Mammographic changes following reduction mammaplasty

Mammographic findings after reduction mammaplasty may be similar to those seen with carcinoma. A knowledge of the expected mammographic alterations would be helpful in differentiating postoperative changes from those seen with carcinoma of the breast. Accordingly, the clinical records and mammograms of patients who underwent reduction mammaplasty at the Dartmouth-Hitchcock Medical Center between March of 1977 and July of 1985 were analyzed. Forty-two patients had at least one mammographic examination following reduction mammaplasty. Periareolar soft-tissue changes and inferior pole alterations were present in almost all examinations of patients during the first 6 months after operation, but they decreased during the next few years. Asymmetrical densities were present in approximately half the patients throughout the follow-up period but decreased in degree. Parenchymal calcifications occurred later; few x-rays showed these calcifications during the first year, but 50 percent were apparent after 2 years. Evidence of fat necrosis occurred in approximately 10 percent. Four patients had biopsies for suspicious densities. Chronic inflammation and inclusion cyst were reported. We believe that changes after reduction mammaplasty are predictable and can usually be differentiated from those associated with cancer.     

Blood loss in major liposuction procedures: a comparison study using suction-assisted versus ultrasonically assisted lipoplasty.

The blood loss that accompanies liposuction procedures has always been a concern. Tumescent injection of the targeted area of liposuction with dilute lidocaine and epinephrine solution has minimized intraoperative blood loss. Proponents of a newer ultrasonically assisted lipoplasty technique have claimed many benefits over traditional suction-assisted lipoplasty. However, few quantitative data are available on the intraoperative blood loss and the significance of postoperative anemia using the ultrasonic method. A prospective clinical observational design was used to investigate 38 patients undergoing suction-assisted lipoplasty and 37 patients undergoing ultrasound-assisted lipoplasty in whom the liposuction aspirate was expected to be more than 1000 ml. These patients were investigated with preoperative measurement of hemoglobin, platelet count, prothrombin time, partial thromboplastin time, and postoperative measurement of hemoglobin on the seventh postoperative day. In addition, hemoglobin concentration and whole blood volume were calculated from the infranatant portion of the liposuction aspirate. The mean +/- SD volume of the liposuction aspirate was 2901 +/- 1471 ml for suction-assisted compared with 2741 +/- 1086 ml for ultrasound-assisted lipoplasty. The mean +/- SD of whole blood volume in liposuction aspirate per case was 36 +/- 50.82 ml for suction-assisted lipoplasty and 36 +/- 28.62 ml for ultrasound-assisted lipoplasty. The mean +/- SD of the preoperative hemoglobin concentration was 13.93 +/- 0.99 g/dl for suction-assisted lipoplasty and 14.05 +/- 1.16 g/dl for ultrasound-assisted lipoplasty, whereas the mean +/- SD of the postoperative hemoglobin concentration was 13 +/- 1.42 g/dl for suction-assisted lipoplasty and 13.05 +/- 1.32 g/dl for ultrasound-assisted lipoplasty. The mean decrease in hemoglobin on the seventh postoperative day was 0.93 +/- 0.92 g/dl for suction-assisted lipoplasty and 1 +/- 0.64 g/dl for ultrasound-assisted lipoplasty. The volume of whole blood loss was estimated to be 12.4 ml in each 1000 ml of liposuction aspirate when using suction-assisted lipoplasty versus 13.1 ml when using ultrasound-assisted lipoplasty. All procedures were done under general anesthesia, and patients were discharged home on the same day. No blood transfusion was required. This study shows that blood loss using the ultrasonic technique is slightly higher, though insignificant, than when using suction. However, this study did not demonstrate a difference in the postoperative hemoglobin decrease between the two techniques.     

Laboratory and histopathologic comparative study of internal ultrasound-assisted lipoplasty and tumescent lipoplasty

Despite the advantages of using internal ultrasound-assisted lipoplasty instead of the classic tumescent lipoplasty, such as reduced bleeding and tissue damage, the authors found no objective or comparative study of these techniques in humans. For this reason, they conducted a clinical study to determine the amount of bleeding and tissue damage caused by each of the techniques. A simple clinical assay was accomplished at the Jalisco Plastic Surgery Institute on seven female patients scheduled for abdominal lipectomy. Two similar sections of the surgical area were marked for lipoplasty techniques: classic tumescent lipoplasty on one side and internal ultrasound-assisted lipoplasty on the other. Both areas were treated simultaneously by surgeons experienced in each technique. Laboratory tests and histologic studies were performed on the aspirated material and the manipulated tissue, respectively. The fluids sent to the laboratory were analyzed to determine the amount of bleeding and tissue damage. In the laboratory, the degree of lesion and tissue damage was evaluated in the dermis, nerves, blood vessels, and adipose cells. With internal ultrasound-assisted lipoplasty, indicators of tissue damage such as glutamic oxalacetic transaminase, pyruvic oxalacetic transaminase, cholinesterase, and myoglobin showed higher values than with tumescent lipoplasty. The same was found for hemoglobin levels and in the histologic data indicative of tissue damage; both values were statistically significant at < 0.001. Internal ultrasound-assisted lipoplasty was not demonstrated to be more innocuous or to have a selective effect in adipose cells, and it generally resulted in more tissue damage and bleeding than the classic tumescent technique.     

Comparative lipoplasty analysis of in vivo-treated adipose tissue

A comparative histologic and chemical analysis was undertaken of adipose tissue treated in vivo with traditional, ultrasound-assisted, and external ultrasound-assisted lipoplasty. A series of six healthy women undergoing elective liposuction according to the superwet technique using a 1:1 infiltration ratio with the estimated quantity of fat to be removed was included in the study. Four separate regions on each patient were treated independently in vivo with traditional liposuction, internal ultrasound-assisted liposuction, or external ultrasound-assisted liposuction for 7 minutes. External massage was used as a control. Four separate specimens of adipose tissue from each patient were assessed for cellular disruption using blinded histologic evaluation. The remainder of tissue was centrifuged to separate the aqueous phase from the cellular components and then spectrophotometrically analyzed for creatinine kinase and glycerol 3-phosphate dehydrogenase activity as markers of cellular disruption. Histologic analysis confirmed 70 to 90 percent cellular disruption with internal ultrasound-assisted liposuction. Suction-assisted and external ultrasound-assisted liposuction showed 5 to 25 percent disruption, whereas massage controls showed only 5 percent. Only internal ultrasound-assisted liposuction showed 5 to 20 percent thermal liquefaction. Absorbance analysis showed creatine kinase activity (sigma units) greatest in ultrasound-exposed tissue. Both external and internal ultrasound-assisted liposuction gave creatine kinase levels 28 to 33 percent greater than suction-assisted liposuction, which varied only 10 percent from controls. Glycerol 3-phosphate dehydrogenase activity was 44 percent greater for internal ultrasound-assisted liposuction than that detected with suction-assisted liposuction. Glycerol 3-phosphate dehydrogenase activity with external ultrasound-assisted liposuction and massage did not vary much from each other, at only 14 percent and 11 percent activity compared with internal ultrasound-assisted liposuction, respectively. Histologic and enzyme analysis of the different types of liposuction and their effect on adipocyte cellular disruption revealed no significant effect of external ultrasound or massage on the adipocytes. Further experimental studies are necessary to evaluate the role and efficacy of alternative techniques for body contouring.     

Agreement of Mammographic Measures of Volumetric Breast Density to MRI

Background

Clinical scores of mammographic breast density are highly subjective. Automated technologies for mammography exist to quantify breast density objectively, but the technique that most accurately measures the quantity of breast fibroglandular tissue is not known.

Purpose

To compare the agreement of three automated mammographic techniques for measuring volumetric breast density with a quantitative volumetric MRI-based technique in a screening population.

Materials and Methods

Women were selected from the UCSF Medical Center screening population that had received both a screening MRI and digital mammogram within one year of each other, had Breast Imaging Reporting and Data System (BI-RADS) assessments of normal or benign finding, and no history of breast cancer or surgery. Agreement was assessed of three mammographic techniques (Single-energy X-ray Absorptiometry [SXA], Quantra, and Volpara) with MRI for percent fibroglandular tissue volume, absolute fibroglandular tissue volume, and total breast volume.

Results

Among 99 women, the automated mammographic density techniques were correlated with MRI measures with R² values ranging from 0.40 (log fibroglandular volume) to 0.91 (total breast volume). Substantial agreement measured by kappa statistic was found between all percent fibroglandular tissue measures (0.72 to 0.63), but only moderate agreement for log fibroglandular volumes. The kappa statistics for all percent density measures were highest in the comparisons of the SXA and MRI results. The largest error source between MRI and the mammography techniques was found to be differences in measures of total breast volume.

Conclusion

Automated volumetric fibroglandular tissue measures from screening digital mammograms were in substantial agreement with MRI and if associated with breast cancer could be used in clinical practice to enhance risk assessment and prevention.     

乳腺癌人类表皮生长因子受体2表达与X线表现的相关性分析

目的：对比分析人类表皮生长因子受体2（HER-2）阳性和阴性乳腺癌X线特征,探讨乳腺癌X线征象与HER-2基因之间的相关性。方法：回顾性分析经手术病理确诊的1153例女性乳腺癌患者的X线表现,根据免疫组织化学结果分为HER-2阳性组（314例）和HER-2阴性组（839例）。对比分析两组乳腺癌肿块和钙化的X线特征,肿块主要分析形态、边界及边缘,钙化主要分析形状及分布形式,并对各项分析结果进行X2检验,P〈0.05为差异性有统计学意义。结果：HER-2阳性组乳腺癌较阴性组多表现为钙化（X2=42.528,P=0.001）,HER-2阴性组乳腺癌X线表现多为单纯肿块（389/839,X2=16.374,P=0.001）。星芒状肿块在HER-2阴性组比例较高（57/514,X2=5.912,P=0.015）,两组类圆形（P=0.480）、分叶状（P=0.111）、不规则形肿块（P=0.152）分布比例则无明显统计学差异。HER-2阳性组乳腺癌肿块边界多模糊不清（X2=8.319,P=0.004）,阴性组肿块边界多为部分清楚（X2=5.818,P=0.016）。HER-2阳性组乳腺癌钙化形态多表现为沙砾状（X2=8.955,P=0.001）、多形性和不定形（X2=7.137,P=0.001）,分布形式无明显统计学差异。结论：HER-2阳性乳腺癌X线表现钙化居多,且多为沙砾状、多形性和不定形钙化,肿块边界多模糊不清;HER-2阴性乳腺癌多表现为单纯肿块,边界多为部分清楚,星芒状肿块多见。     

Radiotransparency of the triglyceride mammary prosthesis: a quantitative analysis with mastectomy specimens.

Breast cancer is the most frequent malignant tumor in women. It is estimated that 10 percent of women will present with a breast cancer during their lives. It is well known that mammography is the best technique for the early diagnosis of nonpalpable tumors, thus improving life expectancy. However, mammary prostheses may hide between 23 and 82 percent of the normal mammary tissue in mammography, and thus may delay the diagnosis of malignant mammary tumors, making prognosis worse. To solve this problem, oil-filled prostheses have been developed. In this study, 14 mastectomy specimens were used. Mammograms of the tissue pieces alone and also mammograms of the tissue pieces covering a 270-cc Trilucent prosthesis were used to verify whether the prosthesis allows observation of malignant signs in mammography. Mammograms were evaluated by an independent experienced radiologist. The following variables were studied: number of mammograms necessary to examine each specimen; kilovoltage and milliamperage necessary for each mammogram; number of microcalcification groups (malignant); number of macroscopic calcifications (benign); and rarefaction areas that were suspected for malignancy. All of these variables were measured for both mammograms for which the mastectomy specimens were covering and those for which the specimens were not covering the prothesis. Finally, the kilovoltage and milliamperage increases necessary to visualize the mammograms with mastectomy specimens covering the prosthesis were determined. Statistical analysis of the results obtained was performed. There were no significant differences in the number of mammograms (p = 0.391), the number of microcalcifications (p = 0.890), the number of macrocalcifications (p = 0.239), and finally in the presence of rarefaction areas (p = 1.000) observed in the mammograms in specimens either covering or not covering the prosthesis. However, there were significant differences (p < 0.001) between the kilovoltage and milliamperage applied to carry out the mammograms of specimens with and without the prosthesis. Thus, Trilucent prostheses allow visualization of the microscopic and macroscopic calcifications as well as rarefaction areas in mammograms. However, these mammograms required a higher kilovoltage and milliamperage compared with specimens not covering the prosthesis. To explore the whole gland, it might be necessary to perform two series of mammograms: one to detect the area shadowed by the prosthesis and one to observe the rest of the peripheral gland.     

Beyond Breast Cancer: Mammographic Features and Mortality Risk in a Population of Healthy Women

Background

Breast fibroglandular (dense) tissue is a risk factor for breast cancer. Beyond breast cancer, little is known regarding the prognostic significance of mammographic features.

Methods

We evaluated relationships between nondense (fatty) breast area and dense area with all-cause mortality in 4,245 initially healthy women from the Breast Cancer Detection Demonstration Project; 1,361 died during a mean follow-up of 28.2 years. Dense area and total breast area were assessed using planimeter measurements from screening mammograms. Percent density reflects dense area relative to breast area and nondense area was calculated as the difference between total breast area and dense area. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by Cox proportional hazards regression.

Results

In age-adjusted models, greater nondense and total breast area were associated with increased risk of death (HR 1.17, 95% CI 1.10-1.24 and HR 1.13, 95% CI 1.06-1.19, per SD difference) while greater dense area and percent density were associated with lower risk of death (HR 0.91, 95% CI 0.86-0.95 and HR 0.87, 95% CI 0.83-0.92, per SD difference). Associations were not attenuated with adjustment for race, education, mammogram type (x-ray or xerogram), smoking status, diabetes and heart disease. With additional adjustment for body mass index, associations were diminished for all features but remained statistically significant for dense area (HR 0.94, 95% CI 0.89-0.99, per SD difference) and percent density (HR 0.93, 95% CI 0.87-0.98, per SD difference).

Conclusions

These data indicate that dense area and percent density may relate to survival in healthy women and suggest the potential utility of mammograms beyond prediction of breast cancer risk.     

Detection of Architectural Distortion in Prior Mammograms via Analysis of Oriented Patterns

We demonstrate methods for the detection of architectural distortion in prior mammograms of interval-cancer cases based on analysis of the orientation of breast tissue patterns in mammograms. We hypothesize that architectural distortion modifies the normal orientation of breast tissue patterns in mammographic images before the formation of masses or tumors. In the initial steps of our methods, the oriented structures in a given mammogram are analyzed using Gabor filters and phase portraits to detect node-like sites of radiating or intersecting tissue patterns. Each detected site is then characterized using the node value, fractal dimension, and a measure of angular dispersion specifically designed to represent spiculating patterns associated with architectural distortion.Our methods were tested with a database of 106 prior mammograms of 56 interval-cancer cases and 52 mammograms of 13 normal cases using the features developed for the characterization of architectural distortion, pattern classification via quadratic discriminant analysis, and validation with the leave-one-patient out procedure. According to the results of free-response receiver operating characteristic analysis, our methods have demonstrated the capability to detect architectural distortion in prior mammograms, taken 15 months (on the average) before clinical diagnosis of breast cancer, with a sensitivity of 80% at about five false positives per patient.     

Macroaggregated calcifications in cancer of the breast

Breast cancer is characterized by the presence of multiple aggregated microcalcinates. However, the authors managed to detect 6 cases of breast cancer with macroaggregate calcifications, of which 3 were not adequately imaged on mammograms. Morphological investigations in all cases have shown that macroaggregate calcifications that are typical of benign lesions, are also detectable in breast cancer. The absence of an image of calcification on mammograms is probably accountable for by its various density.     

Microcalcifications in breast cancer: From pathophysiology to diagnosis and prognosis

The implementation of mammographic screening programmes in many countries has been linked to a marked increase in early detection and improved prognosis for breast cancer patients. Breast tumours can be detected by assessing several features in mammographic images but one of the most common are the presence of small deposits of calcium known as microcalcifications, which in many cases may be the only detectable sign of a breast tumour. In addition to their efficacy in the detection of breast cancer, the presence of microcalcifications within a breast tumour may also convey useful prognostic information. Breast tumours with associated calcifications display an increased rate of HER2 overexpression as well as decreased survival, increased risk of recurrence, high tumour grade and increased likelihood of spread to the lymph nodes. Clearly, the presence of microcalcifications in a tumour is a clinically significant finding, suggesting that a detailed understanding of their formation may improve our knowledge of the early stages of breast tumourigenesis, yet there are no reports which attempt to bring together recent basic science research findings and current knowledge of the clinical significance of microcalcifications. This review will summarise the most current understanding of the formation of calcifications within breast tissue and explore their associated clinical features and prognostic value.     

Effect of low-level laser therapy on abdominal adipocytes before lipoplasty procedures

Low-level laser therapy is a new subspecialty for the medical application of lasers that provides therapeutic rather than surgical outcomes for many medical indications. Recently, low-level laser therapy was reported to "liquefy" or release stored fat in adipocytes by the opening of specialized yet not identified cell membrane-associated pores after a brief treatment. Currently, low-level laser therapy is a U.S. Food and Drug Administration-approved technology for improving pain alleviation. To explore these data further, a series of in vitro studies on human preadipocytes and institutional animal care and use committee-approved protocols in a porcine Yucatan model and an institutional review board-approved clinical study were performed. Using a 635-nm low-level laser of 1.0 J/cm supplied to the authors by the vendor, these studies were designed to determine whether alteration in adipocyte structure or function was modulated after low-level laser therapy. Cultured human preadipocytes after 60 minutes of laser therapy did not change appearance compared with nonirradiated control cells. In the porcine model, low-level laser therapy (30 minutes) was compared with traditional lipoplasty (suction-assisted lipoplasty) and ultrasound-assisted lipoplasty. From histologic and scanning electron microscopic evaluations of the lipoaspirates, no differences were observed between low-level laser therapy-derived and suction-assisted lipoplasty-derived specimens. Using exposure times of 0, 15, 30, and 60 minutes in the presence or absence of superwet wetting solution and in the absence of lipoplasty, total energy values of 0.9 mW were delivered to tissue samples at three increasing depths from each experimental site. No histologic tissue changes or specifically in adipocyte structure were observed at any depth with the longest low-level laser therapy (60 minutes with superwet fluid). Three subjects undergoing large-volume lipoplasty were exposed to superwet wetting fluid infiltration 14 minutes before and 12 minutes after, according to vendor instructions. Tissue samples from infiltrated areas were collected before suction-assisted lipoplasty and lipoaspirates from suction-assisted lipoplasty. No consistent observations of adipocyte disruptions were observed in the histologic or scanning electron microscopy photographs. These data do not support the belief that low-level laser therapy treatment before lipoplasty procedures disrupts tissue adipocyte structure.     

Optical assessment of mammographic breast density by a 12‐wavelength vs a continuous‐spectrum optical spectroscopy device

A 12‐laser‐wavelength, fixed source‐detector position, cup‐based optical breast spectroscopy (OBS) device was developed for use in large‐scale, multicenter trials as a mammographic breast density (MBD) quantification and breast cancer (BC) risk prescreening tool. In this study, the device was evaluated in comparison with a spectrometer‐based device used in previous studies. The devices were compared on their ability to predict mammographic percent density (MPD) and to identify women with high MBD from optical spectra. OBS measurements were made on 60 women, (age 29‐73), using both devices. Recent mammograms were collected for all women and MPD quantified from the mammograms. Principal components (PCs) analysis was performed on both sets of OBS spectra, and multivariate logistic regression analysis of the resulting PC scores was used to identify women with high MBD. Both devices are able to identify high MBD with very high sensitivity and specificity. Partial least‐squares regression of the spectra was used to predict MPD. Both devices show a strong correlation between OBS‐predicted MPD and MPD read from mammograms, however, the correlation is stronger for the continuous‐spectrum device (r = 0.74, P = .001) than for the 12‐wavelength device (r = 0.62, P = .004). Improvements to the cup‐based device to reduce detector saturation should improve the prediction of MPD from the spectra.      

Deep venous thrombosis and pulmonary embolus after face lift: a study of incidence and prophylaxis

Deep venous thrombosis and pulmonary embolus are known risks of surgery. However, the incidence of these conditions in face lift is unknown. In this study, the incidence of deep venous thrombosis/pulmonary embolus after face lift is studied and factors associated with thromboembolic complications are evaluated. One-third of the active members of the American Society for Aesthetic Plastic Surgery were randomly selected. Participating surgeons completed a one-page survey providing information on face-lift procedures during a 12-month study period. A response rate of 80 percent was achieved, with 273 of the 342 surgeons responding to the survey. A total of 9937 face-lift procedures were reported in the 1-year study period. There were 35 patients with deep venous thrombosis (0.35 percent), 14 patients with pulmonary embolus (0.14 percent), and 1 patient death in the series. Although 43.5 percent of patients underwent face lift under general anesthesia, 83.7 percent of deep venous thrombosis/pulmonary embolus events occurred with general anesthesia. For prophylaxis for deep venous thrombosis/pulmonary embolus, 19.7 percent of the surgeons used intermittent compression devices, 19.6 percent used thromboembolic disease hose or Ace wraps, and 60.7 percent used no prophylaxis. Of patients developing deep venous thrombosis/pulmonary embolus, 4.1 percent were treated prophylactically with intermittent compression devices, 36.7 percent with thromboembolic disease hose/Ace wraps, and 59.2 percent with no prophylaxis. It was found that deep venous thrombosis/pulmonary embolus after face lift is a measurable complication experienced by one of nine surgeons surveyed. Deep venous thrombosis/pulmonary embolus is more likely to occur when the procedure is performed under general anesthesia. The majority of plastic surgeons surveyed used no prophylaxis for deep venous thrombosis when performing face-lift procedures. Intermittent compression devices were associated with significantly fewer thromboembolic complications, whereas Ace wrap/thromboembolic disease hose afforded no protection against deep venous thrombosis/pulmonary embolus when used alone. In conclusion, aesthetic surgeons should consider adopting intermittent compression devices when performing face lift under general anesthesia.     

Evidence That Breast Tissue Stiffness Is Associated with Risk of Breast Cancer

Background

Evidence from animal models shows that tissue stiffness increases the invasion and progression of cancers, including mammary cancer. We here use measurements of the volume and the projected area of the compressed breast during mammography to derive estimates of breast tissue stiffness and examine the relationship of stiffness to risk of breast cancer.

Methods

Mammograms were used to measure the volume and projected areas of total and radiologically dense breast tissue in the unaffected breasts of 362 women with newly diagnosed breast cancer (cases) and 656 women of the same age who did not have breast cancer (controls). Measures of breast tissue volume and the projected area of the compressed breast during mammography were used to calculate the deformation of the breast during compression and, with the recorded compression force, to estimate the stiffness of breast tissue. Stiffness was compared in cases and controls, and associations with breast cancer risk examined after adjustment for other risk factors.

Results

After adjustment for percent mammographic density by area measurements, and other risk factors, our estimate of breast tissue stiffness was significantly associated with breast cancer (odds ratio = 1.21, 95% confidence interval = 1.03, 1.43, p = 0.02) and improved breast cancer risk prediction in models with percent mammographic density, by both area and volume measurements.

Conclusion

An estimate of breast tissue stiffness was associated with breast cancer risk and improved risk prediction based on mammographic measures and other risk factors. Stiffness may provide an additional mechanism by which breast tissue composition is associated with risk of breast cancer and merits examination using more direct methods of measurement.     

Risk stratification of women with false-positive test results in mammography screening based on mammographic morphology and density: A case control study

BackgroundThe long-term risk of breast cancer is increased in women with false-positive (FP) mammography screening results. We investigated whether mammographic morphology and/or density can be used to stratify these women according to their risk of future breast cancerMethodsWe undertook a case-control study nested in the population-based screening programme in Copenhagen, Denmark. We included 288 cases and 288 controls based on a cohort of 4743 women with at least one FP-test result in 1991–2005 who were followed up until 17 April 2008. Film-based mammograms were assessed using the Breast Imaging-Reporting and Data System (BI-RADS) density classification, the Tabár classification, and two automated techniques quantifying percentage mammographic density (PMD) and mammographic texture (MTR), respectively. The association with breast cancer was estimated using binary logistic regression calculating Odds Ratios (ORs) and the area under the receiver operating characteristic (ROC) curves (AUCs) adjusted for birth year and age and invitation round at the FP-screenResultsSignificantly increased ORs were seen for BI-RADS D(density)2-D4 (OR 1.94; 1.30-2.91, 2.36; 1.51-3.70 and 4.01; 1.67-9.62, respectively), Tabár’s P(pattern)IV (OR 1.83; 1.16-2.89), PMD Q(quartile)2-Q4 (OR 1.71; 1.02-2.88, 1.97; 1.16-3.35 and 2.43; 1.41-4.19, respectively) and MTR Q4 (1.97; 1.12-3.46) using the lowest/fattiest category as referenceConclusionAll four methods, capturing either mammographic morphology or density, could segregate women with FP-screening results according to their risk of future breast cancer − using already available screening mammograms. Our findings need validation on digital mammograms, but may inform potential future risk stratification and tailored screening strategies     

Classification and management of gynecomastia: defining the role of ultrasound-assisted liposuction

Gynecomastia, or excessive male breast development, has an incidence of 32 to 65 percent in the male population. This condition has important physical and psychological impacts. Advances in elucidating the pathophysiology of gynecomastia have been made, though understanding remains limited. Recommendations for evaluation and workup have varied and are often arbitrary. A diagnostic algorithm is suggested, with emphasis on a comprehensive history, physical examination, and minimizing unnecessary diagnostic testing. Medical management has had limited success; surgical therapy, primarily through excisional techniques, has been the accepted standard. Although effective, excisional techniques subject patients to large, visible scars. Ultrasound-assisted liposuction has recently emerged as a safe and effective method for the treatment of gynecomastia. It is particularly efficient in the removal of the dense, fibrous male breast tissue while offering advantages in minimal external scarring. A new system of classification and graduated treatment is proposed, based on glandular versus fibrous hypertrophy and degree of breast ptosis (skin excess). The authors' series of 61 patients with gynecomastia from 1987 to 2000 at the University of Texas Southwestern Department of Plastic Surgery demonstrated an overall success rate of 86.9 percent using suction-assisted lipectomy (1987 to 1997) and ultrasound-assisted liposuction (1997 to 2000). The authors have found ultrasound-assisted liposuction to be effective in treating most grades of gynecomastia. Excisional techniques are reserved for severe gynecomastia with significant skin excess after attempted ultrasound-assisted liposuction.     

Evaluation of the sensitivity of a medical data-mining application to the number of elements in small databases

Data-mining methods can be used to generate rules, or identify patterns, from medical data to assist clinical diagnosis and decision-making. However, in the initial stages of a clinical study on a new diagnostic approach, there could be a limited medical dataset available; or the medical characteristics could mean that the number of patients involved in the study will never be large. Diagnoses made using the rules discovered from such small medical databases should be considered suspect unless a confidence range for a particular diagnosis can be established. A method to evaluate the sensitivity and reliability of data-mining with small databases is presented in this paper. Efron's bootstrap method for statistical testing was used to assess the accuracy of the rules produced during the training step of the data-mining algorithm. The case study for validating this new approach was based on a limited-sized mammographic database previously used to discover associations between the diagnostic features of breast masses in mammograms and the biopsy-based classification of the masses. Using the new approach, it was possible to distinguish between the association rules that were sensitive to the size of the training datasets from those that were not. The methods proposed should lead to an efficient way for validating the patterns discovered in medical data-mining applications using small datasets.     

Lipoplasty claims experience of U.S. insurance companies

An analysis of medical liability claims for lipoplasty (liposuction) from January of 1985 through June of 1998 compared the insurance industry experience of plastic surgeons with that of other physicians. The Data Sharing Project database of the Physician Insurers Association of America, a trade association of professional liability companies owned and operated by medical professionals that collectively insure approximately 60 percent of America's private practice physicians, was queried. Of the nearly 45,000 total entries in the database, 292 were claims for adverse events related to lipoplasty or liposuction. These raw data were stratified by physician specialty, severity of complication, practice location, patient gender, indemnity payment, and other insurance industry-relevant variables.To simplify interspecialty comparisons, we normalized the claims rate to incidents per 100 insured physicians. The indexed lipoplasty claims rate was 3.0 per 100 insured plastic surgeons and 4.1 for other surgeons; the indexed lipoplasty claims rate for nonsurgical specialists was 2.5 per 100 insured dermatologists and 2.3 for other nonsurgeons. The higher claims rate for surgeons most likely reflects the wider scope of full-service aesthetic surgery performed by surgical specialists. Nearly two-thirds of claims (65.4 percent) during the 13-year survey period were the result of hospital-based lipoplasty; 20.9 percent were office-based claims. The prevalence of hospital-based claims may be a consequence of both historical bias introduced by hospital-based specialty surgery in the early years and prudent patient safety considerations during performance of complex or prolonged procedures in more recent years.Two-thirds of the claims (67 percent) arose from informed-consent or breach-of-contract issues, far higher than the 26 percent aggregate claims norm. The mean indemnity payment was $94,534 per lipoplasty claim; claims paid against board-certified specialists averaged $83,350. Consistent with national lipoplasty demographics, 87 percent of claims were brought by women and 13 percent were brought by men. Seven fatalities (three women and four men) were noted; cause of death is not recorded in this type of database.     

Vertical mammaplasty: early complications after 250 personal consecutive cases.

No surgeon likes to face complications. It takes effort to treat them personally and more effort to note, count, analyze, and demonstrate them. The author carefully followed 250 personal consecutive patients (476 breasts) who underwent vertical mammaplasties between 1990 and 1998; studying the complications and their relationship with the types of breasts and patients was very instructive. The main observations from this study follow. The most frequent benign complication was seroma (5 percent of breasts), which usually required one or two aspirations after surgery. Hematomas occurred in six patients (1.2 percent of breasts), who had all had mastopexies. Hematomas required immediate surgical evacuation. The major complication of breast reduction, i.e., areola necrosis, was rare (only two partial necroses occurred), but it left deformities that were difficult to correct. Infection without tissue necrosis was rare (two cases), and healing complications happened in only 5.4 percent of all cases. Healing complications were directly related to the size and fat content of the breasts. None occurred in mastopexy cases. For reductions, delayed skin healing was observed in 5 percent of cases and delayed breast tissue healing in 3 percent of cases. More healing complications occurred after liposuction of the breast, which was performed in the more fatty breasts. Delayed healing of skin and breast tissue was bothersome because healing was slow, but it left only a moderate deformity. In cases of delayed healing, frequent dressings, rinsing the wound with antiseptic solutions, giving antibiotics if needed, and refraining from early surgical intervention are the keys to success. Good personal contact with the patient, especially if healing is slow, is the best way of helping her and avoiding aggressive attitudes. In conclusion, this survey revealed few complications; however, it does show that the risk of delayed and slow healing is greater in larger breasts. In obese patients, a simpler operation may be indicated, such as liposuction with skin reduction alone or a free nipple graft, as long as the patient is not motivated to obtain the best possible result.