Conservation therapy for breast cancer following augmentation mammaplasty

Breast conservation therapy (wide local excision, axillary lymph node dissection, and whole-breast irradiation) is an increasingly popular alternative to mastectomy for breast cancer patients. A sizable (and growing) number of breast cancers occur in women with prior augmentation mammaplasty. Augmented breast cancer patients are currently being treated with conservation therapy, but no study has investigated complications and cosmetic results of radiation therapy specifically in this group of women. Between 1981 and 1988, we used conservation therapy in 17 augmented breast cancer patients. Fifteen patients were available for follow-up. In 10 (67 percent), significant capsular contracture occurred in the irradiated breast an average of 12 weeks following completion of treatment. Four patients have undergone revisionary surgery to correct symptoms arising from contracture. This poor outcome contradicts the results reported in previously published studies. We conclude that irradiation of the breast for cancer in augmented women results in a high incidence of scar-tissue contracture and poor cosmetic results.     

Diagnosis and management of seroma following breast augmentation: an update

This article is an update to the decision and management algorithms for management of periprosthetic space infection or seroma following breast augmentation, originally published in "Decision and Management Algorithms to Address Patient and Food and Drug Administration Concerns Regarding Breast Augmentation and Implants," published in the October 2004 issue of this Journal. This update specifically addresses additional diagnosis and management alternatives for management of seroma in breast augmentation patients that may relate to lymphoproliferative disorders or anaplastic large cell lymphoma.     

Pectoralis major "trapdoor" flap for silicone breast implant medial knuckle deformities.

Loss of breast parenchyma through surgery and physiologic involution can lead to problems of subglandular silicone breast implant palpability and even contour irregularities. This can give rise to patient concern and detracts from the aesthetics of the breast augmentation, particularly when it occurs medially. We present a simple solution to this problem on the medial side of the breast in the form of a small segmental medially based pectoralis major "trapdoor" flap that augments the implant soft-tissue cover intracapsularly, at the site where it is deficient. The technique, which has been used with success in five patients over 3 years, is described.     

Equilibrium and a two-stage batch adsorber design for reactive or disperse dye removal to minimize adsorbent amount

The adsorption of a reactive dye (Reactive Yellow K-4G) and a disperse dye (Disperse yellow brown S-2RFL) onto polyepicholorohydrin-dimethylamine (EPIDMA) cationic polymer modified bentonite (EPIDMA-bentonite) in batch adsorber was studied, respectively. Two equilibrium models, the Langmuir and Freundlich models were selected to follow the adsorption process. It was shown that the equilibrium experimental data for reactive dye adsorption could be well described by the Freundlich model, but for disperse dye the Langmuir model could be better. Based on the well correlated adsorption isotherm, an adsorption process design model was developed for the design of a two-stage batch adsorber to predict the minimum amount of adsorbent to achieve a specified percentage of dye removal at a given volume of wastewater effluents. The adsorption process design analysis indicated that compared with the single-stage batch adsorption, the two-stage process could significantly save adsorbent to meet the higher demands of dye removal efficiency.     

The safety and efficacy of breast implants for augmentation mammaplasty

This review of the efficacy and safety of breast implants was intended to focus on our current body of knowledge about these devices. There are informational gaps, but not all of these can be laid at the door of imperfect studies or failed scientific methods. Certain properties of the implants are still unmeasurable, immunologic investigation is still evolving, the cause of wound contraction is inexplicable here or in the burnscar contracture, and the indications for and results of this surgery necessarily are subjective. Still, there are a number of investigative avenues open to us, and our cumulative experience shows no reluctance on the part of plastic surgeons to initiate further studies.     

Evaluating breast parenchymal maldistribution with regard to mastopexy and augmentation mammaplasty

Mammary parenchymal maldistribution or lower-pole hypoplasia, a first cousin of the tubular breast deformity, is a common condition complicating the selection of patients for retropectoral augmentation mammaplasty and/or mastopexy. The eccentric mammary parenchyma must be released from the pectoral fascia to obtain good results with augmentation mammaplasty and to minimize the necessity for mastopexy.     

Function of the left cardiac ventricle in "pure" aortic insufficiency prior to and following valve replacement with a biological prosthesis

Contractibility of the left ventricle was investigated in 15 patients with chronic aortic insufficiency with class II and III NYHA lesions. The patients were examined prior to and 6 months-2 years after valve replacement with biological prosthesis. The following parameters have been determined: end-systolic and end-diastolic left ventricular volumes, ejection fraction, mean rate of circular muscle fibers shortening, and segmental contractibility of the left ventricle. Valve replacement with biological prosthesis improved contract ability of the left ventricle in the great majority of the operated patients with chronic aortic insufficiency. Assessed parameters did not correlate well with those obtained following valve replacement.     

"Apron" flap and re-creation of the inframammary fold following TRAM flap breast reconstruction

To the best of our knowledge, the recreation of an inframammary fold after TRAM flap breast reconstruction has not yet been described. This article offers a technique for the creation of an inframammary fold as a secondary procedure. The technique has been performed thus far in two patients with good aesthetic outcomes and no postoperative complications. It may also be suitable for adding bulk to the TRAM flap, especially in bilateral breast reconstruction, and for other minor chest deformities.     

Bone remodelling around the tibia due to total ankle replacement: effects of implant material and implant–bone interfacial conditions

Abstract

One of the major causes of implant loosening is due to excessive bone resorption surrounding the implant due to bone remodelling. The objective of the study is to investigate the effects of implant material and implant–bone interface conditions on bone remodelling around tibia bone due to total ankle replacement. Finite element models of intact and implanted ankles were developed using CT scan data sets. Bone remodelling algorithm was used in combination with FE analysis to predict the bone density changes around the ankle joint. Dorsiflexion, neutral, and plantar flexion positions were considered, along with muscle force and ligaments. Implant–bone interfacial conditions were assumed as debonded and bonded to represent non-osseointegration and fully osseointegration at the porous coated surface of the implant. To investigate the effect of implant material, three finite element models having different material combinations of the implant were developed. For model 1, tibial and talar components were made of Co–Cr–Mo, and meniscal bearing was made of UHMWPE. For model 2, tibial and talar components were made of ceramic and meniscal bearing was made of UHMWPE. For model 3, tibial and talar components were made of ceramic and meniscal bearing was made of CFR-PEEK. Changes in implant material showed no significant changes in bone density due to bone remodelling. Therefore, ceramic appears to be a viable alternative to metal and CFR-PEEK can be used in place of UHMWPE. This study also indicates that proper bonding between implant and bone is essential for long-term survival of the prosthetic components.