The incidence of obscure carcinoma in subcutaneous mastectomy. Results of a national survey.

A national survey of plastic surgeons has been conducted to determinr the incidence of occult breat carcinoma in patients having a subcutaneous mastectomy. The results are reported herein. We believe subcutaneous mastectomy is the most effective prophylactic procedure presently available that is acceptable to women who have a high risk of developing breast cancer.     

A breast-halving incision for subcutaneous mastectomy.

A new "breast-halving incision" for subcutaneous mastectomy is described. It has particular advantages in the large breast, where the incidence of complications is much higher. Its main disadvantage is the length of the incision, which runs across the equator of the breast. However, subcutaneous mastectomy is not primarily a cosmetic operation. The improved results in immediate reconstruction would seem to justify this approach.     

皮下乳腺切除术治疗乳腺增生伴癌症临床分析

目的:探讨皮下乳腺切除术治疗乳腺增生伴癌症的临床疗效和预后分析。方法:随机选取2009年1月至2012年2月在我院就诊乳腺增生伴癌症女性患者68例,均为已婚已育女性,随机分为观察组和对照组,观察组35例给予乳房切除术治疗,对照组33例给予药物保守治疗,观察并比较两组的临床疗效、美容效果和预后情况。结果:观察组临床有效率高达88.57%,显著高于对照组(66.67%)(P<0.05);观察组美容效果良好率为74.29%显著高于对照组(30.30%)(P<0.01);观察组局部复发率、再住院率和死亡率均低于对照组,差异具有统计学意义(P<0.05)。结论:乳腺切除术治疗乳腺增生伴癌症不但安全性高、操作简便、疗效显著、预后好,而且能满足形体要求又能保留其乳腺功能,值得临床进一步的推广和研究。     

Paget's disease of the breast after subcutaneous mastectomy and reconstruction with a silicone prosthesis

Eight years after subcutaneous mastectomy for extensive fibrocystic disease, a patient developed Paget's disease of the breast associated with an underlying infiltrating duct cell adenocarcinoma. We emphasize the need for meticulous examination of the subcutaneous mastectomy specimen and long-term follow-up examination of the breasts in patients treated with subcutaneous mastectomy.     

Fluorescein test for prediction of flap viability during breast reconstructions.

The fluorescein test is a useful ancillary procedure for predicting the viability of breast flaps in reconstructive procedures after subcutaneous mastectomy or radial mastectomy.     

The effectiveness of prophylactic subcutaneous mastectomy in Sprague-Dawley rats induced with 7,12-dimethylbenzanthracene

Fifty-day-old female, albino Sprague-Dawley rats were induced with DMBA, a potent carcinogen that reliably causes multiple breast tumors. Prophylactic subcutaneous mastectomy was performed 2 weeks after injection. Control animals had no breast tissue removed and developed 5.14 tumors per animal, or 1.3 tumors per quadrant. Animals subjected to 50 percent (unilateral) mastectomy developed 5.4 tumors per animal, with 0.72 tumors per surgical quadrant. Animals that underwent 75 percent (three quadrant) mastectomy developed 4.33 tumors per animal, or 0.48 tumors per surgical quadrant. The incidence of tumors was significantly reduced in the surgical areas. However, the risk of any animal developing a breast neoplasm was not reduced in direct proportion to the percentage of breast tissue removed. We believe that this model may prove valuable in evaluating prophylactic subcutaneous mastectomy.     

乳腺癌保乳改良根治术与传统改良根治术临床疗效的比较

目的:对比分析保乳改良根治术与传统改良根治术治疗乳腺癌的临床疗效。方法:将行手术治疗的415例女性乳腺癌患者按手术方式分为保乳改良根治术组76例与传统改良根治术组339例,两组患者术后均接受辅助治疗。比较两组患者术后满意度,术后并发症,复发、转移及死亡率,评价保乳改良根治术的临床疗效。结果:两组患者的发病年龄,术后病理类型,失随访情况,转移、死亡及复发率比较无统计学意义(P0.05)。保乳改良根治术组皮下积液发生率明显低于传统改良根治术组(P0.05),术后满意度明显优于传统改良根治术组(P0.05),其他并发症比较无显著差异(P0.05)。结论:保乳改良根治术能得到和传统改良根治术同样的疗效,且具有损伤小、并发症少、外形美观、术后满意度高等优势。     

Breast reconstruction utilizing subcutaneous tissue expansion followed by polyurethane-covered silicone implants: a 6-year experience

Reconstruction of the breast after modified radical mastectomy can be safely and adequately performed in the subcutaneous plane. Placement of a subcutaneous tissue expander (as either an immediate or a delayed procedure), rapid expansion over a 3- to 4-month period, capsulotomy, and placement of a polyurethane-coated implant have led to satisfactory results over a 6-year period. Breast reconstruction methods are well documented; however, the utilization of expanded subcutaneous chest wall skin has not been reported heretofore.     

Breast reconstruction using an inflatable breast implant with detachable reservoir

An inflatable breast implant having a detachable filling reservoir is described. Once in position, the implant can be filled under controlled conditions postoperatively. The implant functions either as a tissue expander or as a delayed-filling implant in the initial stages of the procedure. Once the desired breast size is achieved, the reservoir is removed, leaving the filled implant in position. This implant has been used successfully in various types of breast reconstructive procedures, including both primary and secondary reconstruction following modified mastectomy, immediate reconstruction following subcutaneous mastectomy, secondary reconstruction following radical mastectomy combined with the latissimus dorsi flap, and following the removal of silicone gel implants with associated capsular contracture. A total of 23 patients, representing 34 breasts, are reported on. The results have been encouraging over a period of 20 months of follow-up.     

Alternatives to subcutaneous mastectomy.

It is our belief that subcutaneous mastectomy often leads to complications, with poor results. In addition, because a considerable amount of breast tissue may be left behind, its value as a prophylactic operation must be questioned. Two alternatives are presented. In our experience, these lead to fewer complications with a more thorough removal of the mammary gland, and achieve a better appearance. The alternatives are (1) simple mastectomy with secondary reconstruction; (2) the type of mastectomy described by Spira--with primary reconstruction using a subpectoral silicone prosthesis covered by muscle and an inferiorly-based dermal flap.     

"Apple coring" the nipple in subcutaneous mastectomy

A simple technique is described for removing the ductal tissue from the nipple in a subcutaneous mastectomy. We believe that complete removal of all the ductal tissue is desirable in this operation, and that it will also decrease the incidence of subsequent infection. The operative technique, the problems, the advantages, and the disadvantages of the procedure are described.     

Breast Reconstruction for Malignant or Premalignant Disease

In ten patients breast reconstruction was done after surgical treatment for a premalignant or malignant breast disease. In six of these, prophylactic subcutaneous mastectomy and implant reconstruction were carried out, and in the remaining four reconstruction was done after simple or modified radical mastectomy. It is suggested that these procedures should be considered by those physicians and surgeons who undertake evaluation and treatment of breast disease in women. Breast reconstruction should be considered and offered to patients who suffer from the severe personal and emotional trauma attendant to surgical operation for breast disease.     

Extra-abdominal desmoid arising from a capsule around a silicone breast implant.

Musculo-aponeurotic fibromatosis is an extremely rare lesion in the breast, only 16 previous cases having been reported. The unilateral tumor in our patient occurred after subcutaneous mastectomy and bilateral placement of implants. The histological evidence suggests that this tumor arose from the capsule surrounding one of the implants.     

Intraductal extension of silicone from a ruptured breast implant.

Silicone rupture is a known complication of closed capsulotomy. Imaging of silicone within breast tissue after rupture of an implant is not uncommon. Intraductal extension of silicone on mammography is a very rare finding. This case report described the imaging features of silicone within the breast tissue and ducts that necessitated subcutaneous mastectomy for definitive treatment.     

Experience with 50 free TRAM flap breast reconstructions

The data from the first 50 patients undergoing free TRAM flap breast reconstruction in two units were examined. Average patient age was 42 years, and average weight was 62 kg. Forty percent of patients were chronic smokers, and 26 percent had low abdominal scars. Twelve percent exercised their abdominal muscles regularly. Eighteen percent had undergone radical mastectomy, whereas 76 percent had undergone modified radical mastectomy and 6 percent had undergone subcutaneous mastectomy. Postoperative radiotherapy had been given in 16 percent of patients, and 54 percent had received postoperative chemotherapy. The average time from mastectomy was 32 months, whereas six breasts were reconstructed immediately. Average operating time was 5.6 hours, and average blood loss was 2.4 units. Average hospital stay was 11.2 days. Complications included three total flap losses (6 percent) and two partial flap losses (4 percent). Abdominal hernia occurred in two patients (4 percent).     

Conservative management in full-thickness nipple-areolar necrosis after subcutaneous mastectomy

Nipple-areolar necrosis is a known and expected complication in a small percentage of patients undergoing subcutaneous mastectomy, especially with concomitant mastopexy or in smokers. Impending ischemia or congestion of the areola can often be ameliorated by simple maneuvers such as suture release. When full-thickness necrosis occurs, conservative management with essential debridement, dressings, and careful wound hygiene alone will often yield a surprisingly good result, requiring little or no revisional surgery.     

Transfer of free flaps to provide well-vascularized, thick cover for breast reconstructions after radical mastectomy.

The use of a free flap to bring in well-vascularized cover for a breast reconstruction (following radical mastectomy) is presented. Eleven of 12 such transfers were successful. (One free groin glap failed, and that reconstruction was abandoned.) Patients for breast reconstruction who have a marked deficiency of healthy, well-vascularized skin and subcutaneous tissue in the area are suitable candidates for this operative procedure. When a free groin flap is transferred, the donor defect is minimal.     

Surgical management of silicone mastitis

The results of the operative treatment of 22 cases of silicone mastitis are presented. Moderate involvement can usually be managed successfully by local excision of the masses, or by a subcutaneous mastectomy with later reconstruction. Patients with severe skin infiltration and/or pectoral muscle involvement are prone to complications, however, and we now believe an aggressive approach--such as a complete mastectomy with nipple banking and excision of the infiltrated muscle, might be best. This would allow the later reconstruction to proceed in relatively uninvolved tissue, and prevent the problems of recurrent inflammation from placing bag-gel prostheses in a residual bed of silicone-infiltrated tissue.     

An improved technique for immediate retropectoral reconstruction after subcutaneous mastectomy

Subcutaneous mastectomy is becoming an operation of choice in certain cases of premalignant and other breast pathology. We describe a technique for simultaneous subcutaneous mastectomy and retropectoral implantation of a silicone prosthesis. Gentle blunt prepectoral, retromammary dissection is performed through an axillary incision as far inferiorly as the inframammary fold, where a fibrous bridge between the anterior surface of the pectoralis major muscle and the skin prevents dissection any lower. Through the same incision, the retropectoral space is dissected to about 5 cm below the inframammary fold. A second incision is made in the inframammary fold to join the retromammary plane of the first dissection. The gland is then dissected subcutaneously and removed through the inframammary incision. A silicone implant is introduced retropectorally through the axillary incision, thus avoiding splitting the pectoralis major. Satisfactory results have been obtained in 23 bilateral and 14 unilateral cases; it is important that the dissection be performed carefully in order to prevent the implant from riding up too high in its musculoaponeurotic sling.     

Treatment of breast contractures with open capsulotomy and replacement of gel prostheses with polyurethane-covered implants

Capsular contracture around gel and gel-saline implants is the most common complication following breast augmentation and reconstruction. Thirty-one patients with postaugmentation gel-implant contractures were treated with open capsulotomy and replacement with polyurethane-covered implants. Eighty-seven percent remain soft after a minimum follow-up of 14 months. Results of replacement after subcutaneous mastectomy and reconstruction are more varied and less successful. Results in 14 patients are presented.