Absorbable versus conventional methods for wound closures in surgeries for benign breast diseases: a randomized case control study

Background: Surgeons and patients prefer absorbable sutures for surgical wound closure in breast surgeries which are usually continuous subcuticular sutures so that patients can skip a hospital visit for suture removal. But in case of breast biopsies authors usually put circumareolar incisions. Here authors find it difficult to put continuous subcuticular sutures. In this contest authors thought of interrupted subcuticular sutures where authors can tackle the above-mentioned limitations; while actually reducing the financial burden of the patients.Methods: In this randomized case controlled study authors included elective general surgical procedures for benign breast diseases that was being carried out in the department of General Surgery Govt. Medical College, Kottayam for a period of 6 months starting from January 2017. Total number of cases taken are 20; 10 each in each group.Results: The mean rank for interrupted method was 14.20 and conventional method was 6.80. Mann-Whitney U statistic was 13.000 and p value was 0.03. Since p value was less than 0.05, authors had clear evidence to reject the null hypothesis. Therefore, authors concluded that both the methods were dissimilar and based on mean rank interrupted method seemed to be better method.Conclusions: Authors recommended interrupted absorbable subcuticular suturing technique in general surgical procedures for benign breast diseases, especially where authors used circumareolar incisions, which saved time of the surgeon and the patient. This can lead to considerable cost savings for the government without compromising clinical effectiveness or safety.

Concentric circumareolar approach in treatment of gynecomastia / 中华内分泌外科杂志

ObjectiveTo discuss the method and significance of concentric circumareolar approach in treatment of gynecomastia.MethodsThe incision was designed with the patient in a standing position.The location of the new nipple was determined,around which a outer cycle with the diameter of 5 cm was marked.And then a concentric inner circle with the diameter of 2.5 -3 cm was marked around the original nipple.The bilateral nipple position should be on the same level.A rim of tissue around the nipple-areola complex( NAC )was deepithelialized,excision of excess glandular tissue was performed subcutaneously and vascular network of dermis was preserved as much as possible.The purse string suture was applied in the circumareolar incision.Results 30 patients with gynecomastia were treated with this method.The result of the operation was pleasing with good aesthetic appearance,normal blood supply,and inconspicuous scars.Conclusion As a surgical approach of gynaecomastia,concentric circumareolar incision can remove excess glandular tissues and redundant skin,and has the benefit of concealing incision,simple procedure and satisfactory outcome.

A Modified Quadrantectomy Through Circumareolar Incision for Patients with Breast Cancer / 한국유방암학회지

Bast conservation therapy has become an accepted method of primary treatment for the early stage breast cancer. The extent of local excision and skin incision has been in controversy, owing to the risk of local recurrence and cosmesis. To improve breast cometic apperance following quadrantectomy for breast cancer, authors propose a novel surgical technique that is carried out local excision through circumareolar skin incision, remodeling of breast ot replace the volum loss. Level I&II axillary dissection were performed and radiotherapy were followed. Twenty-one patients underwent the novel method for breast conserving surgery from September 1995 to October 1998 in the department of surgery at Soonchunhyang University Hospital. Cosmetic outcome was evaluated by means of panel assessment and breast retraction assessment (BRA). The mean age of patient was 43.3 years(30 to 67 years). The distribution of the 22 tumors were located in the right of 11, left of 9 and both breast of 1. The mean fumor size was 1.7 cm(0.5 to 2.8cm). The type of histology was 5 of ductal carcinoma in situ, 13 infiltrating ductal carcinoma, 2 of tubular carcinoma and 1 medullary carcinoma. Five of 22 patients had metastases in the axillary nodes. The cosmetic evaluation was performed by the 3 panelist who scored it a 5-panel scale (E0 to E4). Eighteen cases were scored as E0 (excellent, 81.8%), 1 case as E1 (good), 1 case as E2 (moderate) and 2 cases as E3 (bad) cosmetic results. BRA values were calculated by simple vector geometry employing the Pythagorean theorem, BRA values for the patients ranged 0.5 to 4.4 cm with a mean of 1.6 cm and for a group of 30 control women values ranged from 0.4 to 1.8 cm with mean value of 0.9 cm. When panel scores and BRA values were compared, 18 cases of excellent (E0) scoring had under the 3.5 cm of BRA value. One of two cases with bed (E3) score had over 3.5 cm of BRA vale. Eighteen cases who were less than 60 years old had satisfactory cosmetic results by panel scoring and BRA value. Twenty one cases who underwent a novel method for breast conserving therapy were considered as excellent and fair cosmetic results. It is concluded that the remodeling of breast following modified quadrantectomy through circumareolar skin incision is useful for preventing breast deformity.

Skin-Sparing Mastectomy with Circumareolar Incision and Immediate Reconstruction in Breast Cancer

BACKGROUND : Now, breast reconstruction after a mastectomy is being performed in many cases by using a tissue expander or a TRAM flap. However, a conventional mastectomy leaves long linear scar tissue which is also seen on the breast skin after breast reconstruction. A skin-sparing mastectomy with immediate reconstruction leaves minimal scar tissue, and with a circumareolar incision, it leaves no visible scar tissue. Purpose : The purpose of this study is (1) to identify the clinical indications for a skin-sparing mastectomy with immediate reconstruction, (2) to evaluate the clinical results, and (3) to encourage the application of this method. METHODS : During the recent 20 months, there were 467 breast-cancer surgeryes : 368 metastectomes (78.8%, 368/467), and 30 mastectomes with breast reconstruction (8.2%, 30/368), Among the 30 recon struction cases, a skin-sparing mastectomy with a circumareolar incision and immediate reconstruction was performed on 9 patients. Our patient selection criteria was as follows : (1) patient's desire for recon struction from a cosmetic aspect, (2) clinically early breast cancer, (3) moderate breast size, (4) centrally located tumor, and (5) no skin involvement. RESULT : 1) We performed 9 skin-sparing mastectomies with a circumareolar incision and immediate reconstruction. 2) Three patient who complained of a palpable mass were diagnosed by FNA as having breast cancer. In the other 6 patient, the cancer was diagnosed by a ductal biopsy in 4 cases where the complaint was a bloody nipple discharge, by a H-wire biopsy in one case where mammography re vealed multiple microcalcifications, and by a punch biopsy in one case where the nipple was eczematous. Preoperatively, cases were suspected of having early breast cancer. 3) Four cases were stage 0, 3 cases were stage I, and 2 cases were stage III in postoperative pathologic staging. 4) All the patients were satisfied with their cosmetic results. CONCLUSION : A skin-sparing mastectomy with immediate reconstruction is a new method for breast cancer surgery with modified a skin incision and shows good aesthetic results. We propose more frequent application of this method for the indicated patient, but we need further follow-up of the local recurrence rate and the detection rate in these patients.

Skin-sparing Mastectomy with Circumareolar Incision and Immediate Reconstruction in Breast Cancer / 한국유방암학회지

BACKGROUND: Now, breast reconstruction is being performed in many cases after mastectomy by using tissue expander or TRAM flap. But conventional mastectomy leaves a long linear scar tissue which is also seen on the breast skin after breast reconstruction. Skin spring mastectomy with immediate reconstruction leaves a minimal scar tissue, even though, with circumareolar incision, it makes no visible scar tissue. PURPOSE: The purpose of this study is 1) to identify the clinical indications for Skin-spring mastectomy (SSM) with immediate reconstruction, 2) to evaluate the clinical results and 3) to encourage the application of this method. MATERIALS AND METHODS: During recent 20 months, breast cancer surgery were 467 cases, mastectomy were 368 (78.8%, 368/467), mastectomy with breast reconstruction were 30 case (8.2%, 30/368), Among 30 reconstruction cases, Skin-spring mastectomy (SSM) with circumareolar incision and immediate reconstruction were performed in 9 patient. Our patient selection criteria was as follows; 1) patient's desire of reconstruction on cosmetic aspect 2) clinically early breast cancer 3) moderate breast size 4) central locating tumor 5) no Skin involvement. RESULTS: 1) we performed 9 cases of Skin-spring mastectomy (SSM) with circumareolar incision and immediate reconstruction. 2) Three patient who complainted palpable mass were diagnosed by FNA for breast cancer and the other 6 patient were proved by ductal biopsy in 4 cases whose complaint was bloody nipple discharge, a H-wire biopsy in whose mammography revealed multiple microcalcifications and a punch biopsy in whose nipple was eczematous. All cases were suspected for early breast cancer preoperatively. 3) Four cases were stage 0, 3 cases were stage I lesions and 2 cases were stage III in postoperative pathologic staging. 4) All the patients were satisfied with their cosmetic results. CONCLUSIONS: Skin-spring mastectomy (SSM) with immediate reconstruction is new method for breast cancer operation with modified skin incision and shows good aesthetic results. we propose more frequent application of this method for indicated patient, but we need futher follow-up of local recurrence rate and detection rate in these patients.