Huge Breast Research Articles

Gigantic Macromastia: Modified Superomedial Pedicle is a Good Solution

Abstract Background Reduction of very huge breast—gigantic macromastia—is a challenge to breast surgeons in choosing the right procedure to obtain an optimal outcome. The feasibility of a superomedial pedicle (SMP) with some modifications proves to be a good option to achieve a viable nipple areolar complex (NAC) with good size and shape after good resection above 800 g. Materials and Methods Out of the 35 patients with 70 breast reductions, 15 can be considered gigantic macromastia with reductions above 800 g. A retrospective analysis of 30 breast reductions in these 15 patients from 2010 to 2023 was done. All cases were done using SMP with some modifications. The sternal notch to the nipple, the new NAC site, pedicle length, resection weight, and complications were analyzed. The modifications followed were lowering the new NAC, narrowing the distance between medial and lateral pillar width, medializing the pedicle, and lengthening the vertical limb. Results There was no total necrosis of the NAC. Partial necrosis occurred in three patients that were managed conservatively and one case of fat necrosis needed debridement. All of them had a good size, shape, and form. Conclusion SMP is a versatile technique with flexibility to modify the dimensions to get a robust blood supply to the NAC, after obtaining an adequate resection.

A huge metaplastic breast carcinoma with chest wall invasion and pulmonary metastasis: a rare case report

ABSTRACTMetaplastic breast carcinoma (MBC) is a diverse group of invasive breast carcinoma, in which the neoplastic epithelium differentiates toward squamous cells or mesenchymal looking elements, including but not restricted to spindle, osseous and chondroid cells. MBC was formally considered a distinct pathological pattern by WHO classification of breast tumors in 2000. We report the case of a 49-year-old Syrian female who presented to our hospital due to a painful huge mass in her right breast. Radiographic and clinical findings were highly indicative of breast carcinoma. Therefore, a core needle biopsy was performed, and surprisingly, microscopic examination suggested the diagnosis of soft tissue sarcoma, whereas immune stains confirmed the diagnosis of metaplastic carcinoma. We aim to introduce a challenging case that clarifies the rarity of this tumor, and the methods we used in diagnosing, examining and treating this malignancy.

Quelle chimiothérapie dans les tumeurs phyllodes métastatiques du sein? rapport de cas

Phyllodes tumors (PT) of the breast are rare. They can be benign, borderline or malignant. Malignant forms account for 20-30% of PTs, with distant metastases in 10-26% of cases. Chemotherapy is one of the main therapeutic weapons for metastatic phyllodes tumors (MPTs). We here report four cases of MPTs of the breast managed at The Mohammed VI Center For Cancers Treatment in Casablanca from January 2015 to December 2017. The average age of patients ranged from 25 to 45 years. The mode of revelation was represented, in the majority of cases, by the occurrence of a huge breast mass and in all patients the histological diagnosis was based on the examination of mastectomy specimen. Three patients had lung metastases, two had axillary lymph-node metastases, two had bone metastases and only one had liver metastases. All patients received chemotherapy. Doxorubicin monotherapy and doxorubicin-ifosfamide (AI) were used. Only one patient had a very favorable outcome, with radiologic complete response after 3 AI regimens. MPTs of the breast have a poor prognosis. The role of systemic chemotherapy is to be defined, especially since there are no data available on optimal chemotherapy regimen.

Fiction, Truth and Method

How does fiction help to build a consensual narrative of the time we live? How necessary is this narrative and how close it should resemble the reality? Since its inception, fiction can state and frame ideas and concepts through the refutation of the established aesthetical, ethical, hermeneutical, ontological and political consensus. This inverted logics that Aristotle regarded so dangerous is in fact the ultimate capability of the fictional narrative to capture the reality in vivo and to describe it with its full colours. However, it is undeniable that this intrinsically disruptive strength can be particularly unsettling. The very imagination that turns Gregor Samsa into an insect and transforms David Kepesh into a huge breast can very well distort reality and pretend that a lost election have been rigged and won by a lot. How can one be sure that a culture is mature enough in exercising fact verification and in analysing reality with scientific tolls that it is shielded against ideological, political or religious fictions? How to ensure that society has means to deconstruct distortions and lies engendered by social agents with specific interests? We believe that just a blend of objective means of fact verification, scientific analysis and an uncommitted ethical bond with truth can ensure that society is not misled by lies and misrepresentations of reality.

Transverse Scar Breast Reduction Technique with Suspended Dermal Slings for Correction of Severe Breast Ptosis and Macromastia

Introduction: Visible scarring over the breast mound isa disadvantage of the classic inverted-T breast reductiontechnique. The transverse scar breast reduction (TSBR) techniquewith suspended dermal slings limits the scar formationto the hidden inframammary crease.Patients and Methods: Sixteen female were included inthis study. We used the TSBR technique with suspendeddermal slings for correction of severe breast enlargement andbreast ptosis. Early postoperative complications were recorded.After 2 years, patients’ satisfaction about the surgery wasanalyzed.Results: All cases showed complete wound healing withintwo weeks except one case who showed partial ischemia ofthe nipple areola complex, which was managed successfullyby dressing changes. Regarding late complications, two casesshowed fat necrosis. However, overall patients’ satisfactionwas high.Discussion: Many surgeons use the technique of wisepattern inferior pedicle breast reduction for correction of hugebreasts with severe ptosis. Vertical scar breast reductiontechnique is not best indicated for correction of such condition.Transverse scar breast reduction limited the scars of thesurgery to the hidden inframammary fold and achieved stableand accepted results.Conclusion: Transverse scar breast reduction with suspendeddermal slings corrected huge breast enlargement andsever breast ptosis with a concealed scar restricted to theinframammary crease. Patients’ satisfaction about the outcomeof surgery was high after 2 years of follow-up.

A massive phylloides tumor in the breast: case report and literature review

Phylloides tumor (PT) is a rare fibro epithelial neoplasm comprising <1% of all breast tumors. Clinical spectrum ranges from benign (B), borderline (BL), and locally recurrent to malignant (M) and metastatic type. Phylloides tumors originate from the connective tissue of the breast, so the malignant phylloides are histologically sarcomas. We are reporting a massive phylloides tumor in a 45 years old female. She presented with a huge breast mass occupying almost the whole of the right breast with two areas of pressure necrosis, on the overlying skin. She noticed a small lump 7 months ago in the right breast, which slowly grew to the current dimensions and areas of pressure necrosis appeared recently. FNAC was reported as a complex fibroadenoma; however due to strong suspicion, a core needle biopsy was done. The report came as a phylloides tumor. Simple mastectomy was done. The tumor specimen measured exactly 20×15×10 cm in size; the histopathology report came as benign phylloides tumor.

Breast cancer organoids from a patient with giant papillary carcinoma as a high-fidelity model

BackgroundPapillary carcinoma is an uncommon type of breast cancer. Additionally, patients with huge breast papillary carcinoma are extremely rare in clinical practice. To improve therapeutic effect on such patients, it is urgent to explore biologically and clinically relevant models of the disease to discover effective drugs.MethodsWe collected surgical tumor specimens from a 63-year-old Chinese woman who has been diagnosed breast papillary carcinoma. The tumor was more than 15 cm in diameter, and applied to establish patient-derived papillary carcinoma organoids that could continuously propagate for more than 6 months.ResultsThe papillary carcinoma organoids matched the histological characteristics of orginal tumor by H&E staining identification, and maintained the expression of the breast cancer biomarkers by IHC, including estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor (HER2) and antigen Ki-67 (Ki67). In addition, we performed a 3-D drug screening to examine the effects of endocrine drugs (Fulvestrant, Tamoxifen) and targeted therapy drugs (Palbociclib, Everolimus, BKM120) on breast papillary carcinoma in the mimic in vivo environment. The drug sensitivities of our breast papillary carcinoma organoids were investigated as follows, Fulvestrant (IC50 0.275 μmol), Palbociclib (IC50 2.21 μmol), BKM120 (IC50 3.81 μmol), Everolimus (IC50 4.45 μmol), Tamoxifen (IC50 19.13 μmol).ConclusionsThese results showed that an effective organoid platform for 3-D in vitro culture of breast cancer organoids from patients with breast papillary carcinoma could be used to identify possible treatments, and might be commonly applied to explore clinicopathological characteristics of breast papillary carcinoma.

Supero-medial reduction mammaplasty: a safe and reliable technique in gigantomastia and severe breast ptosis.

Reduction mammaplasty in huge breasts poses a great challenge for plastic surgeons. The classic technique is free nipple and areola grafting after breast amputation. This paper is a short technical report of reduction mammoplasty on 40 patients with severe breast ptosis (suprasternal notch to nipple >35 cm) and giganticomastia (anticipated resection of more than 1 kg per breast) were operated upon using superomedial pedicle technique for reduction mammaplasty. All patients were satisfied with their results aesthetically, and showed relief in their neck pain. There were no cases of total nipple-areola loss. In one breast, the nipple-areolar complex (NAC) was congested intra-operatively and free nipple grafting was done. The NAC sensation was preserved in 36 cases, and all other complications were minimal and self-limiting. The superomedial pedicle technique has proven to be a safe and reliable method for reduction mammaplasty in huge breasts. Compared to the classic free nipple and areola technique, this method showed promising results in preserving the nipple sensation and giving more pleasant natural projecting breasts.

Reliability of Modified Owl Technique in Reduction of Huge Breasts of Different Sizes

Reliability of Modified Owl Technique in Reduction of Huge Breasts of Different Sizes

Electro-Cisplatin-Therapy for Estrogen-Receptor Positive Breast Cancers: an in vitro Model Study

There is a critical need for alternate, affordable and physical techniques to treat cancer, especially to treat those inoperable, recurrent, advanced, huge, and bleeding breast cancers that are refractory to current standard of cure. Towards this, electrical pulse-mediated chemotherapy, known as electrochemotherapy is a boon to these patients. This involves application of high intensity, short duration electrical pulses of the order of 1200V/cm, 100µs, which open up pores in the cell plasma membrane enabling increased permeability of usually impermeable or less permeable chemo drug molecules and hence enhanced drug uptake. Due to the increased conductivity and relative permittivity, cancer cells are more susceptible to applied electric field than normal cells. Thus, with the field confined to the tumor, with no or the least effect on normal cells, this technique could be effectively used to treat solid tumors. For this purpose, estrogen receptor positive, MCF-7, human breast cancer cells were studied using the most commonly administered, platinum chemo drug, cisplatin at various doses and their effectiveness is studied using MTT viability assay. With viabilities as low as 30%, our results indicate that we can safely administer cisplatin using electrical pulses. This treatment has the potential to be transferred to the clinical practice.

Surgical excision of the breast giant fibroadenoma under regional anesthesia by Pecs II and internal intercostal plane block: a case report and brief technical description: a case report.

A 22-years-old female patient at 171 cm and 67 kg visited the Department of Breast Surgery of the hospital with a mass accompanied with pain on the left side breast as chief complaints. Since physical examination revealed a suspected huge mass, breast surgeon decided to perform surgical excision and requested anesthesia to our department. Surgery of breast tumor is often under local anesthesia. However, in case of big size tumor, surgery is usually performed under general anesthesia. The patient feared general anesthesia. Unlike abdominal surgery, there is no need to control visceral pain for breast and anterior thoracic wall surgery. Therefore, we decided to perform resection under regional anesthesia. Herein, we report a successful anesthetic and pain management of the patient undergoing excision of a huge breast fibroadenoma under regional anesthesia using Pecs II and internal intercostal plane block.

Perioperative nursing of huge malignant lobulated breast tumor

Objective To summarize the perioperative nursing of huge malignant lobulated breast tumor, so as to promote the recovery of patients. Methods A total of 11 patients with huge malignant lobulated breast tumor patients were selected, assessed the preoperative status,finished breast tumor site nursing, strengthen psychological nutritional assessment, the adjustment of the respiratory system for the operation, prevent falls. In addition to do a good job in general nursing and postoperative pain management, but should also focus on the observation of the chest wall flap, drainage tube care, to prevent bleeding and infection, etc. Results By implementing the nursing plan, 1 case of breathing difficulties preoperative patients with respiratory function improved, 1 case of refuse treatment of patients accepted surgical treatment after psychological intervention, 2 cases of postoperative patients with skin flap necrosis, local treatment, after compression bandage, 1 case of good recovery, 1 case of poor treatment effect for the wound recovered well after back surgery graft; 1 case of patients with subcutaneous effusion, to adjust the drainage tube, suction fluid, after compression bandage, partial treatment, recovering well. Patients were good recovery, discharged smoothly. Conclusions By constantly sum up experience, through positive assessment of patients after preoperative mental and physical health and attaches importance to patients' skin flap, bleeding, pain, completes the drainage tube nursing and prevention of infection, can effectively promote the recovery of patients. Key words: Breast neoplasms; Perioperative nursing

Unusual Vascular Complications Associated with Transradial Coronary Procedures Among 10,324 Patients: Case Based Experience and Treatment Options.

We aimed to present our experience regarding the unusual vascular complications and specific treatment strategies in patients who underwent transradial coronary procedure (TRC). Transradial access provides lower vascular access site complication rates compared with transfemoral access. However, there is lack of data obtained from large study populations concerning the incidence and treatment strategies of hemorrhagic and vascular complications following a TRC in the literature. 10,324 patients (2,652 patients with percutaneous coronary intervention and 7,672 patients with a diagnostic transradial coronary angiography) who underwent a TRC from February 2010 to December 2014 were reviewed to identify cases of large hematoma, perforation, arteriovenous fistula, and pseudoaneurysm. The observed incidence was 0.44% (45 patients) for all unusual vascular and hemorrhagic complications. Of these 45 patients; 32 patients (0.31%) presented with large hematoma (≥6 cm), 8 patients (0.08%) presented with perforation, 4 patients (0.04%) presented with arteriovenous fistula (AVF), and only 1 case (0.009%) presented with radial artery pseudoaneurysm. Forty-one of forty-five patients were managed with mechanical compression. Surgery was performed in only 3 cases; a patient with a brachial artery perforation leading to compartment syndrome, a patient with AVF resulting in limb ischemia, and a patient with radial artery pseudoaneurysm. A right internal mammarian artery perforation resulting in huge breast hematoma was treated via endovascular graft stent implantation. Hemorrhagic and vascular complications are rarely seen during TRC. However, majority of these complications could be managed conservatively without a requirement for surgical reconstruction.

Phylloid tumour after excision recur as huge breast mass after excision in histology prove to be a case of fibrosarcoma breast

Fibrosarcoma of the breast is a rare entity. Prognosis of fibrosarcoma of the breast is poor and the role of various treatment modalities is not clearly defined due to the rarity of the disease. It must be differentiated from other stromal tumours like malignant phylloid tumour, Malignant fibrous histiocytoma and pleomorphic rhabdomyosarcoma, liposarcoma, leiomyosarcoma. One such case is presented here. Primary sarcomas of the breast are extremely rare and account for less than 0.1% of all malignant tumours of the breast of which the conversion of a phyllodes tumour to sarcoma of the breast is even rarer and only two such case has ever been reported.

The Lateral Thoracodorsal Flap in Delayed Bilateral Breast Reconstruction for an Obese Patient with Redundant Lateral Chest Wall Soft Tissue

Over the past 30 years, surgical methods for breast reconstruction have evolved and numerous studies have been conducted with the aim of improving aesthetic goals. However, risk factors such as smoking, diabetes, huge breast increase the postoperative complication that causes unsatisfactory result to both surgeon and patient [1,2]. Obesity (body mass index [BMI] ≥30 kg/m), one of the main risk factors, not only leads to postoperative reconstruction failure but also prolongs the operating time. It makes surgeon hesitate to choose a single ideal surgical technique. Compared to transverse rectus abdominis myocutaneous flap and latissimus dorsi flap, standard methods for autologous breast reconstruction, local flaps have some advantages in terms of aesthetic results and surgical morbidity. The technique is simpler that reduces the operating time, the surgery is less aggressive, the skin color and texture are similar, and the patient has a shorter recovery period. Described as a fasciocutaneous flap in the 1980s, the lateral thoracodorsal flap is a well studied procedure for late breast reconstruction following radical surgery. It relies on the redundancy of skin that can be pinched together without transferring tension on the mammary region [1-4]. We report the case of bilateral thoracodorsal flap with cohesive gel implant performed to woman who had redundant lateral chest wall soft tissue after modified radical mastectomy. We demonstrated the successful use of the technique, which achieved satisfactory result improving the contour of lateral chest wall.

El concepto de aclimatación

Según Coon y Birsdell uno de los factores principales en la diferenciación de los grupos raciales modernos ha sido la selección natural operando en términos y estímulos inherentes a los ambientes extremos. En el cuarto período glacial la raza mongólioa fue la última en diferenciarse desarrollando pechos enormes, extremidades cortas y cuerpos globulares que irradian el menor calor posible. Mongolia es una planicie con una altitud media de 1.500 mts. Los veranos son cálidos y los inviernos fríos. Sus migraciones alcanzan el grado 60 de latitud norte. El ambiente climático corresponde a extremo frío, extrema altitud, y extrema anoxia tal como ocurre en los altiplanos del Himalaya y de los Andes cuyos habitantes tienen las mismas características.

Mucinous carcinoma of breast: A diagnostic pitfall

Mucinous carcinoma is also known as mucoid carcinoma, colloid carcinoma, gelatinous carcinoma and mucin producing carcinoma. They are uncommon neoplasms of the breast and the reported incidence varies from 1–4%. Most of the mucinous carcinomas occur in older age group. FNAC can aid in diagnosis of mucinous carcinoma with only a few FNAC studies documented in literature. We present here a 56 year old lady with a huge ulcerated breast mass clinically diagnosed as Malignant Phyllodes tumor. An FNAC was done which showed epithelial cell clusters with mild atypia in a background of both bluish violet and pink extracellular material. Spindle shaped cells were noted in the ground substance which led to a diagnosis of a phyllodes tumor with extensive myxoid change. Mastectomy was performed and the histopathological features confirmed a diagnosis of mucinous carcinoma. The tumor had areas showing thick collagenized fibrous septae separating tumor cell clusters and also areas of fibrosis. The pitfall in FNAC diagnosis may be due to the sampling from such an area.

Ultrasonographic findings of missed breast cancer: pitfalls and pearls

Breast ultrasonography (US) is an indispensable tool for diagnosis of palpable and non-palpable breast masses and can facilitate good patient care for breast cancer. However, it is of limited value in cases of isoechoic lesions surrounded by fat, heterogeneous echoic lesions surrounded by a heterogeneous background, deep lesions in huge breasts, subareolar lesions, and lesions caused by poor and underdeveloped operator skills. Some breast tumors such as ductal carcinoma in situ and invasive lobular carcinoma are easily missed on US because of the nature of the lesions. Recent studies have emphasized the use of tools complementary to B-mode US, including real-time elastography and Doppler imaging, in the evaluation of breast lesions missed on US. Radiologists can take a number of steps that will enhance the accuracy of US image interpretation and decrease the rate of false-negative findings. These steps include reviewing clinicopathological data, using mammography and MRI to help assess breast lesions missed on US, strictly adhering to positioning and technical requirements, being alert to subtle features of missed breast lesions, and judging a lesion by its most malignant feature.

Reconstruction of Unexpected Huge Chest Wall Defect after Recurrent Breast Cancer Excision Using a TRAM Flap Combined with Partial Latissimus Dorsi Muscle Flap

Reconstruction of Unexpected Huge Chest Wall Defect after Recurrent Breast Cancer Excision Using a TRAM Flap Combined with Partial Latissimus Dorsi Muscle Flap

512 Intraglandular Flap Technique with Racquet Incision for Cancers Located in Upper Outer Quadrant of the Breast

conservative breast surgery, and thirty patients had myomammary flap reconstruction. Age ranges from 23 to 63 years (median = 41.7). Results: The oncologic outcome of extended LDF with added vascularized chest wall fat in the reconstruction of the huge breast was superior to myomammary flap with near equal oncologic outcome. In special situation; the therapeutic reduction mammoplasty is employed with better outcome than conventional conservative breast surgery as the safety margin which in the first is wider (5−10 cm) and more confidential than the conventional conservative breast surgery (CBS), the aesthetic outcome is better than CBS but the operative time and hospital stay are longer than CBS. In comparison to sparing mastectomies with extended LDF with added vascularized chest wall fat which is aesthetically and oncologically near equal to therapeutic reduction mammoplasty. Conclusion: Modified extended latissimus dorsi myocutaneous flap with added vascularised chest wall fat is a single stage totally autologous breast reconstruction allows reconstruction without the additional cost of an implant, many complications of synthetic implants. Therapeutic reduction mammoplasty is an oncologically safe surgical procedure in special situations that yields satisfactory aesthetic results and low morbidity in large breasted women with cancer.