Breast Implants Research Articles

Goldilocks mastectomy; a modified technique enhancing the aesthetic outcome presented as a single center single-arm prospective cohort study

BackgroundGoldilocks mastectomy represents a midway solution for breast reconstruction between flat chest and sophisticated reconstructive techniques. The literature lacks a standardization of the technique. In this study, we present a step-by-step approach with modifications in the original technique achieving better breast shape and contour within the context of standardization of the technique. MethodsA single arm prospective study was conducted at our center in which female patients with large ptotic breasts indicated for mastectomy were included. Patients with locally advanced skin changes, inflammatory carcinoma, stage IV disease as well as male patients were excluded. Recruited patients were subjected to the same surgical steps. Contralateral breast symmetrization was performed by reduction technique to patients who accepted this. All patients were requested to report their degree of satisfaction according to a simple 5-point Likert scale. Follow up mammogram was performed to all patients 1 year after the procedure. ResultsA total of 55 patients were included with a median (IQR) age of 56.0 (50.0–62.0) years. The median (IQR) BMI was 41.20 (36.55–44.35)Kg/m2. The median (IQR)operative time was 115.0 (105.0–120.0) minutes. Complications were encountered in 12 patients (21.8 %). The follow up period ranged from 19 to 66 months with a median (IQR) 36.0 (28.0–45.0)months. 98.2 % of the studied patients were either satisfied or extremely satisfied. ConclusionsGoldilocks mastectomy is a valid mastectomy option for selected patients with large ptotic breasts. Standardization of the surgical steps can help in improving the aesthetic outcome.

Multicentric reticulohistiocytosis with oral and laryngeal involvement in association with autoimmune/inflammatory syndrome induced by adjuvants (ASIA): expanding the spectrum of two uncommon entities.

Multicentric reticulohistiocytosis (MRH) is the most frequent entity in the group of reticulohistiocytoses. It is usually accompanied by a symmetrical erosive polyarthritis and is frequently associated with cancer and autoimmune disorders. Autoimmune syndrome induced by adjuvants (ASIA) is an inflammatory syndrome triggered by adjuvants such as those contained in vaccines or by silicone implants. Here we report a 71-years old female with a history of breast cancer treated with surgery and subsequent prosthesis who developed a systemic hyperinflammatory syndrome including seronegative symmetric polyarthritis, multiple skin lesions and two large nodular lesions in the oral cavity and larynx. Clinical picture was consistent with a clinical diagnosis of ASIA, with breast implant rupture and/or vaccination against SARS-CoV-2 as possible triggers. Histopathology of skin, oral and laryngeal nodules revealed cutaneous/mucous and submucosal infiltration of large epithelioid mononuclear or binucleated cells with fine granular ground glass-like cytoplasm and round to kidney-shaped nuclei with prominent nucleoli, without atypical features or relevant pleomorphism, accompanied by sparse giant cells and lymphocytes. These cells stained positive for CD68 and CD45 and negative for S100, CD1a, and markers of epithelial or neural/melanocytic differentiation, altogether consistent with a diagnosis of reticulohistiocytosis. Clinic-pathological correlation allowed the final diagnosis of MRH. To our knowledge, this is the first report of a co-occurrence of MRH with ASIA and this is relevant to broaden the spectrum of those both rare diseases.

PET/CT Recognition of Costal Cartilage Infection After Breast Implant Surgery.

Postoperative infection of breast implants can lead to implant removal and other complications. This study aimed to investigate the presence of costal cartilage infection following breast implant surgery and the diagnostic role of PET/CT in identifying this rare complication. A retrospective study included 16 patients with persistent infections after breast implant removal surgery. Patients underwent PET/CT scans before surgery, and surgical plans were made based on PET/CT findings. Surgical procedures were guided by PET/CT, and specimens were collected for pathological examination and microbiological culture. Follow-up assessments were performed at 1, 3, and 12 months postoperatively. Among the 16 patients, 11 were diagnosed with costal cartilage infection, whereas 5 had subcutaneous soft tissue infections. PET/CT accurately identified costal cartilage infection in all cases and localized the infected costal cartilage in the majority of cases. Microbiological culture results showed various pathogens. All patients were cured with one or staged surgery. Costal cartilage infection following breast implant surgery is a significant concern. PET/CT plays a crucial role in the accurate diagnosis and localization of infected costal cartilage, aiding in appropriate surgical management. Patients should be closely monitored for the possibility of costal cartilage infection when experiencing persistent symptoms after breast implant surgery.

Women With Breast Implants Have a Higher Adjusted Rate of Cardiac Catheterization but a Lower Rate of Percutaneous Coronary Intervention Consistent With Suspected Higher False-Positive Rates of Cardiac Stress Imaging Due to Breast Implant Interference

Women With Breast Implants Have a Higher Adjusted Rate of Cardiac Catheterization but a Lower Rate of Percutaneous Coronary Intervention Consistent With Suspected Higher False-Positive Rates of Cardiac Stress Imaging Due to Breast Implant Interference

Optimizing Aesthetic Outcomes after Retroglandular Breast Implant Explantation.

The safety of silicone breast implants has been questioned due to concerns such as the risk of associated lymphoma, as well as rheumatological and systemic symptoms. This has resulted in an increased demand for explantation, posing the challenge of addressing stigmas related to implant removal. There is a dearth of literature on techniques for restoring breast contour postexplantation. After implant removal, the original breast anatomy is altered, and depressed areas may manifest in random locations. To reposition the breast tissue displaced by the implant, we enlarge the retroglandular pocket and subsequently use sutures for centripetal traction, relocating the tissue back to the footprint area but now in an improved position, delineating the breast contour. This maneuver enables us to restore the breast contour to an anatomical condition akin to preimplantation; diminish the final explantation defect, creating a more suitable pocket for delicate mastopexy flaps; recruit breast tissue, allowing internal sutures to conceal tissue irregularities; and redesign the breast contour area on the chest to achieve better symmetry.

The Efficacy and Safety Assessment of Sequential Liposuction Modified Double Ring Areola Incision in Moderate and Severe Breast Ptosis Correction.

A total of 42 cases of moderate and severe breast ptosis were treated with sequential liposuction modified double ring areola incision surgery (experimental group), and 45 cases were treated with traditional double ring areola incision alone surgery (control group). They were followed up for 6 months after the operation. The scar formation and breast ptosis repair were observed, and postoperative complications and patient satisfaction were monitored. Better results such as improved postoperative breast appearance were achieved in the sequential liposuction modified double ring areola incision group compared with the double ring areola incision alone group. After treatment, the distance between the midpoint of the inframammary fold and the nipple, the distance between the suprasternal fossa, and the nipple of the two groups were lower than those before treatment. The distance between the midpoint of the inframammary fold and the nipple showed no difference between the two experimental groups. The distance between the suprasternal fossa and the nipple of the experimental group were lower compared with the control group. Lower complication rates and higher satisfaction rates were observed in patients treated with sequential liposuction modified double ring areola incision. The patients in the experimental group were more satisfied with breast symmetry, breast shape, and breast size than those in the control group. The treatment with sequential liposuction modified double ring areola incision was effective and safe compared with double ring areola incision alone. It could improve the breast shape of patients, improve the satisfaction of patients, and reduce the occurrence of complications.

Comparison of Oncological and Aesthetic Outcomes between Tissue Rearrangement Technique and Pedicled Latissimus Dorsi Flap Reconstruction in Cases of Upper Outer Quadrant Breast Cancer.

Emerging as an adjunct to breast-conserving surgery, oncoplastic breast surgery seeks to improve the cosmetic and functional outcomes for breast cancer surgery. The objective was to assess the potential advantages of using the latissimus dorsi (LD) flap, in comparison with local tissue rearrangement, in terms of aesthetic results and postoperative problems. This study compared the outcomes of patients with a malignant tumor removed from the upper outer quadrant of the breast using a comparative nonrandomized control approach. Participants were split into two groups: reconstruction using local tissue rearrangement was performed on 20 patients (group A), and a pedicled LD flap was used to treat the same number of patients (group B). All patients were examined in the clinics' outpatient setting. Every 3 months, the medical oncology team would do a thorough clinical assessment. Better aesthetic outcomes were significantly higher among patients with an LD flap. The LD flap was able to maintain breast shape in 90%, breast volume in 85%, and the nipple-areola complex direction in 90% of patients. Surgeons' evaluation of both techniques reported significantly higher satisfaction for LD flap than local tissue replacement. Patient satisfaction was significantly higher among patients with an LD flap. With regard to the postoperative complications, there were no significant differences between either group. Oncoplastic breast surgery with reconstruction using the pedicled LD flap provides maintenance of the shape of female breasts with better aesthetic outcomes and patient and surgeon satisfaction than reconstruction using local tissue rearrangement, with a comparable complication rate.

71918 - The Swedish Breast Implant Registry (BRIMP) - experience with 50.000 Implants

71918 - The Swedish Breast Implant Registry (BRIMP) - experience with 50.000 Implants

Aqua Breast Augmentation (ABA): Hydrodissection Breast Augmentation Technique.

Breast augmentation is a prevalent procedure in plastic surgery. In this article we present the Aqua Breast Technique (ABA), an approach aimed at enhancing patient satisfaction and reducing downtime. This technique leverages tumescent anesthesia and a small incision in the inframammary fold, avoiding electrocautery and surgical drains, to fulfill the growing demand for painless procedures with minimal recovery periods. The study retrospectively analyzed 238 patients who underwent breast augmentation using the ABA technique at Instituto Rubi between 2021 and 2024. The ABA protocol involves detailed preoperative design, local anesthesia, a precise 3-centimeter incision, careful dissection, and specific postoperative care, emphasizing hydrodissection for tissue separation and the use of smooth round silicone implants through a Keller funnel. The application of the ABA technique to 238 patients, with a mean follow-up time 14months. Ten patients required surgical intervention due to complications. Hematoma and infection rates were 0.42%, while capsulectomies were required in 2.1% of cases. Aqua Breast Augmentation technique has been successfully applied as ahydrodissection-based breast augmentation technique method, with low complication rates, short downtime, and reduced postoperative pain. Level V, therapeutic study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Nanotechnology applications in breast implant manufacturing for improved durability and functionality

Breast implants are often used in restorative and cosmetic surgeries. However, the materials used for implants today could be better regarding biocompatibility and mechanical strength. It is possible to make composite biomaterials out of nanomaterials with better mechanical qualities than common implant materials like silicone elastomers and saline-filled shells. Researchers have found that adding carbon nanotubes, graphene, and hydroxyapatite nanoparticles to the shells of metal and silicone implants makes them much stronger, more flexible, and less likely to break. Researchers are also looking into polymer nanocomposites made of polycaprolactone and polylactic acid to see if they can break down better and integrate better with tissues. Changing the surface of implants at the nanoscale level can make them more biocompatible by controlling how proteins stick to the material and how cells interact with it. Animal tests with nanocoatings of polyacrylate, chitosan, and hyaluronic acid showed that they lowered the formation of capsules and inflammation. Antimicrobial nanoparticles, such as silver, zinc oxide, and antibiotics, are attached to the surfaces of implants to protect against infections and release drugs locally. Nanocontrast agents are used in high-resolution MRI and ultrasound images of implant shell integrity to get new imaging and diagnosis tools. By tracking biomarkers, nanostructured sensors could be used to find seromas, ruptures, and device failures with little to no damage. Much work has been done to show that different nanotechnologies can help breast implants in a pre-clinical setting. However, problems with regulation and standardization still need to be fixed before the implants can be used in people and made in large quantities. The process needs to be improved even more to make a lot of nanocomposite and etched surfaces. To make sure patients are safe, it is also important to do long-term biocompatibility and nanotoxicology tests. Nanotechnology has a lot of promise to change the way breast implants are made so that they look better and improve people's quality of life. This review examines nanotechnology's emerging applications for enhancing breast implants' durability and performance.

Breast implant illness: A United Kingdom patient-centred approach

Silicone breast implants are widely prevalent. An increasing group of patients detail self-reported somatic and psychological symptoms that have been ascribed as breast implant illness (BII) and seek capsulectomy and implant removal. To guide consultations and shared decision making, more outcome data relating to this intervention are required. To present a multicentre study of patient-centred (n = 100) outcome data, following total capsulectomy with implant removal for BII. A questionnaire survey was cross-referenced with medical records. Collected data included demographics, operation details, pre- and postoperative symptom scores, overall self-perceived percentage improvement in BII symptoms and breast shape satisfaction ratings after explantation. The 10 most frequently self-reported symptoms were fatigue (81%), pains/aches (72%), brain/memory fog (56%), mood disturbances (36%), neuropathic pain (28%), hair loss (28%), headaches (25%), gastric symptoms/intolerances (24%), eczema/rash (18%) and vision disturbance (17%). A high proportion of patients (98%) experienced a 62 ± 4% average symptom improvement; most self-reported symptoms (21/28) improved significantly after explantation with total capsulectomy (p < 0.05). Furthermore, patients had high overall self-perceived BII percentage improvement (76 ± 3%) and satisfaction with breast shape numerical rating score (8 ± 0.30) postoperatively. Despite BII not being a defined disease entity, symptom association with silicone breast implants continues for a growing number of patients. It is important to recognise that in this patient group, capsulectomy and implant removal may not be curative, however we have demonstrated that symptom improvement can occur. It is very difficult to prove a causal link between breast implants and BII; to do so will require extensive prospective data collection.

Bacterial Biofilm on Tissue Expander and Acellular Dermal Graft After Breast Reconstruction.

A 27-year-old female underwent bilateral mastectomy with left axillary dissection and had immediate breast reconstruction with textured silicone implants and acellular dermal graft (ADG) reinforcement of the inferior quadrants. The patient was maintained on oral antibiotics postoperatively and initially did well. However, she subsequently presented with fever, erythema, and tenderness in the left chest and was admitted for intravenous antibiotic therapy. Despite improvement of her symptoms, she ultimately cultured positive for Staphylococcus aureus and had the tissue expander and the ADG material explanted. These explanted specimens were immediately examined with confocal microscopy using Live/Dead staining under hydrated conditions for the presence of bacterial biofilms. Biofilm bacteria were clearly visualized adherent to both the tissue expander shell and also to the ADG surface. This is the first direct demonstration of viable bacteria in biofilm configuration on the surface of a tissue expander and acellular dermal graft after breast reconstruction.

A Prospective Observational Clinical Cohort of Women with Suspected Breast Implant Illness.

Background: This study aims to describe a prospective clinical cohort of patients with silicone breast implants and suspected Breast Implant Illness (BII). Methods: Women were included in a specialized silicone outpatient clinic at Amsterdam UMC, the Netherlands. Baseline characteristics were collected including medical history, implant details, and symptoms. Experienced physicians categorized BII suspicion as high, moderate, or low, based on symptoms and after exclusion of other probable causes. Additionally, participants completed questionnaires assessing symptoms and daily life impact at baseline, 6 months, 1, 2, and 5 years. For this initial analysis, the results from the first three years of inclusions were collected. Results: Data from 353 women were collected from December 2020-December 2023. At baseline, the most reported symptoms were fatigue, arthralgia, myalgia, and morning stiffness, accompanied by local symptoms in 83.3% of patients. At the clinic, 112 women were categorized as having high suspicion of BII, 147 women as moderate, and 94 women as low. At follow-up, 182 women (51.6%) opted for explantation. Following explantation, women with a high or moderate suspicion of BII experienced more significant symptom improvement, accompanied by a decrease in anxiety and a greater sense of control over their illness, compared to women with a low suspicion of BII. Conclusions: Our study highlights a distinct interplay of systemic and local symptoms among women with suspicion of BII. Women with a high or moderate BII suspicion benefit significantly more from explantation than women with low suspicion. Experienced physicians are pivotal in effectively assessing and guiding this patient group, highlighting the need for tailored clinical approaches.

Outcomes of In-Office, High Resolution, Ultrasound Silicone Breast Implant Surveillance by Plastic Surgeons.

Implant rupture is a known complication in cosmetic breast surgery but access and cost barriers hinder proper implant surveillance. This study aims to validate High Resolution Ultrasound (HRUS) for diagnosing silicone implant rupture, and secondarily, explore the predictors of implant rupture in a single-surgeon cohort. A retrospective chart review identified patients who underwent HRUS of silicone breast implants that were placed by the senior author (WPA). HRUS sensitivity/specificity and predictive values were calculated. Multivariable logistic regression assessed predictors of implant rupture. Kaplan-Meier methods estimated 10 and 15-year implant survival. Among 254 patients (508 implants) included, 52 patients (104 implants) underwent operative exploration for various reasons; 20 implants had confirmed ruptures. Examining this operative cohort, HRUS had excellent positive and negative predictive value, respectively, 100% (95% CI 83.1-100%) and 97.6% (95% CI 91.6-99.3%); the sensitivity was 90.9% (95% CI 70.8-98.9%) and specificity was 100% (95% CI 95.6%-100%). The median age of the implant at the time of ultrasound was 119 months (10 years; IQR 79-152 months). After multivariable adjustment, the only the implant age was a significant predictor of implant rupture (p=0.04). Across the entire cohort, Kaplan-Meier methods estimated a 10-year and 15-year implant survival rate of 0.98 (95% CI 0.96-0.99) and 0.80 (95% CI 0.71-0.87), respectively. Subgroup analysis showed 10 and 15-year implant survival rates of 0.99 and 0.92, respectively, for surveillance-only HRUS patients. Plastic surgeon delivered office-based HRUS surveillance is a highly sensitive and specific method to assess silicone breast implant integrity.

Breast Implant Removal-Only: The Role of Targeted Compression.

The number of women seeking explantation of their breast implants has increased in recent years. Anxiety due to potential health problems has been one of the major catalysts. Mastopexy with or without autoaugmentation and fat grafting are the main techniques used in breast implant removal surgery. To analyse the aesthetic and satisfactory outcomes after simple breast implant removal assisted by targeted compression. Twenty-eight patients were included in the series. Targeted compression of the breast after implant removal was performed during the 1st month. A satisfaction survey using a Likert scale was used before and after the final visit. The patients were followed up for 1year. The mean age of the patients was 41years old, and the mean time between implantation and removal was 10years. Subjective reasons for removal (46.4% of the patients) were more frequent in women with less time since implantation (5 years) versus 15years for implant-related problems. A total of 57.14% of the women were satisfied with the aesthetic result, and 42.86% were very satisfied. Only 17.8% of the total would consider an aesthetic refinement. Simple breast implant removal yields good aesthetic outcomes, and patients are satisfied with the results. Good management of compression of the breast and close follow-up to treat any collection in the pocket provides good adhesion and allows for effective management of the process of deflation and setting of the breast mound. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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

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

The Prevalence and Histological Characteristics of the Double Capsule Phenomenon in Breast Augmentation With Implants.

Double capsule formation around breast implants is associated with implant rotation and seroma. However, the prevalence and histological characteristics remain unclear. To quantify the prevalence of double capsule formation between different implant surface textures and to explore the histological differences between the inner- and outer capsules from breast implant capsule biopsies. The study was performed on data from the Copenhagen Breast Implant (COBI) Biobank comparing the prevalence of double capsule formation around Allergan Biocell implants (Allergan, Dublin, Ireland), Eurosilicone Cristalline implants (GC Aesthetics, Dublin, Ireland), and Mentor Siltex implants (Mentor, Irvine, CA). The histological characteristics of the inner and outer capsules was analyzed using a validated assessment tool. The study included data from 588 patients and 1128 implants. Double capsule formation was found around 25 implants resulting in an overall prevalence of 2.5% for textured implants. Mentor implants with a Siltex surface had a double capsule prevalence of 0.72%, which was significantly lower than the prevalence for Allergan implants with a Biocell surface (7.8%), (P<.001), and Eurosilicone implants with a Cristalline surface (3.4%), (P=.03). Histological analysis showed that inner capsules had lower cellular density (P=.04) and were more calcified (P=.03) compared with outer capsules. The risk of double capsule formation was highly correlated with the roughness of the breast implant texture, with the risk of double capsule formation around Mentor Siltex implants being significantly lower than that of macrotextured implants. The histological analysis implies that loss of vascularization to the inner capsule results in a lower cellular density and more frequently calcification.

Clinical application of endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants

To investigate the effectiveness of endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants. The clinical data of 138 female patients with breast cancer who met the selection criteria between April 2019 and December 2023 were retrospectively analyzed. The mean age of the patients was 43.8 years (range, 27-61 years). The maximum diameter of the tumors ranged from 1.00 to 7.10 cm, with an average of 2.70 cm. Pathological examination showed that 108 cases were positive for both estrogen receptor and progesterone receptor, and 40 cases were positive for human epidermal growth factor receptor 2. All patients underwent endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants. The operation time, intraoperative blood loss, prosthesis size, and occurences of nipple-areola complex (NAC) ischemia, flap ischemia, infection, and capsular contracture were recorded. The Breast-Q2.0 score was used to evaluate breast aesthetics, patient satisfaction, and quality of life (including the social mental health score, breast satisfaction score, and chest pain score). Patients were divided into two groups based on the time of operation after the technique was implemented: group A (within 1 year, 25 cases) and group B (after 1 year, 113 cases). The above outcome indicators were compared between the two groups. Furthermore, based on the postoperative follow-up duration, patients were classified into a short-term group (follow-up time was less than 1 year) and a long-term group (follow-up time was more than 1 year). The baseline data and postoperative Breast-Q2.0 scores were compared between the two groups. The average operation time was 120.76 minutes, the average intraoperative blood loss was 23.77 mL, and the average prosthesis size was 218.37 mL. Postoperative NAC ischemia occurred in 21 cases (15.22%), flap ischemia in 30 cases (21.74%), infection in 23 cases (16.67%), capsular contracture in 33 cases (23.91%), and prosthesis removal in 2 cases (1.45%). The operation time of group A was significantly longer than that of group B ( P<0.05), and there was no significant difference in intraoperative blood loss, prosthesis size, and related complications between the two groups ( P>0.05). All patients were followed up 3-48 months (mean, 20 months). There were 33 cases in the short-term group and 105 cases in the long-term group. There was no significant difference in baseline data such as age, body mass index, number of menopause cases, number of neoadjuvant chemotherapy cases, number of axillary lymph node dissection cases, breast cup size, degree of breast ptosis, and postoperative radiotherapy constituent ratio between the two groups ( P>0.05). At last follow-up, the breast satisfaction score in the patients' Breast-Q2.0 score ranged from 33 to 100, with an average of 60.9; the social mental health score ranged from 38 to 100, with an average of 71.3; the chest pain score ranged from 20 to 80, with an average of 47.3. The social mental health score of the long-term group was significantly higher than that of the short-term group ( P<0.05); there was no significant difference in breast satisfaction scores and chest pain scores between the two groups ( P>0.05). No patient died during the follow-up, and 2 patients relapsed at 649 days and 689 days postoperatively, respectively. The recurrence-free survival rate was 98.62%. Endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants has fewer complications and less damage, and the aesthetic effect of reconstructed breast is better.

Effectiveness of sequential method pure single-port lumpectomy-breast conserving surgery for early-stage breast cancer in different quadrants

To compare the effectiveness of sequential method pure single-port lumpectomy-breast conserving surgery (SMPSL-BCS) in treating early-stage breast cancer patients with tumors in different quadrants. A retrospective analysis was conducted on 200 early-stage breast cancer female patients admitted between January 2023 and December 2023. According to the quadrant where the tumor was located, the patients were allocated into the upper outer quadrant group (UO group), lower outer quadrant group (LO group), upper inner quadrant group (UI group), and lower inner quadrant group (LI group), with 50 cases in each group. There was no significant difference ( P>0.05) in the baseline data, including age, body mass index, smoking history, marital status, comorbidities, affected breast side, maximum tumor diameter on ultrasound, maximum pathological tumor diameter, clinical tumor stage, molecular subtype, and disease duration. The operation time, intraoperative blood loss, postoperative drainage volume, and extubation time were recorded and compared between groups. Additionally, the occurrence of early-stage complications (1-3 months after operation; including subcutaneous fluid accumulation, incision infection, superficial skin burns) and late-stage complications (>3 months after operation; including pectoralis major muscle adhesion, changes in breast appearance and shape, sensory discomfort) were assessed. At 6 months after operation, the cosmetic outcome of breast-conserving surgery was rated for all groups. The UO group had the shortest operation time, followed by the UI group, LO group, and LI group, showing significant differences between groups ( P<0.05). The UO group had the least intraoperative blood loss, followed by the LO group, UI group, and LI group; except for the difference between UO group and LO group, which was not significant ( P>0.05), the differences between the other groups were significant ( P<0.05). The UO group had the least postoperative drainage volume, followed by the LO group, UI group, and LI group; except for the difference between LO group and UI group, which was not significant ( P>0.05), the differences between the other groups were significant ( P<0.05). The extubation time of the LI group was significantly longer than that of the other groups ( P<0.05). All patients were followed up 4-12 months, with an average of 8 months. And 193 patients were followed up more than 6 months, including 48 patients in UO group, 47 in LO group, 49 in UI group, and 49 in LI group. In the early-stage period, the LI group had a higher incidence of subcutaneous fluid accumulation after tube removal compared to the UO group and LO group ( P<0.05), while there was no significant difference in the incidences of other early complications between groups ( P>0.05). In the late-stage period, the LI group had significantly higher incidences of pectoralis major muscle adhesion and changes in breast appearance and shape than UO group and LO group ( P<0.05), and a significantly higher incidence of sensory discomfort than UO group ( P<0.05). There was no significant difference in the incidences of other late-stage complications between groups ( P>0.05). At 6 months after operation, the cosmetic outcomes of breast-conserving surgery were significantly better in UO group, LO group, and UI group than in LI group ( P<0.05); there was no significant difference between the other groups ( P>0.05). In the treatment of early-stage breast cancer using SMPSL-BCS, patients with tumors located in the upper outer quadrant show the best effectiveness. The effectivenesses are similar for patients with tumors in the lower outer and upper inner quadrants. However, patients with tumors in the lower inner quadrant do not experience significant advantages. Therefore, it is recommended that SMPSL-BCS should not be the first-choice surgical method for patients with tumors in the lower inner quadrant.

Effectiveness comparison of endoscopic removal of injectable Amazingel with/without immediate prepectoral implant-based breast augmentation

To explore the surgical technique and preliminary safety and aesthetic results of endoscopic removal of injectable Amazingel with/without immediate prepectoral implant-based breast augmentation for patients. The clinical data of 25 patients who underwent endoscopic removal of injectable Amazingel with/without immediate prepectoral implant-based breast augmentation between April 2020 and January 2024 and met the selection criteria was retrospective analysed. The patients' age ranged from 33 to 73 years, with a mean of 50.4 years, and the body mass index ranged from 16.8 to 26.6 kg/m 2, with a mean of 21.5 kg/m 2. They were all bilaterally injected with Amazingel, and the time between initial injections and surgery ranged from 17 to 26 years, with a mean of 21.4 years. Early safety was evaluated by the incidence of early postoperative complications, and early aesthetic results were evaluated using Harris scores (including breast shape satisfaction, sensation satisfaction, and elasticity satisfaction) at 3 months after operation. There were 9 cases underwent Amazingel removal (group A) and 16 cases underwent Amazingel removal with immediate prepectoral implant-based breast augmentation (group B). Intraoperative removal of Amazingel ranged from 808 to 1 285 mL, with a mean of 1 050.7 mL; the mass of the capsule removed ranged from 36 to 169 g, with a mean of 103.6 g; and a gross anatomical prosthesis was used with a median size of 345 mL (range, 315-355 mL). The operation time ranged from 95 to 395 minutes, with a mean of 194.2 minutes; and the cost of the procedure ranged from 8000to 91 000 yuan, with a mean of 33 000 yuan. Patients had a median follow-up time of 22.7 months (range, 3.0-48.1 months). There was 1 case of intraoperative skin burn due to the operation of the electric scalpel, which healed naturally after operation without flap necrosis. There was no adverse conditions such as prosthesis outline showing, ripple sign, and capsular contracture during follow-up; a small amount of Amazingel residue was found in 2 patients at 1 year after operation. The Harris score at 3 months after operation was used to evaluate the early aesthetic results, and the breast shape, elasticity, and sensation satisfaction of group A were lower than group B, but the differences between the two groups were not significant ( P>0.05). Endoscopic removal of injectable Amazingel with/without immediate prepectoral implant-based breast augmentation is safe in the early stage with good aesthetic results, and it is also recommended that patients who had the indications for combined immediate breast augmentation after removal to rebuild the breast appearance.