Resected Breast Tissue Research Articles

Prospective randomized comparison of conventional instruments and the Harmonic Focus® device in breast-conserving therapy for primary breast cancer

BackgroundIn recent years, surgeons have utilized Harmonic instruments to perform breast cancer resection. Retrospective and prospective studies have demonstrated that the use of this surgical device for mastectomy and axillary dissection can reduce perioperative blood loss, seroma formation, and duration and total amount of drainage. No study has analyzed the feasibility of Harmonic instruments in breast-conserving surgery. We conducted a prospective, randomized clinical trial comparing Harmonic instrument and conventional surgery in the performance of breast-conserving surgery and axillary procedures to determine differences in surgical procedures, postoperative outcome, and complications. MethodsOne hundred and six patients with operable breast cancer who underwent breast-conserving surgery at a single institution between December 2009 and January 2011 were included in the analysis. Surgery was performed in 52 patients with the Harmonic Focus® device and in 54 with scissors and electrocautery. This study focused on operative time, drainage volume, and postoperative outcome measures like blood loss, surgery related complications and patient-reported postoperative pain. ResultsWe found a multivariable independent influence in axillary seroma formation and volume of breast drainage with HS. Evident difference in volume and duration of axillary and breast drainage, subjective and objective postoperative pain, reduction in serum hemoglobin, size and weight of resected breast tissue and length of hospital stay in favor of the Harmonic instrument could also be shown. DiscussionThe Harmonic instrument provides key benefits in surgical technique, postoperative outcome, and complication rates in breast cancer surgery.

Excessive Resections in Breast-Conserving Surgery: A Retrospective Multicentre Study

The main determinant of cosmetic outcomes following breast-conserving surgery (BCS) for breast cancer is the volume of resection. The importance of achieving optimal oncological control may lead to an unnecessarily large resection of breast tissue. The aim of this study is to evaluate excess resection volume in BCS for cancer by determining a calculated resection ratio (CRR). This retrospective study was conducted in four affiliated institutions and involved 726 consecutive patients with T1-T2 invasive breast cancer treated by BCS between January 2006 and 2009. The pathology reports were reviewed for tumor palpability, tumor size, surgical specimen size, and oncological margin status. The optimal resection volume (ORV) was defined as the spherical tumor volume with an added 1.0 cm margin of healthy breast tissue. The total resection volume (TRV) was defined as the ellipsoid volume of the surgical specimen. CRR was determined by dividing the TRV by the ORV. Of all tumors, 72% (525/726) were palpable, and 28% (201/726) were nonpalpable. The tumor stage was T1 in 492 patients (67.8%) and T2 in 234 patients (32.2%). The median CRR was 2.5 (0.01-42.93). Margin status was positive or focally positive in 153 patients (21.1%). Lower tumor stage was associated with a higher CRR (factor 0.61 [p < 0.0001] and a lower positive margin rate [p = 0.064]). Accordingly, the median CRR of the nonpalpable lesions was higher than that of the palpable lesions (3.1 and 2.2, respectively; p < 0.01), and the involved margin rate was lower (17.4% and 22.5%, respectively; p = 0.13). Of patients with a CRR >4.0, 10.7% still had tumor involved margins. This study clearly shows that BCS is associated with excessive resection of healthy breast tissue while clear margins are not assured. Surgical factors should be modified to improve surgical accuracy.

Clinical and pathologic evaluation of implanted free dermal fat grafts after breast cancer surgery: A retrospective analysis

The efficacy of immediate breast reconstruction using a free dermal fat graft (FDFG) was evaluated clinically. A total of 22 breasts in 21 patients who underwent partial mastectomy for early breast cancer involving mainly the inner upper quadrant were enrolled in this study. The defect was reconstructed immediately by filling it with an autologous FDFG. At 6 months and 1, 2, 3, 4, and 5 years postoperatively, the width (horizontal length) and thickness (distance perpendicular to skin) of the FDFG on computed tomography (CT) scans were measured. Histologic samples from the implanted FDFG were collected by core needle biopsy (CNB). The correlations between clinical findings and volume of the FDFG on CT and the proportion of fatty tissue in the CNB were examined statistically. Cosmetic results were also evaluated. On CT, the mean width of the FDFG was 95%, 81%, 79%, 73%, 68%, and 47% and the mean thickness were 125%, 121%, 120%, 115%, 104%, and 103% at 6 months, and 1-5 years postoperatively, respectively. In the CNB samples, the mean fatty tissue distribution was 76%, 63%, and 54% at 1 year, 1-4 years, and >4 years postoperatively, respectively. The percent change in the width of the FDFG at 6 months after the operation displayed a significant negative correlation with the postmenopausal period and a significant positive correlation with the maximum surgical margin. On CT, thickness was negatively correlated with the size of the resected breast tissue, and thickness of the implanted FDFG. No clinicopathologic factors or technical factors were related to FDFG outcome and the proportion of fat tissue in the CNB sample, except for axillary dissection. Nineteen of 21 patients had good to excellent cosmesis. FDFG implanted into breast defects after partial mastectomy undergo mild resorption and degeneration to fibrous tissue, but most patients have good to excellent cosmesis.

Ultrasound-guided breast-sparing surgery to improve cosmetic outcomes and quality of life. A prospective multicentre randomised controlled clinical trial comparing ultrasound-guided surgery to traditional palpation-guided surgery (COBALT trial)

BackgroundBreast-conserving surgery for breast cancer was developed as a method to preserve healthy breast tissue, thereby improving cosmetic outcomes. Thus far, the primary aim of breast-conserving surgery has been the achievement of tumour-free resection margins and prevention of local recurrence, whereas the cosmetic outcome has been considered less important. Large studies have reported poor cosmetic outcomes in 20-40% of patients after breast-conserving surgery, with the volume of the resected breast tissue being the major determinant. There is clear evidence for the efficacy of ultrasonography in the resection of nonpalpable tumours. Surgical resection of palpable breast cancer is performed with guidance by intra-operative palpation. These palpation-guided excisions often result in an unnecessarily wide resection of adjacent healthy breast tissue, while the rate of tumour-involved resection margins is still high. It is hypothesised that the use of intra-operative ultrasonography in the excision of palpable breast cancer will improve the ability to spare healthy breast tissue while maintaining or even improving the oncological margin status. The aim of this study is to compare ultrasound-guided surgery for palpable tumours with the standard palpation-guided surgery in terms of the extent of healthy breast tissue resection, the percentage of tumour-free margins, cosmetic outcomes and quality of life.Methods/designIn this prospective multicentre randomised controlled clinical trial, 120 women who have been diagnosed with palpable early-stage (T1-2N0-1) primary invasive breast cancer and deemed suitable for breast-conserving surgery will be randomised between ultrasound-guided surgery and palpation-guided surgery. With this sample size, an expected 20% reduction of resected breast tissue and an 18% difference in tumour-free margins can be detected with a power of 80%. Secondary endpoints include cosmetic outcomes and quality of life. The rationale, study design and planned analyses are described.ConclusionThe COBALT trial is a prospective, multicentre, randomised controlled study to assess the efficacy of ultrasound-guided breast-conserving surgery in patients with palpable early-stage primary invasive breast cancer in terms of the sparing of breast tissue, oncological margin status, cosmetic outcomes and quality of life.Trial Registration NumberNetherlands Trial Register (NTR): NTR2579

A Reliable Method for the Preoperative Estimation of Tissue to Be Removed during Reduction Mammaplasty

Insurance requirements for prior authorization of reduction mammaplasty are becoming increasingly stringent, with the sole criterion determined by the surgeon being the estimation of the amount of tissue to be removed. Previous formulas for predicting resected tissue weights have been inconsistent and particularly unreliable in smaller reductions. This study describes a dependable, surgeon-specific method based on two simple preoperative measurements to estimate tissue resection weights in patients undergoing reduction mammaplasty. The medical charts of 72 consecutive patients who underwent reduction mammaplasty were reviewed. Preoperatively obtained measurements from the first 15 patients in the authors' series were plotted against the actual corresponding amount of breast tissue removed at the time of surgery. Linear regression of this plot was used to generate a mathematical formula that was then used to predict resection weights of the subsequent 57 patients. The results were compared with the actual weights recorded intraoperatively. Several measurements were evaluated and Pearson coefficients generated. The mathematical product of two unique breast-only surface measurements along horizontal and vertical planes generated the linear regression formula with the greatest accuracy (r = 0.95) for predicting the weight of tissue to be resected compared with either measurement alone or sternal notch-to-nipple distance. By using two simple preoperative measurements correlated with tissue resection weights in a small series of procedures, any reconstructive surgeon can create his or her own reliable formula for predicting breast tissue resection weights for reduction mammaplasty.

Determination of Elastic Properties of Resected Human Breast Tissue Samples Using Optical Coherence Tomographic Elastography

Abstract: The present study is concerned with the application of optical coherence tomographic (OCT) elastography technique for quantitative assessment of the elastic properties of resected human breast tissue samples subjected to axial compressive loading in vitro. Three classes of breast tissue samples, namely normal, benign (fibroadenoma) and malignant (invasive ductal carcinoma), were considered. A speckle tracking technique based on two‐dimensional cross correlation was employed to track the speckle motion between original (pre‐compressed) and the displaced (post‐compressed) OCT images of the tissue samples for the measurement of displacement and strain maps. The overall data reduction approach for quantitative assessment of elastic properties was validated against the results of gelatin phantoms containing activated charcoal particles as scattering centres. Results are presented in the form of OCT images and displacement and axial strain maps for normal, benign and malignant breast tissue samples. Based on the stress–strain relationship obtained for these three classes, the values of stiffness coefficients were reported in terms of modulus of elasticity. Results of the study reveal significant differences between the two‐dimensional displacement vector maps of normal and cancerous breast tissue samples. The stiffness of benign tissue samples is found to be about two times higher than that of normal tissue samples, whereas for malignant samples, it is about four times higher, thereby signifying appreciable differences in the stiffness of cancerous and normal tissue samples.

Incidental Detection of Breast Apocrine Carcinoma via Endometrial Cytology

Breast apocrine carcinoma is a rare malignancy characterized histologically by a predominance of acidophilic tumor cells exhibiting apocrine metaplasia. Apocrine tumors represent only about 0.4% of all breast cancers. Many cases are diagnosed at stage I or II; thus, the prognosis is better than that for other types of breast cancer. Here we present a 57-year-old female patient with primary apocrine breast carcinoma that was incidentally discovered by endometrial cytology. The patient had undergone routine uterine cancer screening at the age of 56 with resulting positive endometrial cytology. Subsequent histological examination of an endometrial biopsy revealed suspected metastatic uterine adenocarcinoma. Further evaluation revealed a 3-cm mass in the left breast, which was histopathologically diagnosed as breast cancer. Dual procedures were performed at the departments of gynecology and breast surgery. The patient underwent a modified radical mastectomy of the left breast and left axillary lymph node dissection. Laparotomy revealed multiple adhesions throughout the peritoneal cavity that suggested invasive metastatic cancer, and a right adnexectomy was performed. Histopathological examination of the resected left breast and right ovary tissues revealed apocrine carcinoma. Thus, stage IV breast cancer was diagnosed. The patient finished 6 cycles of paclitaxel and is now under observation on an outpatient basis. In this patient, breast cancer was discovered incidentally through a detailed work-up after a positive result of endometrial cytology. Uterine cancer screening has the potential, although rare, to detect metastatic cancer originating elsewhere. This should be taken into consideration during the work-up due to positive endometrial cytology.

BINARY TISSUE CLASSIFICATION STUDIES ON RESECTED HUMAN BREAST TISSUES USING OPTICAL COHERENCE TOMOGRAPHY IMAGES

We report the results of a comparative study of Fourier domain analysis (FDA) and texture analysis (TA) of optical coherence tomography (OCT) images of resected human breast tissues for binary classification between normal–abnormal classes and benign–malignant classes. With the incorporation of Fisher linear discriminant analysis (FLDA) in TA for feature extraction, the TA-based algorithm provided improved diagnostic performance as compared to the FDA-based algorithm in discriminating OCT images corresponding to breast tissues with three different pathologies. The specificity and sensitivity values obtained for normal–abnormal classification were both 100%, whereas they were 90% and 85%, respectively for benign–malignant classification.

Keyhole Pattern for Preoperative Marking for Reduction Mammaplasty

BACKGROUND There are many techniques used for reduction mammaplasty; however, the most frequently performed procedures result in an inverted T scar. Preoperative marking is an important step for the success of the procedure, especially for surgeons at the initial learning stage. However, there is no consensus regarding the best method. In 1981, Strömbeck designed a pattern for preoperative marking for reduction mammaplasty. This pattern provides stable parameters that promotes an acceptable symmetry marking. OBJECTIVE To evaluate the use of the Strömbeck pattern for preoperative marking for reduction mammaplasty. METHODS Fifty-seven patients who underwent reduction mammaplasty between April 2006 and April 2007 were prospectively evaluated. Patient ages ranged from 17 to 61 years; the mean body mass index was 22.2 kg/m2. After defining the standard landmarks of the breast, preoperative markings were made using the Strömbeck pattern. Breast reduction surgery was performed under local anesthesia with sedation. Postoperative results were evaluated according to a numerical visual analogue scale, at the seven-, 15-and 30-day follow-up periods. The Student's t test and the Kruskal-Wallis test were used for statistical analysis (P&lt;0.05). RESULTS The mean weight of resected breast tissue was 317.5 g for the right breast and 305.8 g for the left breast (P=0.17). Scores obtained using a visual analogue scale showed a progressive increase in the scores during the postoperative follow-up period (P&lt;0.0001). CONCLUSION The use of the Strömbeck pattern enabled surgeons to perform reduction mammaplasty with good postoperative results as seen in the follow-up periods.

Partial Breast Reconstruction for an Inferomedial Breast Carcinoma Using an Omental Flap

Various oncoplastic techniques are used for partial reconstruction after breast-conserving surgery (BCS), but treatment of an inferomedial breast carcinoma (IMBC) can be difficult, especially in a small breast. We review our experience with immediate partial breast reconstruction after BCS for an IMBC using a laparoscopically harvested omental flap (OF). The subjects were 24 patients with an IMBC who underwent immediate partial breast reconstruction with the OF between April 2002 and June 2009. A wide excision (>20% of the breast tissue) was performed through a skin incision along the medial inframammary fold. The pedicled OF was harvested laparoscopically and used to fill the dead space in the inferomedial quadrant. The mean follow-up period was 35 months. The mean tumor size was 3.2 cm. The mean volume of resected breast tissue was 180 g and the mean extent of resection was 40%. The complication rate was 12.5% and all were minor and treated conservatively. Laparoscopy-associated complications did not occur, except for one minor injury of the gastroepiploic artery. The surgical margin was positive in only 1 patient (4.2%) and neither local nor systemic recurrence has occurred to date in any patients. Cosmetic outcomes were mostly satisfactory, with minimal donor-site scars in the abdominal wall. Cosmetic failure occurred in 1 patient (4.2%) due to an inadequate OF volume. Laparoscopic harvesting of the OF is a safe procedure with minimal donor-site morbidities and deformities. This approach is an option for immediate partial reconstruction after BCS for an IMBC.

Keyhole pattern for preoperative marking for reduction mammaplasty

There are many techniques used for reduction mammaplasty; however, the most frequently performed procedures result in an inverted T scar. Preoperative marking is an important step for the success of the procedure, especially for surgeons at the initial learning stage. However, there is no consensus regarding the best method. In 1981, Strömbeck designed a pattern for preoperative marking for reduction mammaplasty. This pattern provides stable parameters that promotes an acceptable symmetry marking. To evaluate the use of the Strömbeck pattern for preoperative marking for reduction mammaplasty. Fifty-seven patients who underwent reduction mammaplasty between April 2006 and April 2007 were prospectively evaluated. Patient ages ranged from 17 to 61 years; the mean body mass index was 22.2 kg/m(2). After defining the standard landmarks of the breast, preoperative markings were made using the Strömbeck pattern. Breast reduction surgery was performed under local anesthesia with sedation. Postoperative results were evaluated according to a numerical visual analogue scale, at the seven-, 15- and 30-day follow-up periods. The Student's t test and the Kruskal-Wallis test were used for statistical analysis (P<0.05). The mean weight of resected breast tissue was 317.5 g for the right breast and 305.8 g for the left breast (P=0.17). Scores obtained using a visual analogue scale showed a progressive increase in the scores during the postoperative follow-up period (P<0.0001). The use of the Strömbeck pattern enabled surgeons to perform reduction mammaplasty with good postoperative results as seen in the follow-up periods.

Reduction Mammoplasty With Superolateral Dermoglandular Pedicle

The techniques of reduction mammoplasty are multiple and varied. Each one has advantages and disadvantages. With any of them, full preservation of vascularity and sensitizing of the nipple-areola complex (NAC) should be sought, as well as functionality of the breast. We present our 15 years' experience using the superolateral dermoglandular pedicle, a technique that fully preserves the integrity of the breast. During that 15-year period, we operated on 702 breasts in 356 patients, using the superolateral dermoglandular pedicle, with the NAC requiring a migration of 5 to 16 cm (mean: 9.2 cm), having resected breast tissue between 300 and 1380 g, (average: 660 g). The technique was used in women between 16 and 63 years of age (average 37), who wanted breast reduction and who required a migration of the NAC greater than 5 cm. We had minor complications consisting of wound dehiscence (5.9%), scar hyperpigmentation (3.9%), fat necrosis (3.8%), hypertrophic scarring (3.1%), alterations in sensitivity (2.27%), and keloid scarring (0.5%). We had 9 cases of necrosis of the NAC (1.28%), of which 7 were partial (0.99%) and 2 were total (0.28%). Satisfaction with the results was 94%. The technique of reduction mammoplasty with a superolateral dermoglandular pedicle has been used in mammary hypertrophy and gigantomasty with excellent results. Its design is simple, its performance easy, and its aesthetic results are highly reproducible. The position of the pedicle allows full preservation of the vascularity, sensitivity, and functionality of the breast, and is therefore a highly recommendable technique.

Atypical medullary carcinoma of the breast.

A 57-year-old woman was seen in our department for pain in the left breast, which had been noticed two months earlier. Her family history and past medical history were unremarkable. On arrival, a movable tumor 2 cm in diameter was palpated in the upper-outer-quadrant of the left breast. The ipsilateral axillary lymph nodes were not palpable. Blood chemistry results, including tumor markers, were normal. Mammography revealed a mass that had ill-defined borders and a higher central density with some spiculations in the left breast. The diagnosis was category 5 (Fig. 1). The tumor was seen by breast ultrasonography (Aplio, Toshiba, Tokyo, Japan) as a low echoic mass, 28 9 27 mm, with ill-defined borders, irregular margins, and internal heterogeneity. The anterior border was disrupted by tumor invasion (Fig. 2). Power Doppler US showed rich blood flow in the tumor (Fig. 3). Contrast-enhanced magnetic resonance imaging (MRI) showed the tumor as highly enhanced with irregular margins (Fig. 4). The time–intensity curve was an early peak and plateau pattern, suggesting malignancy. Pathological findings from a core needle biopsy revealed an infiltrating ductal carcinoma of the breast. Estrogen receptor (ER) and progesterone receptor (PgR) were positive, and the HER-2 score was 2?. No metastases were seen in the brain, lungs, liver, bones, abdominal cavity lymph nodes, infraclavicular lymph nodes, and axillary lymph nodes by computed tomography (CT) and bone scintigram. With a diagnosis of left breast cancer (T2N0M0 = Stage IIA), left quadrantectomy and biopsy of sentinel lymph nodes were performed. According to the intra-operative rapid pathological diagnosis, the sentinel lymph nodes were negative for metastasis. However, an intraductal carcinoma was noted at the resection margin on the papillary side of the resected breast tissue. Therefore, a pectoral muscle-sparing mastectomy was performed. The final pathological diagnosis was atypical medullary carcinoma (Fig. 5).

Saline replacement after local resection of the breast: a simple technique with good control and improved patient satisfaction

Here we report a study on the use of saline replacement after local resection of the breast. Local resection of breast tissue is widely used in the treatment of breast cancer due to the development of imaging analysis technology such as mammography, ultrasound sonography, computed tomography, and magnetic resonance. Preserving the size and shape of the breast after treatment is beneficial for the patient, and deformity of the residual breast can be a serious problem. Following resection, the subcutaneous tissue was sutured with 4-0 polydioaxanone, and a 20-G syringe was inserted through the skin into the hole. After suturing the skin with 4-0 nylon, an adequate volume of saline was injected. A conservative treatment group did not receive saline injections and was used as controls. We sent self-administered questionnaires to 60 patients who had undergone local resection of the breast and received 55 responses (92%). Saline replacement was performed in 28 of the 55 patients, and conservative treatment (no saline replacement) was performed in 27 patients. The average volume of injected saline was 46ml (range, 5-150ml). There were no statistically significant differences in skin irritation, pain, fatigue, or daily activity between the two groups, but the saline replacement group was more satisfied with the surgical scar (p<0.05) and shape of the breast (p=0.05) after surgery. Saline replacement after local resection of the breast is a simple technique that provides benefits for patients undergoing conservative surgery of the breast.

“Moving window” operation for breast-conserving surgery

Although endoscope-assisted surgery has been used for partial mastectomy to improve the cosmetic outcome, this procedure may be somewhat cumbersome, thereby increasing operating time and blood loss. Moreover, the use of expensive disposable endoscopic instruments is required. We have performed partial mastectomy via a small periareolar incision (transareolar approach) and/or axillary incision (transaxillary approach) using a wound retractor and bipolar scissors without disposable endoscopic instruments in 58 patients with noninvasive or invasive breast cancer. Axillary lymph node dissection is also performed via small axillary incision using a wound retractor and bipolar scissors. Average surgical duration was 132 min in transareolar approach and 125 min in transaxillary approach. Average blood loss was 38 and 48 ml, respectively. Postoperatively, the margin of resected breast tissue was histologically confirmed to be negative in 56 of 58 patients (97%) patients. Postoperative appearance of conserved breast was excellent in many patients, unless a large volume of breast tissue was removed. A wound retractor provides maximum exposure with minimum incision size, thereby allows performance of breast-conserving surgery via a small periareolar and/or axillary incision in patients with a nipple-areola complex that is mobile and not small. It can reduce operating time and blood loss when compared with endoscope-assisted partial mastectomy.

Breast conserving surgery after neoadjuvant therapy for large primary breast cancer

Aim The aim of this study was to evaluate the safety of breast conserving surgery in patients with breast tumours satisfactorily downstaged after neoadjuvant therapy. Methods A retrospective cohort study was undertaken to analyze the loco-regional recurrence (LRR) after breast conserving surgery. We enrolled 88 patients with breast cancer subjected to neoadjuvant therapy (NAT group) who achieved an objective response due to neoadjuvant treatment and compared them with 191 patients with early breast cancer (EBC group) who were submitted to primary conserving surgery. Lumpectomy or quadrantectomy with axillary lymph node dissection was performed in all patients who received adjuvant radiotherapy. Systemic adjuvant therapy was offered to all patients. The mean periods of observation were 61.3 months in the NAT group and 67.5 months in the EBC group. Results The mean age was 53 years in the NAT group and 56 years in the EBC group ( p = 0.04). There was no histological type and histological grade difference between groups. In the NAT group, the mean diameter of residual tumour was lower and the mean volume of breast tissue resection was higher than in the EBC group ( p = 0.01 and p = 0.002, respectively). The ipsilateral recurrence rate was 7.9% in the NAT group and 7.8% in the EBC group ( p = 0.9). The most important predictive factor of recurrence in the NAT group was the age of patient. Conclusion Breast conserving therapy is a safe procedure in satisfactorily downstaged breast cancer after neoadjuvant therapy.

Safety and Aesthetic Improvement Using the Omega Pattern Reduction Mammaplasty after Breast Conservation Surgery and Radiation Therapy

With the continued popularity of lumpectomy and radiation therapy for many early-stage breast cancer patients, a considerable number of large-breasted patients are being identified who are unhappy with subsequent asymmetry and cosmetic distortion and symptoms related to their macromastia. Bilateral reduction mammaplasty is the most direct means of achieving size balance, improving cosmesis, and relieving symptoms related to macromastia. However, most plastic surgeons are fearful of reduction of the irradiated breast using traditional pedicle techniques for nipple transfer. An alternative procedure intended to minimize this risk is the reduction mammaplasty with an omega incision. The omega technique uses a central excision resulting in a moderate resection of skin and breast tissue while elevating the nipple-areola complex. Between 2001 and 2005, the authors used the omega reduction technique in five post-lumpectomy and irradiation patients with resultant large, asymmetric breasts. The volume of excised tissue from the irradiated breast was 250 to 327 g (mean, 291 g). All patients were relieved of their preoperative macromastia symptoms and achieved improved breast symmetry. In addition, there were no wound healing complications, and all women were satisfied with their cosmetic result. The omega breast reduction technique creates the widest possible pedicle with the least length, thus maximizing blood supply and avoiding the development of more tenuous flaps and a separate nipple pedicle. The authors believe it is a safer technique for the correction of breast asymmetry and improvement in symptomatic macromastia in patients who have previously undergone lumpectomy and radiation therapy.

Functional effects of preserving the intercostobrachial nerve and the lateral thoracic vein during axillary dissection in breast cancer conservative surgery

Conventional axillary dissection in breast cancer surgery implicates the section of the neurovascular elements passing through the dissected tissue: the intercostobrachial nerve (ICBN) and lateral thoracic vein (LTV). Preservation of the ICBN during axillary dissection is well documented in the literature, with slightly contradictory results of its influence to postoperative pain. There is no published data, as far as we know, on the functional effects of preserving the LTV. We supposed that ligation of the LTV contributes to the emergence of postoperative breast edema, which is common in breast cancer conservative surgery. The preservation of venous drainage could diminish the frequency of this undesired occurrence. In a prospective study, 126 patients undergoing axillary node clearance for breast cancer of stages I and II were randomly selected for preservation of ICBN and LTV (n=65), or for conventional dissection (n=61). Sensory deficit, pain and breast edema as a dichotomized characteristics were examined in the first two weeks after the surgery. No difference in the number of dissected nodes was seen between the two groups (p = 0.7). The loss of sensitivity was significantly less common in the group randomized for ICBN preservation (16/65 vs. 30/61,p < 0.005), while there was no difference in the pain intensity and duration (49/65 vs 44/61, p > 0.05). LTV was preserved in 22 patients in the group for preservation, and in none of the control group. Breast edema was registered in 33 patients from the group for preservation (51%) and in 37 patients from the control group (61%). The difference in distribution was not significant, and the same results were obtained when the frequency of breast edema in the group with preserved LTV (22 patients, 10 of them without breast edema) was compared with the all others (p > 0.05). The preservation of the ICBN significantly improved the functional effect of the axillary dissection for breast cancer by reducing sensory loss, while there was no difference in pain intensity and duration. Although we did not prove that the preservation of LTV prevents breast edema after conservative surgery for breast cancer, we think that more complex analysis, including parameters such as the extent of resection of breast tissue, the dimension and constitutional characteristics of the breast, tumor location, obesity, and further developments in surgical technique, would reveal at least discrete improvements in the functional results of this surgical approach.

Doughnut mastopexy lumpectomy versus standard lumpectomy in breast cancer surgery: A prospective study

Aims Doughnut mastopexy lumpectomy (DML) is a unique breast resection in which a tissue segment is removed and the breast reshaped through a periareolar incision. The present prospective investigation compares DML and standard lumpectomy (SL) in relation to surgical variables, histological parameters, postoperative morbidity and cosmetic outcome. Methods 127 patients with breast cancer were offered the choice between two conservative surgical approaches: doughnut mastopexy lumpectomy (DML group, n = 39) or standard lumpectomy (SL group, n = 88). The groups were comparable for radiological tumour size, tumour location within the breast, histological size, and pT category. Comparison was performed in term of surgical variables, histological parameters, postoperative morbidity and cosmetic outcome. Results The patients undergoing DML were younger than the patients who chose SL. In the DML group, the skin incision was 3-fold longer than in the SL group but was obtained with a final scar located around the nipple areola complex without further postoperative complications. The average volume of the breast specimen was higher in the DML group compared with SL group. The clinician assessment of cosmetic outcome reported a higher rate of acceptable result in the DML group than in the SL group. However, patient's assessment did not show difference of cosmetic satisfaction between groups. Conclusion Our comparative study indicates that DML may be a useful alternative to SL not only in terms of accurate breast tissue resection but also in term of cosmetic results.

Breastfeeding After Reduction Mammaplasty

Breastfeeding following reduction mammaplasty by using 3 different techniques is evaluated in this retrospective study. A questionnaire was sent to 178 patients who had undergone the operation at childbearing age and provided data on quality and duration of preoperative and postoperative breastfeeding, as well as reasons for not attempting or failing. Demographic data and operative details were obtained from patients' records. One hundred six of the patients who replied to the questionnaire and had given birth after reduction mammaplasty were included in this study. Breastfeeding was considered successful if it was performed for at least 3 weeks without supplementation. For women who attempted to breastfeed postoperatively, successful rates were 71% for superior pedicle mammaplasty, 77% for the inferior pedicle technique, and 63% following horizontal bipedicled reduction mammaplasty. However, 22% of women had not made any attempt to breastfeed at all after breast reduction. The postoperative ability to breastfeed was not found to relate to the amount of resected breast tissue or the time elapsing between operation and delivery. It is concluded that after breast reduction with pedicled transposition of the nipple-areola complex and preservation of adequate subareolar breast tissue, the ability to breastfeed highly depends on encouragement and support offered to women rather than the choice of the operative technique.