Removal Of Breast Tissue Research Articles

Spinal joint moment prediction following simulated breast surgery using a female whole-body musculoskeletal model

This study aimed to use a musculoskeletal model to predict changes in spinal moments following simulated breast surgery. A female full body musculoskeletal model with a fully articulated thoracolumbar spine and independent moveable breast segments was customised for this study. Key findings suggest that the simulated removal of breast tissue (750 g to 1501 g) can reduce the magnitude of lumbar spine extensor moments by >0.05 Nm/kg during walking and jogging. A customised female whole-body musculoskeletal model is capable of providing a first approximation of changes in spinal loading following simulated breast surgery.

Abstract PO2-07-04: Applying the Alliance Trial Guidelines in Multi-focal Breast Disease Using an Artificial Intelligence Computational Platform: Economic Analysis and Cosmetic Sensitivity

Abstract Background: Traditionally, multi-focal breast cancer results in mastectomy. The Alliance Trial offers a paradigm shift in surgical options available for multi-focal breast cancer patients in the context of adjuvant chemotherapy. In the trial, patients with multi-focal disease (< 3 tumors) who underwent breast conservation surgery (BCS) were found to have similar outcomes to patients undergoing mastectomy. BCS for large volume tumors ( >30%) has been cited as having a high potential for cosmetic defect, and hence represents a typical upper limit for potential tissue removal in BCS. Here, we evaluated a patient cohort to better understand the economic impact of the Alliance trial and further categorize patients that would most benefit without suffering cosmetic impact. We employed a novel computational technology to quantify the ratio of tumor size to breast tissue volume. Methods: Using a publicly available, single site cohort (n=243, DUMC) of breast cancer patients that underwent mastectomy, we segmented the tumors using our TumorSight Viz software platform. This platform uses artificial intelligence to segment the tumor and surrounding tissues and allows for a volumetric and morphologic assessment in 3D space. We then applied relevant inclusion/exclusion criteria from the Alliance Trial to the cohort (Saha et al, 2018). In trial eligible patients, we used TumorSight Viz to create a convex hull (CH) around the multi-focal disease using dilations of 1 cm and 2 cm. The volume of the CH, corresponding to proposed surgical extirpation, and the overall breast volume (BV) were then computationally assessed in 3D. The ratio of CH to BV (CH:BV) was calculated and a cutoff of 30% (high potential for cosmetic deformity) was applied. A cost analysis was then carried out. We determined the aggregate per annum savings that could potentially be realized by transforming a subset of mastectomies to BCS by tabulating total costs of mastectomy+reconstruction vs. BCS+WBI (whole-breast irradiation), as well as adjusted for relative rates of adjuvant therapy (~80%) across the nationwide patient population. Results: We found that 19.3% of adjuvant mastectomy patients were eligible for BCS based on Alliance Trial criteria. Of those, 68% had tumor CH:BV < 30% when using a 1 cm dilation around the tumor. When using a 2 cm dilation, 56% had tumor CH:BV < 30%. Together, these results indicate that of all adjuvant mastectomy patients, an estimated 10.8-13.1% are eligible for BCS based on volumetric measures of cosmetically acceptable breast tissue removal. Our economic analysis of BCS vs. mastectomy revealed an estimated $28,500 cost savings for patients with private insurance, suggesting that both decreased costs and improved quality-of-life (QOL) can be mutually aligned. By assessing the nationwide number of patients receiving adjuvant therapy for breast cancer, alongside the percentage potentially eligible for BCS using the above cosmetic defect analysis, we estimate that BCS conversion from mastectomy offers to provide a net savings of $300-350 million annually. Conclusion: The Alliance Trial guidelines unveiled the potential option of BCS in ~20% of patients with multi-focal disease in our cohort, demonstrating considerable cost-savings. Computational tools can further differentiate individuals who may not be best candidates for BCS in this setting, ensuring high QOL and informed decision-making. Citation Format: John Pfeiffer, Matthew Biancalana, Dorys Lopez-Ramos, Bradley Feiger, Anuja Antony. Applying the Alliance Trial Guidelines in Multi-focal Breast Disease Using an Artificial Intelligence Computational Platform: Economic Analysis and Cosmetic Sensitivity [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-07-04.

Treatment Options for the Clinical Management of Axillary Breast Tissue.

Axillary breast tissue includes any combination of fat, nipple, areolae, and glandular tissue alongside breasts and affects 2%-6% of women and 1%-3% of men. Patients may experience functional and/or cosmetic concerns due to axillary breast tissue. There are nonsurgical options for its removal, such as CoolSculpting and Kybella, and surgical options such as liposuction, BodyTite liposuction, and excision. Determining which technique to use in each case is critical in achieving an excellent outcome. Currently, there are no established treatment algorithms for the removal of axillary breast tissue. A retrospective review between January 1, 2013, and June 20, 2022, was performed. Data that were extracted included age, BMI, date of procedure, procedure, fat suctioned, tissue excised, and follow-up period. The authors analyzed outcomes and formulated a treatment algorithm based on tissue type (fat versus glandular), amount of tissue excess, skin laxity, and accessory nipple presence. A total of 43 patients (83 axillae) met our inclusion criteria and were included in our analysis. All patients were female with a mean age of 35.5 ± 10.9 years, a mean BMI of 23.0 ± 3.1, and a mean follow-up period of 8.8 ± 11.1 months. For inclusion, patients had to have undergone CoolSculpting, liposuction, BodyTite liposuction, liposuction with excision, or excision alone. All patients tolerated the procedures well and reported no serious complications. Nonsurgical and surgical removal of axillary breast tissue is safe and effective. The algorithm presented can be utilized by plastic and reconstructive surgeons to ensure optimal results for axillary breast tissue removal.

34238 Laser revision of periareolar scarring following masculinizing chest surgery: A case report

Background: Masculinizing chest surgery (top surgery) involves the removal of breast tissue and nipple repositioning/reshaping to achieve a masculine chest appearance in transmasculine and transgender men. Keyhole mastectomy (KM) involves breast tissue removal via periareolar incision, which avoids the linear scarring seen with double-incision mastectomies (DM). Patients prefer the KM to the DM for this cosmetic advantage. However, outcomes are consistently poorer for the KM and literature regarding revision of post-KM scarring is limited to invasive surgical approaches. No studies examining laser revision have been published. Herein, we describe a case of laser revision for periareolar scarring following KM. Case: A 15-year-old transgender male presented 10 months following KM with hypertrophic, erythematous, and hyperpigmented periareolar scars bilaterally. Postsurgical complications included abscess formation requiring surgical revision. He had been using chest compression (ACE wrap) and silicone gel sheets to minimize scarring, but desired improved skin texture and decreased erythema to facilitate tattoo camouflage. The left areola was treated with 5 pulsed dye laser (PDL) (595 nm) and 5 CO2 laser (10,600 nm) sessions while the right was treated with 3 PDL sessions and a single CO2 session. Treatments were spaced 6-8 weeks apart. The patient reported improvement in skin texture and decreased erythema after 3 treatments with continued benefit after subsequent treatments without adverse events. Discussion: Laser therapy has been successfully used in the revision of postsurgical and burn scars. Our novel case highlights that laser therapy may be an effective option for treating periareolar scarring and dyspigmentation following KM.

O050 A ten-year review of methodological trends and outcomes in riskreducing mastectomy and associated reconstruction at a tertiary referral centre

Abstract Introduction Risk-reducing mastectomy (RRM) is the removal of breast tissue to substantially decrease the risk of developing breast cancer in individuals with higher breast cancer susceptibility due to strong family history or genetic mutations. This retrospective study evaluates cases of RRM, and subsequent reconstruction performed at a tertiary referral centre over the last decade, with emphasis on mastectomy and reconstructive trends. Methods A retrospective review of all cases of RRM performed between January 2010 and January 2020, divided into two groups corresponding to the first half (group 1) and second half (group 2) of the decade was conducted. Data collected included demographics, genetic test results, family and personal history of breast cancer, co-morbidities, mastectomy type, reconstruction type, surgical histopathology findings and complications. Results A total of 167 patients (group 1=76, group 2=91) underwent RRM, with a significant increase in cases of RRM despite negative genetic test results (p=0.047). The proportion of nipple sparing techniques for RRM compared to more traditional skin-sparing techniques. Concomitantly, post-RRM reconstruction has progressively become solely implant-based, to coincide with a rise in ADM usage. This is consistent with national trends towards fewer complex autologous procedures. Take-home message Emergent trends in risk-reducing mastectomy and reconstructive techniques are occurring against a background of broadened indications for RRM and more frequent patient requests for RRM in the absence of any documented pathogenic gene mutation. As breast surgery continues to evolve, it is important to evaluate specific trends such as more conservative forms of mastectomy and novel techniques/devices for breast reconstruction to ensure optimal patient care and levels of satisfaction.

Patient reported outcomes following breast conserving surgery are improved by minimizing re-excisions and excessive breast tissue removal

BackgroundPatient reported outcomes (PRO's) are a valuable tool in obtaining the patients' perspective on the effectiveness of breast conservation surgery. Investigation has primarily been focused on patient and disease related factors impacting PRO's, with a limited focus on surgically modifiable factors. We investigate the impact that the volume of breast tissue removed, and performance of re-excisions have on PRO's. MethodsRetrospective evaluation of the BREAST-Q (breast conservation module) in patients undergoing breast conserving surgery over a 3 year period. Multivariate analysis of patient, disease, and treatment related factors impacting PRO's. Results163 patients completed the BREAST-Q. The median satisfaction with breast score was 67 (IQR, 48–88). Increasing volume of resected breast tissue was negatively associated with appearance of the breast (−0.05/cm3 (CI; −0.08 to −0.01)), as was the performance of re-excisions (−6.59 (CI; −14.73 – 0)). Physical well-being of chest was negatively associated with the volume of breast tissue removed (−0.05/cm3 (CI; −0.08 – 0)), but not re-excisions. Psychosocial well-being was negatively affected by the volume of tissue removed ((-0.04/cm3(CI; −0.07 – 0)), and re-excisions (−2.88 (CI; −10.96 – 0)). Patient body mass index, disease stage, receipt of Tamoxifen, as well as axillary lymph node dissection also impacted BREAST-Q domain scores. ConclusionThe removal of larger volumes of breast tissue and performance of re-excisions negatively impact patient quality of life and breast satisfaction following breast conserving surgery. Optimal patient reported outcomes are associated with accurate tumour removal, which minimizes re-excisions and the removal of normal breast tissue.

Incidence of Primary Complications Afterwards Modified Radical Mastectomy in Breast Cancer

The cancer of breast is the 2nd leading source of cancer death in females. A modified radical mastectomy encompassed the combines removal of the axillary lymph nodes with all breast tissue removal from the affected breast. The most common complication of surgery is formation of seroma. Inadequate data is accessible on this topic. This analysis therefore provides valued information on this problem associated with infection of wound. Objective: To govern the initial complications after radical modified mastectomy in women with cancer of breast. Study Design: A descriptive case study. Place and Duration: In the Surgical department of Muhammad Teaching Hospital, Peshawar for the duration of one-year from November 2020 to October 2021. Methods: This descriptive case study was conducted at the surgical department of Muhammad Teaching Hospital, Peshawar for the duration of one-year from November 2020 to October 2021. The estimated sample size had an incidence of 18%, margin of error = 10% and CI = 95% of the sample size required is 62 patients. The sampling method used was non-probability purposive. Patients who met the selection criteria underwent a modified radical mastectomy with the prior conversant written consent. The patients were discharged home on the second day of surgery and were monitored weekly for the first 6 weeks at the clinic for primary complications such as seroma formation and wound infection. All related demographic data such as clinical information and age such breast cancer staging with possible complications were recorded at the culmination of 6-weeks. Data were entered into SPSS software version 21 and analyzed. Results: The study included 62 females with a modified radical mastectomy for breast cancer who fully met the criteria of inclusion. 46.10± 13.02 years was the patients mean age with 20-75 years age range. The mean postoperative day of infection in wound was 4.60± 1.9 days and the mean postoperative day for seroma was 9.21± 3.98 days. Stage II breast cancer was diagnosed in 44 patients (70.9%) and stage I breast cancer in 18 patients (29.1%). Wound infection was observed in 5 patients (8.1%), while 16 patients (25.8%) experienced complications related to seroma formation. Conclusion: This study showed that complications such as infection in the wound are significantly lower, but the incidence of seroma is consistent with nationwide studies that justify novel interferences to reduce the rate of these complications. Keywords: Modified radical mastectomy, Seroma, Wound infection.

Thoracic Spinal Anaesthesia for Modified Radical Mastectomy (MRM)

Background: Breast cancer mostly affects patients older than 65 years old. Geriatric patients may have comorbidities so the selection of anaesthesia for breast cancer surgery is challenging. In the past decade, thoracic spinal anaesthesia as regional anaesthesia was feasibly performed for laparoscopic cholecystectomy and minor breast surgery. This article aims to evaluate thoracal spinal anaesthesia for Modified Radical Mastectomy (MRM) in our hospital settings. Case: Three cases of Thoracal Spinal Anaesthesia were carried out for MRM surgery after neoadjuvant chemotherapy treatment. This procedure consists of removal of breast tissue and the ipsilateral axillary contents. The comorbidities include hypertension, cardiomegaly, and mild anaemia. There was no conversion to general anaesthesia during surgery until completion. Duration for surgery less than 120 minutes. No significant hemodynamic instability and complaint were found during intra and postoperative. Conclusion: From these cases, thoracal spinal anaesthesia was acceptable as regional anaesthesia for MRM in geriatric patient.

Association between Paravertebral Block and Pain Score at the Time of Hospital Discharge in Oncoplastic Breast Surgery: A Retrospective Cohort Study.

Using nonopioid analgesics may decrease the risk of patients chronically using opioids postoperatively. The authors evaluated the relationship between paravertebral block and pain score at the time of hospital discharge. The authors performed a retrospective cohort study of 89 women with American Society of Anesthesiologists Physical Status I to III undergoing oncoplastic breast surgery with 20 to 50 percent breast tissue removal and immediate contralateral reconstruction between August of 2015 and August of 2018. The primary outcome was pain score at hospital discharge with or without paravertebral block. The secondary outcome was postoperative length of stay. Data were analyzed using the Wilcoxon rank sum test, t test, Fisher's exact test, univariable and multivariable regression, Kaplan-Meier analyses, and Cox regression. Median pain score at hospital discharge was lower with paravertebral block [2 (interquartile range, 0 to 2) compared to 4 (interquartile range, 3 to 5); p < 0.001]. Multivariable regression revealed that pain score at the time of hospital discharge was inversely associated with paravertebral block after adjusting for age, body mass index, American Society of Anesthesiologists class, extent of lymph node surgery, and duration of surgery (p < 0.001). Pain score at hospital discharge was also associated with total opioid consumption during the first 24 hours after surgery (p = 0.001). Patients who received paravertebral blocks had median total 24-hour postoperative opioid consumption in morphine equivalents of 7 mg (interquartile range, 3 to 10 mg) compared with 13 mg (interquartile range, 7 to 18 mg) (p < 0.001), and median length of stay of 18 hours (interquartile range, 16 to 20 hours) compared with 22 hours (interquartile range, 21 to 27 hours) (p < 0.001). Paravertebral blocks are associated with decreased pain score at the time of hospital discharge. Therapeutic, III.

Identification of a localization wire tip in an occult breast lesion using a handheld magnetometer.

The Sentimag hand-held probe detects the magnetic response from iron oxide particles trapped in a sentinel node. To investigate if an electromagnetic probe can be helpful in the identification of a hook wire tip located in an occult breast lesion. Forty-two patients undergoing lumpectomy without axillary procedure were enrolled. In all cases, suspicious non-palpable microcalcifications without mass were found, and a vacuum-assisted stereotactic biopsy was performed. On the day of surgery, a traditional localization wire (LW) was placed under imaging guidance. The Sentimag magnetometer was used to precisely detect the wire tip through the skin. Then, the skin incision was made and Sentimag was used again to guide the surgeon to the lumpectomy bed. The accuracy of excision was assessed with intra-operative specimen 3D tomosynthesis. Median lesion size was 16 mm (range: 4-38 mm) and median depth was 33 mm (range: 14-78 mm). In all cases, the wire tip was successfully identified. Neither wire displacement nor transection occurred. Intraoperative radiography demonstrated doubtful margin requiring selective cavity shaving in 6 patients (14%). The need for cavity shaving was significantly influenced by the lesion size and histology: median size 30 mm (range: 24-38 mm) compared to 15 mm (range: 4-28 mm) and histology of ductal carcinoma in situ (DCIS) compared to atypical ductal hyperplasia (ADH) and lobular neoplasia (LN). Tumors requiring cavity shaving tended to be deeper - they had a median depth of 43 mm (range: 17-78 mm) compared to 32 mm (range: 14-76 mm) in patients who did not need cavity shaving, but this parameter was statistically significant. Intraoperative identification of the wire tip using Sentimag is a simple technique facilitating targeted excision without excessive removal of breast tissue. Since it is not associated with additional costs, it may be worth considering, particularly in developing countries.

Chest Masculinization Technique and Outcomes in 72 Double-incision Chest-contouring Procedures with Free Nipple Grafting.

Background:Chest masculinization for gender affirmation is the removal of breast tissue and excess skin, often with repositioning of the nipple areola complexes to achieve a male-appearing chest. A double-incision technique with free nipple grafting (FNG) is the preferred method for trans men with large, ptotic breasts. The authors present the outcomes of 72 consecutive chest masculinization cases using this technique.Methods:A retrospective chart review was performed between 2015 and 2020 on all patients who underwent chest masculinization surgery for gender dysphoria by the senior author (JDK). Patients who underwent masculinization by concentric circle or liposuction-only techniques were excluded. Potential risk factors for complications were analyzed with Chi-square and logistic regression techniques. P < 0.05 was considered significant.Results:Seventy-two patients underwent bilateral mastectomy with free nipple grafting. There were 6 major complications resulting in return to operating room, re-admission, or need for interventional procedure. These included 4 hematomas, 1 infection, and 1 hospital admission for shortness of breath and pain.Minor complications treated conservatively included 3 seromas, 1 instance of delayed wound healing, 1 case of superficial thrombophlebitis, and 4 hypertrophic scars. Eleven patients experienced nipple areolar complex complications. Four patients underwent revision surgery. Nicotine use was associated with a higher rate of hematoma (χ2: 9.95, P = 0.007). Later operative date, a surrogate for experience, was associated with decreased return to the operating room (Odds ratio: 0.99, P = 0.025).Conclusion:Double-incision chest contouring with free nipple grafting provides good chest contour for transgender men,with low complication rates.

THE THERAPEUTIC BENEFITS OF ARM MASSAGE IN RELIEVING PAIN AND PREVENTING LYMPHEDEMA AFTER MASTECTOMY

Mastectomy is a surgical procedure that involves the removal of breast tissue. It is commonly performed as a treatment option for breast cancer. After the mastectomy, there are different options for breast reconstruction, which is the rebuilding of the breast shape. Reconstruction can be done using implants or the patient's own tissue from another part of the body. Mastectomy is often recommended as a treatment option when breast-conserving surgery is not possible or when the individual prefers to have the entire breast removed. It can be a life-saving procedure and an important step in the journey towards recovery and healing. Arm massage can be really beneficial for patients with mastectomy. It can help relieve pain, improve circulation, reduce swelling, and prevent lymphedema. Massaging the affected arm gently and using techniques like lymphatic drainage can promote healing and enhance overall well-being.

Lowering Re-excision Rates After Breast-Conserving Surgery: Unraveling the Intersection Between Surgeon Case Volumes and Techniques.

The re-excision rates after breast-conserving surgery (BCS) are significantly varied, with surgeon case volume as one influential factor. Surgeons with higher case volumes have been shown to have lower reoperation rates. This study attempted to determine whether this may be attributable to excessive breast tissue removal during initial BCS. A retrospective study analyzed referrals to the authors' cancer center during 3years. Patients undergoing initial BCS for ductal carcinoma in situ or T1-T3 breast cancers were included. Patient age, tumor factors, surgeon case volume, and the calculated resection ratio (CRR) were analyzed. The total resection volume was divided by the optimal resection volume to produce the CRR, which reflected the magnitude of excess tissue resected during initial BCS. Comparison of the mean CRR between surgeon case-volume categories was performed with a repeated measures analysis of variance. A multivariate regression model assessed the effects of the CRR and surgeon case volume on re-excision rates. Larger tumor size, lobular histology, and lower CRR were associated with increased re-excision rates. The CRR was similar for each surgeon case-volume group. Surgeon case volume was not independently associated with re-excision rates, but surgeons with very high case volumes had lower odds of re-excision than surgeons with intermediate case volumes (odds ratio 0.44; 95% confidence interval 0.21-0.91). When control was used for the CRR, apparent differences in re-excision rates between surgeon case-volume groups were observed, suggesting that surgeons with higher case volumes may be more accurate when performing BCS.

Optimization of Wire-guided Technique With Bracketing Reduces Resection Volumes in Breast-conserving Surgery for Early Breast Cancer

BackgroundWire-guided localization (WGL) of early breast cancer can be facilitated using multiple wires, which is called bracketing wire-guided localization (BWL). The primary aim of this study is to compare BWL and conventional WGL regarding minimization of resection volumes without compromising margin status. Secondly, BWL is evaluated as an alternative method for intraoperative ultrasound (US) guidance in poorly definable breast tumors on US. Patients and MethodsIn this retrospective cohort study, patients with preoperatively diagnosed breast cancer undergoing wide local excision between January 2016 and December 2018 were analyzed. Patients with multifocal disease or neoadjuvant treatment were excluded from this study. Optimal resection with minimal healthy breast tissue removal was assessed using the calculated resection ratio (CRR). ResultsBWL was performed in 17 (9%) patients, WGL in 44 (22%), and US in 139 (70%). The rate of negative margins was comparable in all 3 groups. The CRR was significantly smaller for BWL (0.6) than WGL (1.3) in tumors larger than 1.5 cm. Additionally, BWL (0.8) led to smaller CRRs than US (1.7). This could be explained by the high number of small tumors (≤ 1.5 cm) in the US group for which greater CRRs are obtained than for large tumors (> 1.5 cm) (1.9 vs. 1.4; P = .005). ConclusionFor breast tumors larger than 1.5 cm, BWL achieves more optimal resection volumes without compromising margin status compared with WGL. Moreover, BWL seems a suitable alternative to US in patients with poorly ultrasound-visible breast tumors and patients with a small tumor in a (large) breast.

Excessive Healthy Breast Tissue Removal during Wide Local Excision of Breast Cancer after Neo-Adjuvant Therapy

Excessive Healthy Breast Tissue Removal during Wide Local Excision of Breast Cancer after Neo-Adjuvant Therapy

Chest Wall Masculinization in Female-to-Male Transsexuals: Our Treatment Algorithm and Life Satisfaction Questionnaire.

Esthetic masculinization of the chest wall is one of the first surgical steps in female-to-male transsexual (FTMTS) reassignment.This surgical procedure is not a simple mastectomy: it is required for removal of breast tissue with glandular resection and skin excess revision, to reduce and replace the nipple-areola complex in the right location, minimizing chest wall scars. The creation of an esthetically pleasing male chest allows the patient to live at ease in the male gender role.In this article, we present our series of 68 FTMTSs who underwent bilateral mastectomies for surgical sexual reassignment (a total of 136 mastectomies) according to our algorithm, in the period between January 2010 and December 2017. We selected 4 different operative procedures, classified as subcutaneous ("pull-through" and "concentric circular" techniques) and skin extended ("ultrathin vertical bipedicle" and free nipple graft).We achieved a total complication rate of 6.6%, less than that reported in the literature; additional procedures for esthetic improvements were performed in 14.7% of cases. The mean patient satisfaction was approximately 4.57% of a maximal value of 5 (excellent).To help surgeons in choosing the most appropriate FTMTS surgical technique and to reduce unfavorable results, we propose the use of our treatment algorithm in preoperative evaluation of the chest wall according to the breast volume, degree of glandular ptosis, and skin elasticity.

Measurement of Depth of Premammary Fascia and Breast Parenchyma by Sonography and Histological Quantitation

Most surgical texts recommend the skin flap elevation in mastectomy at a plane between small and large fat lobules. However, raising a skin flap at this plane results in necrosis of skin in 10 to 15% cases. Objective of mastectomy is to remove the tumor along with entire breast parenchyma containing ducto-lobular units. Pre-mammary fascia is interposed between subcutaneous fat and breast parenchyma. Most of the terminal ducto-lobular units (TDLUs) reach superficially the plane of pre-mammary fascia. Raising a skin flap superficial to pre-mammary fascia would allow the surgeon to remove most of the breast parenchymal tissue without leaving any TDLUs under the flaps. The depth of pre-mammary fascia was measured by ultrasound in 50 patients at four spots, one in each quadrant of the breast before mastectomy. The distance between dermis and nearest TDLU was measured histologically at the same four spots in 50 mastectomy specimens. Maximum depth of pre-mammary fascia by sonography was observed in upper outer quadrant (UOQ) (mean = 1.8 cm) and minimum in lower inner quadrant (LIQ) (mean = 1.2 cm). Histologically maximum depth of TDLU was found in UOQ (mean = 1.9 cm) and the minimum depth in the LIQ (mean = 1.3 cm). There was a very strong correlation between sonographic and histologic measurements (Pearson’s rho = 0.93). This study demonstrated that ducto-lobular tissue is located deep to pre-mammary fascia. Skin flap elevation at the plane of pre-mammary fascia would ensure complete removal of breast tissue during mastectomy.

Breast Reconstruction

Breast reconstruction is an essential component of breast cancer multidisciplinary care. Restoring the breast form has repeatedly been shown to improve self-image, psychological well-being, and overall quality of life. Excellent aesthetic and functional results may be obtained with close collaboration between the breast surgical oncology and reconstructive plastic surgery teams. Plastic surgical consultation should be obtained for all women undergoing mastectomy and in selected women with anticipated contour deformity following breast conservation therapy. Most breast cancer patients will undergo reconstruction in stages coordinated with the individual’s multimodal oncologic therapy. In the majority of patients undergoing mastectomy, this reconstructive process may begin immediately at the time of breast tissue removal. Implant-based and autologous reconstructive approaches may both yield excellent results but need to be matched with patients’ goals, lifestyle, anatomy, and medical comorbidities. This review contains 15 figures, 7 tables and 55 references Key words: autologous reconstruction, breast implant, breast reconstruction, flap, microsurgical breast reconstruction, nipple-sparing mastectomy, oncoplastic, perforator flap, single stage

Breast Reconstruction

Breast reconstruction is an essential component of breast cancer multidisciplinary care. Restoring the breast form has repeatedly been shown to improve self-image, psychological well-being, and overall quality of life. Excellent aesthetic and functional results may be obtained with close collaboration between the breast surgical oncology and reconstructive plastic surgery teams. Plastic surgical consultation should be obtained for all women undergoing mastectomy and in selected women with anticipated contour deformity following breast conservation therapy. Most breast cancer patients will undergo reconstruction in stages coordinated with the individual’s multimodal oncologic therapy. In the majority of patients undergoing mastectomy, this reconstructive process may begin immediately at the time of breast tissue removal. Implant-based and autologous reconstructive approaches may both yield excellent results but need to be matched with patients’ goals, lifestyle, anatomy, and medical comorbidities. This review contains 15 figures, 7 tables and 55 references Key words: autologous reconstruction, breast implant, breast reconstruction, flap, microsurgical breast reconstruction, nipple-sparing mastectomy, oncoplastic, perforator flap, single stage

Chest Surgery in Female to Male Transgender Individuals

Societal awareness of transgender individuals has led to increased acceptance and demand for sex-confirming surgery. In female to male transsexuals, the most common procedure is removal of breast tissue to masculinize the chest. Eighty-eight transgender patients underwent either a subcutaneous nipple-sparing mastectomy (NSM) with or without a periareolar mastopexy or nipple reduction, or bilateral mastectomies with free nipple grafts (MFNG) with or without nipple reduction. Surgical techniques are discussed. Demographic data, use of testosterone, specimen weights, rates of wound dehiscence, infection, hematoma, hypertrophic scars, nipple loss, and revision surgery were all assessed. Of the 88 patients in the study, 40 underwent NSM and 48 underwent MFNG. Patients undergoing NSM were 4.1 times more likely to have a hematoma compared with patients undergoing MFNG (P <0.05). Mastectomy weight was not correlated with the occurrence of hematoma (P >0.80). Only 1 patient who underwent NSM required revision, whereas 5 patients in the MFNG patient population underwent revision. Patients were more likely to have hypertrophic scarring with the MFNG technique (0% vs 25%, P < 0.01) There were no infections, no wound dehiscence, and no nipple loss in any patient. Eighty-three percent of the patients who responded to a satisfaction survey (57/88) were very satisfied with their result, and 100% would recommend this procedure to other transgender individuals. Female to male transgender mastectomy can be performed with low complication rates and high satisfaction. Nipple-sparing mastectomy were more likely to have a hematoma than patients undergoing MFNG.