of internal female genital organs significantly increase the risk of breast cancer. No significant financial relationships to disclose.

Efeito do raloxifeno sobre a densidade mamográfica em mulheres na pós-menopausa

OBJETIVO: avaliar a densidade mamográfica (DM) de mulheres na pós-menopausa submetidas ao tratamento com raloxifeno. MÉTODOS: em estudo aberto prospectivo, não randomizado, avaliaram-se 80 mulheres (média de idade=61,1 anos). Quarenta pacientes receberam 60 mg/dia de raloxifeno e 40 mulheres compuseram o grupo não tratado (controle), pareadas pela idade e tempo de menopausa. O grupo tratado foi composto por pacientes com osteoporose da coluna lombar. Foram excluídas aquelas com história de cirurgia mamária e usuárias de terapia hormonal (TH) até seis meses prévios. A DM foi avaliada de forma qualitativa (subjetiva) e quantitativa (objetiva) em dois momentos: inicial e após seis meses de seguimento. As 320 mamografias (crânio-caudal e oblíqua) foram interpretadas qualitativamente pela classificação do Breast Imaging Reporting and Data System (BI-RADS) e quantitativamente pela digitalização computadorizada da imagem. Para análise estatística empregaram-se os testes t, Wilcoxon Mann-Whitney, correlação de Spearman e teste de concordância de kappa. RESULTADOS: na comparação estatística inicial, os grupos foram homogêneos para todas as variáveis analisadas (idade, tempo de menopausa, paridade, amamentação, TH prévia e índice de massa corpórea). Na DM inicial, pelos métodos qualitativo e quantitativo, houve correlação negativa com a idade, em ambos os grupos (p<0,05). Para as demais variáveis analisadas, não houve correlação significativa. Após seis meses não se encontrou alteração na DM em 38 usuárias de raloxifeno e 38 controles pela análise qualitativa, enquanto que pela análise quantitativa, a imagem manteve-se inalterada em 30 usuárias de raloxifeno e em 27 controles (p>0,05). Observou-se fraco valor de concordância (kappa=0,25) entre a classificação de BI-RADS e a digitalização da imagem. CONCLUSÕES: mulheres na pós-menopausa com osteoporose, submetidas ao tratamento com raloxifeno por seis meses, não apresentaram alterações no padrão de DM.

A model for predicting age at menopause in white women

To develop a model to predict the age at natural menopause and the risk for premenopausal hysterectomy. Cross-sectional study. Multicenter study. A total of 1,345 white women. Ten single nucleotide polymorphisms (SNPs) of seven estrogen (E)-metabolizing genes (i.e., catechol-O-methyltransferase, 17-beta-hydroxysteroid dehydrogenase type 1, cytochrome P-450 [CYP] 17, CYP1A1, CYP1B1, CYP19, and E receptor [ER] alpha) were analyzed by sequencing-on-chip-technology. Patients' reproductive and medical histories were ascertained and correlated to genotypes. The model incorporates the number of full term pregnancies, the body mass index (BMI), a history of breast surgery, and the presence of CYP17 and CYP1B1-4 polymorphisms as well as the BMI to predict age at natural menopause and the risk for undergoing premenopausal hysterectomy. We present the first model to date, which can predict age at natural menopause and the risk for undergoing premenopausal hysterectomy based on genotype information and personal history.

Measurement of breast areola/nipple proportion in Chinese women and analysis of correlation factors

目的 为塑造自然、匀称而具有美感的乳房提供参考和依据.方法对45例22～45岁、对自己乳房满意且无乳房手术史的女性志愿者,分别测量体重、身高、乳头直径、乳晕直径、胸乳线(乳头至胸骨切迹连线距离)、乳房内侧半径(乳头至乳房下皱襞内侧止点连线距离)、乳房外侧半径(乳头至乳房下皱襞外侧止点连线距离)、乳房下半径(乳头至乳房下皱襞最低点连线距离).以乳房外侧半径长度作为乳房大小参考指标,由此计算和确定乳房、乳晕、乳头之间的比例,并对可能影响其变化的年龄、体重、身高等因素进行研究分析.结果该组样本显示中国妇女乳房与乳晕之比约为3.7:1.0,乳晕乳头之比约为3.4:1. 0.体重、体重指数与乳房大小、乳晕乳头比例之间呈正相关,具有显著的统计学意义;而年龄、身高的影响在该样本中并未显现.结论乳房与乳晕、乳头间具有一定的合适比例,体重和肥胖可能是影响该比例关系的因素.乳房、乳晕、乳头比例的确定对东方妇女的乳房整形和再造具有美学价值,可被用于手术中对乳房大小的理想化设计和预测。

Omega and inverted omega incision: a concept of uniform incision in breast surgery.

In the history of breast surgery, we have seen a lot of changes in orientation, position, and localization of breast incisions. Most of the biopsy incisions have been made with no consideration of future mastectomy or reconstruction because a wide ellipse of skin removed during the mastectomy included the biopsy site. The primary surgical treatment was in the competence of the oncologic or general surgeon. Reconstruction was not an integral part of breast carcinoma therapy and was considered as a secondary, unimportant treatment to be preformed by a plastic surgeon at a later date if desired by the patient. Wide acceptance of conservative breast operations, skin-sparing mastectomy, and reconstruction as an integral part of breast cancer therapy necessitates new consideration about the initial incisions used for breast biopsy. We consider the omega incision not only as a type of incision but also as a concept that can be used for all breast surgery, including biopsy, lumpectomy, skin-sparing mastectomy, and reconstruction.

Plastic and Reconstructive Surgery of the Breast

This splendid book fulfills the need, as it has never been fulfilled before, of plastic surgeons for a really definitive and comprehensive treatise on all phases of plastic surgery of the breast. Written by more than 50 contributing authors and masterfully edited by Robert Goldwyn, MD, the volume is a veritable treasury of knowledge on this subject. The first chapter, by Gordon Letterman and Maxine Schurter, is the best exposition I have seen on the history of breast surgery. Following this, to complete the first section, there are chapters on the anatomy, pathology, physiology, and radiological studies of the breast, plus one on patient's attitudes towards their own breasts, or lack or excess thereof. The second section consists of 11 chapters on all of the well-known methods for reduction of breasts and correction of ptosis. The third section is comprised of five chapters on bilateral, unilateral, and differential augmentation of