Resected Weight Research Articles

Reduction Mammaplasty

In extreme cases of breast hypertrophy, amputation of the nipple-areolar complex and transplantation during reduction mammaplasty has been advocated to avoid nipple necrosis. We report our experience with 172 patients having inferior breast pedicle reduction without amputation of the nipple-areolar complex. Mean total weight of resected tissue was 1,946 g (548 to 5,100 g), with a mean nipple-areolar transposition of 10 cm (0.5 to 23 cm). Dividing patients into four groups by weight of resection, we compared complication rates. In this series, where nipple-areola amputation was avoided, there was a 99.6% survival rate of the nipple-areolar complex with 97.1% retention of nipple sensibility. Patients with extreme breast hypertrophy (3,000 g resected tissue) experienced no increase in complications when compared to smaller reductions. In most cases of gigantomastia, amputation of the nipple can be avoided using the inferior breast pedicle technique. Size of breast resection alone should not determine the fate of the nipple.

Reduction mammaplasty: a safe and effective outpatient procedure.

Traditionally, reduction mammaplasty has been performed on an inpatient basis with a one to two day hospitalization. Many procedures once commonly performed on an inpatient basis have been shown to be safe and effective when performed in an outpatient setting. The purpose of this study was to determine if reduction mammaplasty could be performed safely on an outpatient basis and to compare findings between inpatient and outpatient groups. An outcome based retrospective review of patients who had bilateral reduction mammaplasty from 1989 to 1993 was performed at two centers. Minimum follow-up was nine months. Of 331 patients, 161 were outpatients and 170 were inpatients. Seventy-six percent of the surgeries were performed in the hospital and 24 percent at a free-standing surgical facility. There were no statistical differences between the two groups when comparing age, marital status, preoperative health status, operative technique, and resection weight. Evaluation of patient body weights, use of antibiotics, and complications did reveal statistical differences between the two groups. The inpatients were heavier, more likely to experience a complication, and less likely to receive antibiotics. There was, however, no difference between the two groups for incidence of rehospitalization, return to the emergency department, or reoperation.A patient satisfaction survey was conducted with both outpatient and inpatient groups reporting high satisfaction with their results. Over 95 percent of patients in both groups felt the experience was a positive one. The survey indicated high patient acceptance of breast reduction on an outpatient basis for the outpatient population. The data confirms that reduction mammaplasty is a safe and effective procedure when performed on an outpatient basis. The cost savings associated with outpatient surgery is significant and an important consideration in this era of health care reform.

Outpatient reduction mammaplasty: a review of 338 consecutive cases.

Reduction mammaplasty is usually accomplished under general anesthesia, often with an overnight stay. With cost-containment pressures, the ability to perform this surgery in an outpatient setting would have obvious benefits. We present a series of 338 patients who have undergone bilateral reduction mammaplasty over a 3-year period. Two hundred eighty-six cases (84.6%) were performed on an outpatient basis and 52 (15.4%) were inpatients. Patient age ranged from 13 to 82 years. Significant differences were found between the two groups regarding average age (34.3 and 42.4 years, respectively) and average total resection weights (1,486.1 gm and 1,895.6 gm, respectively). The maximum total resection weight was 6,000 gm in the outpatient group and 7,140 gm in the inpatient group. Surgical techniques included inferior pedicle (N = 273), central mound (N = 54), and free nipple graft (N = 11). There were no substantial differences in the incidence of minor complications, including wound separation, seromas, hypertrophic scars, infection, and hypopigmentation. Autologous transfusion was utilized in 18 patients early in the series. Of the 175 patients (52%) who returned a follow-up questionnaire, all considered their outpatient experience a positive one. In addition, 33% of the inpatients who responded (N = 8/24) felt their hospital stay was unnecessary. Outpatient surgery resulted in a savings of $1,500 to $2,500 when compared to an overnight stay. Reduction mammaplasty can be performed safely in an outpatient setting and is not necessarily limited by age or extent of resection.

Reduction mammaplasty: analysis of patients' weight, resection weights, and late complications.

The medical records of 291 patients who had undergone reduction mammaplasty were analysed. A total of 216 (74%) of the women were overweight and 67 (23%) to such a degree that according to our policy they should not have been candidates for operation. Most of the patients were young-199 (68%) were less than 40 years old and 110 (38%) were less than 25 years old. Total bilateral resection weights in many younger women were quite low. Of the 199 patients less than 40 years old 64 (32%) had less than 500 g total bilateral resection weight whereas 85 (92%) of the women 40 years old or more had resections of more than 500 g. Late complications were few-the rate of infection was similar in all weight groups. Fat and nipple necrosis-although rare-were more likely to occur in the obese and in patients over 30 years old.

Conservative Treatment of Breast Cancers by Mammaplasty and Irradiation

Conservative treatment of breast cancers confined to the lower quadrants often leaves a residual deformity. In order to prevent these poor cosmetic results, 20 patients with lower quadrant cancers have been treated since 1986 at the Institut Curie by wide lumpectomy combined with immediate remodeling of the gland by nipple-bearing superior pedicle mammaplasty and preoperative (9 cases) or postoperative (11 cases) irradiation. The contralateral breast was always rendered symmetrical at the same time. The mean weight of resection was 248 gm, and the resection margins were always free of tumor. The treatment protocols were not modified by the addition of mammaplasty to lumpectomy, and this combination did not induce any significant complications. The mean follow-up was 4.5 years (range 1 to 7.5 years). There was one case of local recurrence; there were four cases of metastases. In this series, the oncologic results were identical to those of conventional treatment by lumpectomy and irradiation. The cosmetic result was good or very good in 75 percent of patients and 91 percent of patients in the group in which mammaplasty was performed prior to irradiation. Treatment of breast cancers by superior pedicle reduction mammaplasty and irradiation is indicated in tumors located in the lower quadrants, whose size in relation to the breast volume is such that conventional conservative treatment by lumpectomy and irradiation would achieve a poor cosmetic result.

Reduction Mammaplasty

The guidelines by which insurers determine eligibility for coverage of reduction mammaplasty must rely largely on only subjective materials, yet they often apply strict criteria ranging from minimum resection weights to outright refusal to compensate. I have reviewed the data from 100 consecutive reduction mammaplasties performed by me over the last 2 years. Body weight, combined specimen weight, and height relationships were studied. Patient-identifiable questionnaires regarding the presence or absence of preoperative regional discomforts were sent to the same group. It was not possible to construct a useful formula that would verify either subject complaints of discomfort or the prospect for their relief based on body dimension or specimen weight. This study suggests that a graded, three-level minimum specimen weight standard for body weights less than 70 kg, 70 to 79 kg, and over 80 kg would be more equitable.

Volume determinations of the whole prostate and of adenomas by transrectal ultrasound in patients with clinically benign prostatic hyperplasia: correlation of resected weight, blood loss and duration of operation

To study whether transrectal ultrasound (TRUS) volume determinations of the whole prostate and of the adenomas alone correlate to resected weight, operation time and blood loss in patients operated upon with transurethral resection of the prostate because of presumed benign prostatic hyperplasia (BPH). The whole prostate and the transition zone, which corresponds to the adenomas, were measured separately in 159 patients with presumed BPH, pre-operatively and 4 months post-operatively. The transition zone volume correlated well with the resected weight (r = 0.91; P < 0.0001), the blood loss (r = 0.67; P < 0.0001) and the operation time (r = 0.67; P < 0.0001). Four months post-operatively a reduction of the total prostate volume was recorded which corresponded well with the resected weight (r = 0.91; P < 0.0001). TRUS with high resolution 7 MHz probes successfully estimated the size of the whole prostate and that of the adenomas alone. The transition zone volume predicted the expected resection weight of adenomas and to some extent the duration of the operation and the blood loss. These calculations may be used for more accurate pre-operative planning. Together with its superior detection rate for prostate cancer, TRUS seems to be a powerful tool in the pre-operative morphological assessment of patients with prostatism.

Predicted and actual change in serum PSA following prostatectomy for BPH

Objective. To determine the relationship between prostatic adenoma volume and serum prostate-specific antigen (PSA) levels in patients with benign prostatic hyperplasia (BPH), and to compare the predicted change in serum PSA following prostatectomy with the actual change observed. Methods. Transrectal ultrasound (TRUS) estimation of prostatic adenoma (transition zone) and total gland volumes were calculated in 96 patients prior to prostatectomy. BPH was confirmed histologically following transurethral prostatectomy (in 86) and open prostatectomy (in 10). Serum PSA was measured preoperatively in all patients and post-operatively in 87 patients. Results. Correlation coefficients of 0.607 and 0.614 were observed between PSA and adenoma and total gland volumes, respectively. The geometric mean ratio of PSA to adenoma volume was 0.120 μg/L/cc with 95% CI (0.104, 0.139) and to total gland volume was 0.068 μg/L/cc with 95% CI (0.058, 0.078). TRUS-determined adenoma and total gland volumes correlated well (r = 0.915), as did TRUS-determined adenoma volume and resected weight (r = 0.878). The mean ratio of change in PSA to resected weight was −0.096 μg/L/g with 95% CI (−0.128, −0.064). Neither total gland volume nor operation type affected the relationship between change in serum PSA and resected weight. Conclusions. The adenoma should be the main determinant of serum PSA levels in patients with BPH. TRUS adenoma volume measurement is therefore the most appropriate preoperative measure when one is interpreting elevated levels of serum PSA in men thought clinically to have BPH.

Minimierung der Narbenausdehnung unter Anwendung der B-Technik bei Formkorrekturen an der Brust

For the last two years, the B-technique has been used in mammaplasty to minimise the extent of scars, if the expected resection weight is 700 g or less. 33 patients were operated by means of this technique. Scar formation and areola sensation were examined and compared with 188 patients operated by the techniques of McKissock, Strömbeck or Pitanguy. 19 of those patients and 3 patients, who had been operated on by the B-technique, developed hypertrophic scars. The widths of the scars was significantly smaller after operation by the B-technique, than by other techniques. After operation by the B-technique, the areola sensation was unchanged in 67% compared to 46% after operation by above mentioned and other techniques. In cases, where the expected resection weight does not exceed 700 g, the B-technique is superior to other techniques, because the medial scars can be avoided.

Transurethral Resection for a Large Prostate—Is it Safe?

A retrospective self-audit exercise was undertaken on 47 men who underwent transurethral resection of the prostate and in whom the resected weight was 80 g or more. The operative mortality and morbidity rates were 6 and 55% respectively, being highest in the "very old and unfit" group (22 and 88%). The complication rate increased if the resected prostatic weight was 100 g or more, or if the resection time exceeded 75 min. It was concluded that careful selection of patients is necessary before undertaking TUR for a large gland.

Coagulation Tests in Predicting Haemorrhage after Prostatic Resection

It is known that disseminated intravascular coagulation (DIC) can contribute towards blood loss after transurethral resection of the prostate because of the absorption of various prostatic substances. The aim of the present study was to establish whether simple coagulation tests (prothrombin time/activated partial thromboplastin time) carried out immediately after surgery would be useful in predicting those patients who bleed excessively after prostatic resection due to DIC. Criteria to determine significant post-operative haemorrhage were defined. Of 110 patients entered into the study, 34.5% had significant post-operative bleeding and 74% of these had an abnormal prothrombin time (> or = 15 s) immediately after surgery. An abnormal prothrombin time was associated with the resection of large prostates but could also predict the risk of bleeding independent of the resected weight; 18% of patients with an abnormal prothrombin time were also found to have an abnormal activated partial thromboplastin time and all of these had significant blood loss. A group of patients with an abnormal prothrombin time and a resected dry weight > or = 35 g was identified as a high risk group.

Follow-up evaluation of patients with Graves’ disease treated by subtotal thyroidectomy and risk factor analysis for postoperative thyroid dysfunction

Eight-year follow-up evaluation and analysis of factors related to postoperative thyroid dysfunction were made in 216 patients with Graves' disease treated by subtotal thyroidectomy. The postoperative status of thyroid function were as follows according to hypersensitive TSH level: 65 patients (30.1%) were euthyroid, 25 (11.5%) had overt hyperthyroidism requiring treatment, 14 (6.5%) had subclinical hyperthyroidism with normal thyroid hormone and suppressed TSH, 21 (9.8%) were overt hypothyroid requiring thyroid hormone replacement and 91 (41.1%) had latent hypothyroidism without hormone replacement. In order to know factors related to postoperative thyroid function, age, sex, preoperative levels of TSH receptor antibody (TRAb), thyroid antibody titers, degree of lymphocyte infiltration, duration of medical treatment, weight of the resected thyroid tissue and weight of the remnant thyroid tissue were determined. No factor except thyroid remnant and antimicrosomal antibody titer was related to postoperative thyroid function. The weight of remnant should be less than 6 g to avoid recurrent hyperthyroidism. As recurrence of hyperthyroidism was observed more than 5 yr after surgery, long follow-up is needed.

Evaluation of Current Practices in Routine Preoperative Crossmatching for Transurethral Resection of the Prostate

Increasing demand for blood during elective surgery has led to attempts to rationalize routine preoperative crossmatching to those operations when there is a reasonable (greater than 30%) chance of it being required. Results of a questionnaire returned by 86% of the urology units in Great Britain show that 41% continue to crossmatch 2 units of blood before transurethral prostatectomy.A review of 301 transurethral prostatectomies performed with preoperative grouping and saving of blood showed that only 11% of the patients required transfusion. The need for transfusion was significantly associated with presentation in chronic or acute on chronic retention (p <0.01), and the operative factors of weight of resection (p <0.0001) and degree of hemostasis (p <0.001). Therefore, a policy of routine preoperative blood grouping and saving is safe, and could be widely adopted, leading to financial saving and a decrease in wastage of blood that becomes too old to use.

Urinary incontinence following total prostatectomy--evaluation by urodynamics and urethrography

Urinary incontinence following total prostatectomy was evaluated in 10 patients by urodynamics and lateral urethrography. The pathological stage of the tumors in these patients was pT2 in 5 patients, pT3 in 3 patients and pT4 in 2 patients. Urinary incontinence was present in 8 patients, of whom 7 were stress incontinence and one was urge and stress incontinence. The severity of incontinence of these patients was mild in 5 patients, moderate in 3 and severe in 2. The incontinence was severer in the patients with the tumors of pT3 or pT4 than in the patients with the tumors of pT2. But the severity of incontinence was not related to the pathological grade or resected weight of the tumors. The bladder capacity and bladder compliance were 214.9 ml and 14.3 ml/cmH2O in average, respectively, and was not related to severity of incontinence. The statistical significant differences between continence or mild incontinence patients and moderate or severe incontinence patients were found for the mean functional profile length (2.04 versus 1.37 cm, respectively; p < 0.05) and maximum urethral closure pressure (42.3 versus 17.3 cmH2O, respectively; p < 0.05). But some patients with continence or mild incontinence demonstrated low values in either parameters. No statistical difference was found between continence and mild incontinence patients. On lateral urethrography, the posterior urethrovesical angle was not correlated with the severity of incontinence.

経直腸的リニア走査法による前立腺重量計測法の検討

The correlation between the resected weight of prostate and the estimated weight of prostate by transrectal longitudinal ultrasound was evaluated for 53 patients with benign prostatic hypertrophy. Sonography was done with a real time linear scanner and 5.0 MHz transducer. Maximal prostatic dimensions were measured along the two major axes, namely the maximal length and the maximal thickness of total prostate and adenoma. By regarding benign prostatic hypertrophy as an ellipsoid, we calculated the weight of prostate according to the ellipsoid formula. The correlation coefficient was calculated as; r = 0.929, Y = 0.942Xt - 2.642 (Xt: total estimated weight), r = 0.962, Y = 0.965Xa + 0.028 (Xa: estimated weight of adenoma). The estimated weight of the prostate correlated with the resected weight of the prostate. These results suggested that rough estimation of the weight of benign prostatic hypertrophy was found to be possible by using this calculation technique.

Outcome of elective prostatectomy.

To determine the symptomatic and urodynamic outcome of elective prostatectomy and to establish whether the outcome is influenced or can be predicted by preoperative urodynamic measurements. Prospective non-randomised study with follow up at a mean of 11 months after operation. Most men were assessed jointly by a urologist and a general practitioner. Department of urology in a teaching hospital serving a large district population. 253 Men listed for elective prostatectomy because of symptoms and low urinary flow rates (less than 15 ml/s) and excluding those already on a waiting list or with acute urinary retention, clinically apparent prostatic cancer, and neurological or cerebrovascular disease; 217 (86%) were followed up. Elective prostatectomy. Classification on the basis of relief of symptoms assessed by patients and urologist and general practitioner and of symptom scores obtained by questionnaire. Of the 217 men followed up, 171 (79%) had a satisfactory subjective review and 155 (72%) had a satisfactory review and also low symptom scores. An unsatisfactory outcome was associated with preoperative symptoms of urge incontinence, small prostatic size and resected weight, low voiding pressures, and low urethral resistance. Preoperative maximum urinary flow rates did not predict outcome. Men with poor outcome could be classified into two groups: those with irritative symptoms who were more likely before operation to have had urge incontinence and detrusor instability and men with symptoms of poor urinary flow who were more likely before operation to have had a small prostate, low voiding pressures, and low urethral resistance. In patients in the second group flow rates or voiding pressures improved little after operation. Men with stable detrusors and either low urethral resistance or low voiding pressures were less likely to do well after prostatectomy, but despite these associations preoperative urodynamic measurements were unable to predict outcome accurately. Prostatectomy was satisfactory in relieving symptoms and improving urodynamic measurements in most men, but even in those with classic symptoms and low urinary flow rates a substantial minority experienced little improvement afterwards and urodynamic measurements did not accurately predict outcome in individual patients.

経腹壁的超音波断層法による簡易前立腺計測方法の検討と評価

We evaluated 107 patients who were diagnosed as benign prostatic hypertrophy preoperatively and underwent transurethral resection of the prostate. We obtained the maximum cross section of the adenoma by transabdominal scanning using a real-time large-sized convex scanner and a 3.5 MNz. transducer. Regarding the adenoma as an ellipsoid with revolution around its transverse axis, 2 diameters (breadth and height) were measured with transverse scan (a and b, respectively). We then calculated the values of the estimated size of the adenoma according to the formula for a spheroid. V = (pi/6) ab2. Thus the calculated weight were correlated with the resected weight of the specimen after a complete transurethral resection of the prostate. As a result, the sonographic estimation provided a high correlation coefficient: r = 0.956. The result suggested that our method of transabdominal ultrasonography in the preoperative evaluation of the prostatic size was rapid, simple and noninvasive, was well adapted for screening sufferers from prostatic diseases, and gave preoperative information for transurethral resection of the prostate and other surgical operation.

Results of follow-up examinations after reduction mammoplasty

164 patients in whom reduction mammoplasty according to Strömbeck had been performed, were followed up and questioned by means of a questionnaire as regards improvement of their preoperative complaints and their satisfaction with the success of the operation. 93% of the complaints were removed or at least alleviated. New complaints occurred in 16% of the women due to the visibility of the scars and scar pain. 51% of the women stated that the operation had been fully satisfactory, whereas 46% made some reservation and 3% were dissatisfied. The following complications were observed: 4 partial necroses of the mammillae, 2 haematomas, 2 wound infections, 2 fatty tissue necroses and 26 secondary sutures. The complications at the mammillae and the blood losses were found to correlate with the amount of resected weight. However, surgical experience was also an important factor, both as regards the complication rate and the cosmetic result, especially in cicatrisation and the shape and seat of the mammillae. On the whole, 69% of the results can be classified as "good", 30% as "satisfactory" and 1% as "poor".

Accuracy of Preoperative Estimation of Resection Weight in Transurethral Prostatectomy

In a prospective study of 150 consecutive transurethral resections of the prostate gland the preoperative estimate of gland weight was compared to the actual resected weight. The data revealed a wide variation between estimated and actual weight in all size glands.