Breast surgery

A primary objective of aesthetic and recon-structive breast operations is to restore normal, satisfactory for the patient, presentation of the breasts. Successful breast surgery requires preoperative evaluation, selection of an appropriate operative technique, and analysis of surgical outcomes as a basis for future clinical advancements. This puts particular emphasis on the understanding of breast beauty components. Because of its subjective character, the term "breast aesthetics" is poorly defined and thus its reliable standardized assessment can be particularly challenging. 1-9 Background: Because of its subjective character, the term "breast attractive-ness" is poorly defined and thus its reliable standardized assessment can be particularly challenging. Because of objective analysis of the observer's gaze pattern, eye-tracking technology may provide a better insight into the visual perception of breast aesthetics and symmetry. Methods: One hundred observers, 50 women and 50 men, assessed the aesthetics and symmetry of eight types of female breasts displayed as digital images on frontal, lateral, and oblique projections. The gaze pattern of each observer was recorded using eye-tracking technology, and gaze data were subsequently analyzed. Results: Although sex and breast type exerted an effect on attention capturing by some areas of interest, key characteristics of gaze patterns in female and male observers were essentially the same. Irrespective of observers' sex, the longest fixation duration and the highest fixation number were recorded for lower breast regions, in particular, for the nipple-areola complex. Mean fixation duration in this area corresponded to 58 and 57 percent of overall observation time for female and male observers, respectively, during the assessment of breast aesthetics; and to 56 and 52 percent of overall observation time for female and male observers, respectively, during the assessment of breast symmetry. Conclusions: Nipple-areola complex and lower breast are key focus areas for the assessment of breast aesthetics and symmetry. Gaze data collected during this study may constitute a valuable source of reference values for future eye-tracking research on various patient groups' visual perception of breast attractiveness and deformities. (Plast.

We read with interest "Breast Augmentation and Augmentation-Mastopexy With Local Anesthesia and Intravenous Sedation," by Colque and Eisemann. The article prompted us to share with your readers the novel ultrasound-guided anesthetic techniques we use in breast surgery.

This report provides the results of our research concerning the oncological safety of pectoralis fascia (PF) preservation in modified radical mastectomy (MRM) and it’s usefulness. As the PF can be an excellent aid in implant based reconstruction, to demonstrate in which cases PF invasion is not to be expected is of ultimate importance. To our knowledge, no papers in the literature have clearly demonstrated the clinical and pathological factors that correlates with invasion of the PF. We studied the specimens from 30 cases of MRM in order to establish those factors. Tumor characteristics including histopathological and immunohistochemical data were recorded, and statistical analysis was used to search association between them and the possibility of PF invasion. The demonstration that tumor-PF distance is the only significant independent variable to predict this invasion allow us to safely preserve PF in selected cases. Better image methods to preoperatively foretell this distance are an open field of research.

The aim of this paper is to describe the figure of the Italian surgeon Iginio Tansini (1855–1943), who was full professor of surgery and director of the Department of Surgery at the University of Pavia (1903–1931). In that period, he modernized the School of Surgery founded by Antonio Scarpa (1752–1832) in the previous century; he introduced the experimental method in the discipline. One of his major contributions was an innovative technique of mastectomy followed by plastic reconstruction with myocutaneous flap. Tansini was a pioneer in oncology, supporting the importance of an early diagnosis based on a biopsy; he was also the first in Italy to practice a gastrectomy for stomach cancer with success in 1887.

Objective:  To determine the frequency of early breast cancer in women presenting with palpable breast lumps.
Study design:  Prospective cohort study.
Place & Duration of study:  Surgical Unit - IV Civil Hospital Karachi, from December 2011 to June 2012.
Methodology: All female patients 13 year and above with palpable breast lumps were recruited in this study after seeking their consent. Triple assessment was carried out and core biopsies taken. Histopathology reports were recorded. To determine the frequency of early breast cancer in women presenting with palpable breast lumps.
Results: Two hundred and eighty two females between 15 to 80 year (mean= 36.5 year) presented with breast lumps. Of the total 72% (n=199) lumps were benign on histopathology while 29 % (n=83) showed malignancy. There were 19 (7%) cases of breast abscess.
Conclusion: The frequency of breast cancer was 29% in present group of patients presenting with breast lumps.

Background: Lumpectomy is a standard surgery for breast cancer; however, it results in breast deformity, especially after radiation therapy. Wider surgical margin correlates lower local recurrence rate. However, bigger defect brings worse cosmetic outcome. The use of a simple filler for the defect is expected. We aimed to improve the cosmetic outcome by using an absorbable Vicryl mesh for breast reconstruction immediately post-lumpectomy. Methods: One sheet of Vicryl woven mesh was prepared for insertion, washed the cavity with natural saline, and placed into the space. The cosmetic outcome was scored for the size, shape, scar, and softness of the breast. The size, shape, color, and position of the nipple eareola complex were also scored. Adverse events were collected retrospectively. Results: From April 2008 to October 2014, 24 female patients received immediate Vicryl mesh insertion. A lumpectomy only group was recruited for cosmetic analysis. All patients received postsurgical radiotherapy. The mean cosmetic assessment score was 8.0 and 9.1 of 12 for the Vicryl mesh group and lumpectomy only group, respectively (P Z 0.17). Sixteen patients had adverse events such as erythema at approximately 2 weeks post-surgery. No significant differences were shown except adverse events between two groups. No patient has had local recurrence thus far. Conclusion: Immediate Vicryl mesh insertion leads to significantly increased incidence of post-operative complications and delay in commencement of adjuvant radiotherapy. Furthermore, the cosmetic outcomes are not superior to that of no reconstruction. The development of superior biomaterials is anticipated for breast reconstruction after lumpectomy.