Lost Breast Research Articles

Awareness of External Breast Prosthesis, it’s availability and affordability in Eastern Nigeria

The major impact of mastectomy is on the self-image and the mental status of patients, which may negatively affect their quality of life. External breast prosthesis (EBP) gives the woman a better shape as it takes the shape of the lost breast. This improves her confidence, looks and general disposition. We assessed EBP awareness among mastectomy patients, its availability and affordability in the Eastern region of Nigeria. The survey was conducted among mastectomy patients attending clinics at University of Nigeria Teaching Hospital Enugu, Federal Medical Centre Owerri and Federal Medical Centre Umuahia, all in South East Nigeria. A total of 32 mastectomy patients filled out questionnaires designed to obtain relevant data on knowledge of existence, availability and affordability of EBP in three big cities in South Eastern Nigeria. Data were analysed using the Statistical Analysis Software Version 8.2. Result showed only half (50%) of the participants were aware of the existence of EBP. Out of 32 patients, 23 (71.9%) were not using EBP and only 9 (28.1%) were currently using EBP. The majority of the participants (85.7%) do not know where and how to get EBP and therefore do not have access to EBP, while 4.8% cannot afford EBP.Contribution: There is poor awareness of the existence of EBP among breast cancer survivors. Consequently, there is poor usage of this device which otherwise, would help to restore self esteem in this population. The study exposed the need for awareness creation on the existence of EBP.

신유물론의 타자의 윤리

New materialism emphasizes on the nature of matter and the modes of self-transformation in our material environment. Until now, the body has remained mired through the discursive practices of biology and natural sciences. However, the body is also a material. The bodies have capacities that emerge within a multitude of organic and social processes functioning interactively and productively. Additionally, the materialization of the body entails an interlocking relationship between the organic transformations of the body and the material details of everyday life. Susan Miller’s solo performance dramatizes the materialization of the damaged body through vibrant entanglement between chemotherapy of breast cancer and her daily life. The scar on her lost breast amounts to the loss of love, material vitality and generative forces. And the unforeseen mutations and trajectories of illness are the results of trans-corporeality between biological processes and environmental conditions. This paper thus examines a new material perspective on the damaged female body through Miller’s illness narrative.

Reconstructive surgery in the complex treatment of breast cancer (10 years of experience)

The aim of the study is to improve the quality of life of women with breast cancer (BC) and a high risk of its development by performing one-stage or delayed reconstruction of the lost breast.The objectives of the study were: to clarify the criteria for selecting patients for prophylactic mastectomy; development of surgical tactics in the treatment of breast cancer and a high risk of its development; assessment of oncological safety of LME; clarification of the methods of reconstruction of the breast; analysis of postoperative complications, including the effect of neoadjuvant PCT during simultaneous breast reconstruction on their frequency, and determination of possible ways to prevent them.Material and methods. The prospective controlled study included 258 patients who underwent surgical treatment in our department between 2007 and 2016. The criteria for the inclusion of patients in the study were: carrying out radical surgical treatment for breast cancer, both in isolation and in combination with the reconstruction of the lost breast; carriage of germline mutations in the tumor suppressor genes BRCA1 and BRCA2, the presence of first-degree relatives suffering from breast cancer, previous BRCA-associated breast cancer; the desire of patients with multiple recurrent proliferative benign breast diseases that are not amenable to conservative and surgical treatment to use the surgical method of breast cancer prophylaxis with immediate restoration of the breast.Results. According to the Beck Depression Questionnaire, 72 % of patients in the first group of patients had a critical and high level of depression, while patients who underwent CME with one-stage reconstruction did not have such levels of depression. At the same time, a relatively favorable psychological state of patients with a low level of depression was observed in 17 of 21 patients in the RME + delayed reconstruction group (which amounted to 81% of the group), in 21 of 22 patients in the RME + simultaneous reconstruction group (95% of the group), and only in 5 of 43 patients in the RME group (12% of the group) (χ2 = 51.6; critical value 9.2 at p ≤ 0.01).Conclusions. When analyzing the results obtained, we once again became convinced of the oncological safety of LME with a one-stage reconstruction of the breast, subject to certain requirements. In the presence of appropriate conditions, it is possible to preserve the SAC during the LME. Preventive LME with simultaneous breast reconstruction is the method of choice in patients with a high risk of developing breast cancer, subject to the appropriate selection criteria and the patient's desire.

Ways to Improve the Aesthetic and Functional Results of Reconstruction Mammoplasty in Cancer Patients

Premise. Modern approaches to skin-sparing mastectomy produce impressive esthetic results with high degree of symmetry. However, functional properties of reconstructed breast (haptic properties, consensual mobility) often leave much to be desired. The article presents an original technique of skin-sparing surgeries in case of breast cancer with single-step reconstruction of thoracodorsal flap which was preliminarily subjected to lipofilling. Methods. The trial involves 18 patients with breast cancer who had a skin-sparing mastectomy with relation to breast cancer with single-step reconstruction of thoracodorsal flap which was preliminarily subjected to lipofilling. The indications for this surgical intervention have been identified. Lipofilling technique within the projection of the future thoracodorsal flap, breast tissue cutting, flap dissection and formation of symmetrical breast has been described. Results. When using BCCT.core 3.0 software, excellent and good results were equally distributed. In 5 cases (27.8%) we managed to obtain absolutely symmetrical breasts not only in terms of visual perception but also in terms of haptic properties. A small percentage of complications allows to consider the suggested surgical intervention to be effective method for breast reconstruction. Conclusions. Replacement of lost breast capacity by thoracodorsal flap which was previously subjected to lipografting, as well as renunciation of combination of tissue graft with the implant produces high degree of symmetry not only visually but also in terms of haptic properties and consensual breast symmetry.

Women experiences of using external breast prosthesis after mastectomy

Objective:The aim of this study was to identify the experiences of breast cancer patients using external breast prostheses (EBP) in the context of the Pakistani society.Methods:A qualitative descriptive exploratory design was used in the study. In-depth individual interviews were conducted with 15 postmastectomy women using EBP. A semi-structured interview guide with open-ended questions was used for the interviews. The analysis of the data was organized into four categories according to the study questions including reasons for using EBP, feeling about EBP, challenges for using EBP, and coping with lost breast. Each category was further divided into subcategories.Results:Women used EBP because they felt strange, incomplete, and embarrassed in front of other people, due to the asymmetrical shape of the chest after mastectomy. They faced several challenges with regard to obtaining and using the EBP. While EBP was used as an alternative of their lost breast, they experienced sadness and embarrassment. They found it challenging to take care of the EBP and were required to make changes in their lifestyle. However, they accepted living with their lost breast, either through rationalization, family support, or faith and prayers, which helped them to cope.Conclusions:The study findings have given insight into some real experiences of mastectomy patients. Mastectomy not only affects women's physical health but also their psychological health, as a result of which they become reluctant to socialize. Using EBP can help them to improve their body image and body posture. Health-care providers' support is very important to the families of the patients specifically where patients are very shy to openly seek information due to cultural constraints.

The role of guideline reinforcement in improving quality of referrals to a specialist breast clinic

The role of guideline reinforcement in improving quality of referrals to a specialist breast clinic

Breast Reconstruction Using Stem Cells and Engineered Biomaterials

Breast reconstruction is an option to restore the breasts after the surgical removal of breast tissue during cancerrelated surgery. Tissue engineering techniques offer novel solutions to this problem through development of bioactive tissue constructs that can regenerate adipose tissue for normal structure and function. Recently, a number of studies have been designed to explore various methods to engineer human adipose tissue for breast reconstruction. These approaches combine the use of a scaffolding material (which is able to provide the proper volume, shape and mechanical stability, as well as timed growth factor delivery), with the use of mesenchymal stromal cells derived from the patient fat tissue - also referred to as adipose derived stem cells (ADSCs)- to re-grow adipose tissue to functionally replace the lost breast. In order for these mixed implants to successfully serve as a feasible clinical option, it is mandatory that the implant manufacturing process be GMP compliant. This article aims to review recent patents covering the development of soft tissue implants for breast reconstruction. The focus will be oriented towards the cell component, particularly on the mesenchymal stem cells used as a tissue regeneration cell source.

Breast reconstruction: current and future options

When initiated by the devastating diagnosis of cancer, post ablative breast restoration has at its core the goal of restoring anatomic normalcy. The concepts of body image, wholeness, and overall well-being have been introduced to explain the paramount psychological influence the breast has on both individuals and society as a whole. Hence, a growing subspecialty has been established to recreate or simulate the lost breast. At least one third of breast cancer victims consider breast reconstruction. Breast reconstruction post mastectomy may be offered at the time of mastectomy or delayed post mastectomy after adjuvant therapy. This may be utilizing autologous tissues or implants and each has risks and benefits, especially when considering adjuvant therapy. In addition, there has been a move away from a traditional mastectomy to less invasive, but still curative procedures, such as skin-sparing and nipple-sparing mastectomy. These procedures provide the breast envelope to facilitate reconstruction. This paper reviews the primary issues in breast reconstruction, as well as their psychologic, oncologic, and social impact.

Women’s motives to opt for either implant or DIEP-flap breast reconstruction

Understanding women's motives concerning breast reconstructive surgery will contribute to a better counselling and care for the increasing number of women choosing post-mastectomy breast reconstruction (BR). We interviewed 31 women who opted for implant or deep inferior epigastric perforator (DIEP)-flap BR after therapeutic or prophylactic mastectomy. Motives for BR in general and for the selected type of BR were investigated following a phenomenological qualitative research approach. Women opting for implant BR were concerned with surgery-related issues, such as recovery time, number of scars and impact of surgery. They wanted to return to their daily life and restore their body image as soon as possible. Patients choosing DIEP-flap BR were more focussed on regaining a natural breast and wanted to benefit from the advantages of autologous tissue. Women scheduled for prophylactic mastectomy saw BR as an integral part of their treatment. Patients opting for BR after therapeutic mastectomy wanted to regain a complete body image with BR. Patients' motives for implant BR were primarily related to surgical issues, whereas women who chose DIEP-flap BR especially focussed on regaining a breast that resembles their own lost breast as well as possible. Clinical variables (such as therapeutic or prophylactic mastectomy, breast irradiation, and waiting lists) need to be taken into account when considering a certain type of BR, as these can be of great importance in the decision-making process.

Breast Augmentation After Reduction Mammaplasty

Although patients are typically satisfied after reduction mammaplasty, a subgroup later deems the volume of remaining breast tissue inadequate and presents for breast enhancement. Our purpose was to identify patient and procedural risk factors that may contribute to an over-reduced breast and the desire for breast augmentation after initial reduction. Seven patients were identified who had breast augmentation an average of 13 years after breast reduction. Four patients were satisfied with breast size immediately after reduction mammaplasty but lost breast volume subsequent to weight loss or childbearing. Three patients with a body mass index of 18 to 20 were dissatisfied immediately after reduction. Body image improved in 100% of patients after enhancement. Getting the size right depends upon thorough discussion with the patient regarding desired size, insurance requirements, and potential for decreased size after weight loss or childbearing. Breast augmentation may improve body image in patients with small breasts after reduction.

Issues related to choice of breast reconstruction in early-stage breast cancer

Reconstructive surgeons focus their efforts on refining and developing techniques that optimize oncologic outcome and recreate the most natural breast mound possible. The introduction of perforator flaps offers the potential for faster and more complete recovery, while increasing technical complexity and the risks associated with microsurgical reconstruction. Despite appealing long-lasting results, autologous reconstruction is not the ideal reconstructive choice for every patient. Tissue/expander reconstruction can produce a satisfactory aesthetic outcome and is the reconstruction of choice for most women undergoing breast reconstruction. Immediate autologous reconstruction at the time of mastectomy best resembles the lost breast and favorably withstands radiation, compared with other reconstructive methods. However, the best method for integrating reconstruction and radiation is being actively debated. Placing a tissue expander at the time of mastectomy allows a skin-sparing approach and gives the patient a chance to see how she will feel with an implant. This approach avoids radiation damage to tissue reconstruction flaps, saving them for use later if necessary. This approach, using a tissue expander as a first step, is growing in popularity.

Breast volume replacement using the de-epithialized latissimus dorsi myocutaneous flap

The de-epithelialized latissimus dorsi myocutaneous flap can be used for volume replacement of the subcutaneous mastectomy or unilateral hypoplasia, or for the replacement of the contracted prosthetic implant. Acceptable aesthetic results should be expected, and the permanence of the procedure is an improvement over the conventional silicone implant method of breast volume replacement. The procedure is applicable to both obese and thin patients, and should be considered as a reasonable alternative to the other methods of autologous replacement of lost breast tissue.

Latissimus dorsi myocutaneous flap for breast reconstruction

THE ideal breast reconstruction following mastectomy should: be a one-stage procedure; restore deficient skin; replace the contour of the absent pectoralis major muscle; restore lost breast volume; replace the absent nipple-areolar complex; and match in a symmetrical and pleasing way the contour of the remaining breast. We believe that the first 3 of these objectives can be achieved in many patients by the use of a myocutaneous flap incorporating the latissimus dorsi muscle. The latissimus dorsi myocutaneous flap was first reported for chest wall reconstruction by d’Este (1912). It was used as a superiorly based flap of skin and muscle having its pedicle base in the axilla. The flap was used at the time of radical mastectomy to cover the remaining defect. David (1949) and Campbell (1950) used a superiorly based latissimus dorsi muscle flap to reconstruct extensive chest wall defects. The latissimus dorsi muscle has also been used for the reconstruction of elbow flexion and extension (Schottstaedt, 1955; zancolli, 1973). DesPrez (1971) included the latissimus dorsi in bilateral bipedicle flaps for the closure of a defect secondary to a myelomeningocele. Olivari (1976) reported using a latissimus dorsi myocutaneous flap for the reconstruction of a chest wall defect. His technique was almost identical to that used by d’Este. Increased understanding of the blood supply of the skin overlying muscle as discussed by Daniel and Williams (1973) has further widened the range of myocutaneous flaps. Orticochea (1972) and McGraw (1976) took advantage of the vascular interconnection of skin and muscle in using the gracilis myocutaneous flap for penile and vaginal reconstruction. Harii (1976) reported the first free myocutaneous flap transfer. He used the gracilis muscle and its overlying skin based on the superior vascular pedicle of the muscle, which receives its arterial blood supply from the profunda femoris artery, thus further demonstrating that the skin can survive on the muscular perforators. Blood is supplied to the latissimus dorsi muscle by the thoracodorsal artery which is the terminal branch of the subscapular artery. The muscle is innervated by the thoracodorsal nerve, a branch of the posterior cord of the brachial plexus (Fig. I). The entire muscle, based on its neurovascular pedicle, can be mobilised after the division of the muscular origin from the lower 4 ribs, the lower 6 thoracic vertebrae, the lumber vertebrae, the sacral vertebrae, the supraspinal ligament and the posterior crest of the ilium. It can then be transposed to cover defects of the chest wall, the shoulder, the lower neck and the upper arm. An island of skin may be left on the muscle and used as necessary for the reconstruction (Fig. 2). We report the use of such a myocutaneous flap in a 3 I-year-old woman who 4 years previously had a radical mastectomy, including removal of the pectoralis major, for a stage I carcinoma. necrosis and an atrophic scar resulted (Fig. 3).