ABSTRACT
In order to provide a physiological solution for patients with breast cancer-related lymphedema (BCRL), the surgeon must understand where and how the pathology of lymphedema occurred. Based on each patient’s pathology, the treatment plan should be carefully decided and individualized. At the authors’ institution, the treatment plan is made individually based on each patient’s symptoms and relative factors. Most early-stage patients first undergo decongestive therapy and then, depending on the efficacy of the treatment, a surgical approach is suggested. If the patient is indicated for surgery, all the points of lymphatic flow obstruction are carefully examined. Thus a BCRL patient can be considered for lymphaticovenous anastomosis (LVA), a lymph node flap, scar resection, or a combination thereof. LVA targets ectatic superficial collecting lymphatics, which are located within the deep fat layer, and preoperative mapping using ultrasonography is critical. If there is contracture on the axilla, axillary scar removal is indicated to relieve the vein pressure and allow better drainage. Furthermore, removing the scars and reconstructing the fat layer will allow a better chance for the lymphatics to regenerate. After complete removal of scar tissue, a regional fat flap or a superficial circumflex iliac artery perforator flap with lymph node transfer is performed. By deciding the surgical planning for BCRL based on each patient’s pathophysiology, optimal outcomes can be achieved. Depending on each patient’s pathophysiology, LVA, scar removal, vascularized lymph node transfer with a sufficient adipocutaneous flap, and simultaneous breast reconstruction should be planned.
ABSTRACT
In order to provide a physiological solution for patients with breast cancer-related lymphedema (BCRL), the surgeon must understand where and how the pathology of lymphedema occurred. Based on each patient’s pathology, the treatment plan should be carefully decided and individualized. At the authors’ institution, the treatment plan is made individually based on each patient’s symptoms and relative factors. Most early-stage patients first undergo decongestive therapy and then, depending on the efficacy of the treatment, a surgical approach is suggested. If the patient is indicated for surgery, all the points of lymphatic flow obstruction are carefully examined. Thus a BCRL patient can be considered for lymphaticovenous anastomosis (LVA), a lymph node flap, scar resection, or a combination thereof. LVA targets ectatic superficial collecting lymphatics, which are located within the deep fat layer, and preoperative mapping using ultrasonography is critical. If there is contracture on the axilla, axillary scar removal is indicated to relieve the vein pressure and allow better drainage. Furthermore, removing the scars and reconstructing the fat layer will allow a better chance for the lymphatics to regenerate. After complete removal of scar tissue, a regional fat flap or a superficial circumflex iliac artery perforator flap with lymph node transfer is performed. By deciding the surgical planning for BCRL based on each patient’s pathophysiology, optimal outcomes can be achieved. Depending on each patient’s pathophysiology, LVA, scar removal, vascularized lymph node transfer with a sufficient adipocutaneous flap, and simultaneous breast reconstruction should be planned.
ABSTRACT
Background@#Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder involving the nervous system characterized by the development of neurofibromas throughout the body. Patients with NF1 are also known to have cognitive, behavioral, social, and emotional problems. Using the Symptom Checklist-90-Revision (SCL-90-R) questionnaire, we aimed to assess the psychological characteristics of NF1 patients seeking surgery at a tertiary hospital. @*Methods@#Adult NF1 patients visiting a plastic surgery outpatient clinic between March 2018 and March 2020 were enrolled in this study. The presence and intensity of psychopathological symptoms were assessed using 10 domains, including the General Severity Index (GSI). Standard T-scores were used to compare the results to population-based norms. The impact of demographic factors was also analyzed. @*Results@#In total, 65 patients were included in the study. The mean GSI of all patients was 43.7, and the mean score of the other nine domains was 45.3. No scores deviated from the population-based normal ranges. Nonetheless, women had significantly higher mean T-scores than men in a few domains, including the GSI, obsessive-compulsive disorder, depression, and anxiety. Most of the other characteristics, such as age, education, marital status, family history, and tumor site did not have significant effects. @*Conclusions@#Adult NF1 patients who visit plastic surgery clinics for elective surgery have psychopathological characteristics that do not differ from the general population according to the SCL-90-R. The results of this study can be considered in consultations with these patients.