Could Perimenopausal Estrogen Prevent Breast Cancer? Exploring the Differential Effects of Estrogen-Only Versus Combined Hormone Replacement Therapy.

Breast cancer is the commonest cancer among women in the western world, accounting for up to 30% of all cancers in women. There is a long-standing controversy about the potential link to hormone replacement therapy (HRT), with large observational studies suggesting that HRT increases the risk, while the Women's Health Initiative (WHI), a prospective, randomized placebo-controlled trial, has reported several times over a period of 20 years that combined (estrogen and progestogen) HRT increases the risk, while estrogen-only HRT given to women who have had a prior hysterectomy, is associated with a significantly reduced risk of developing breast cancer. Evidence from the randomized trial shows a significant reduction in both incidence of and mortality from breast cancer in women who took estrogen replacement therapy; this message needs to be presented clearly and robustly so that it can help women with decision making when considering HRT for menopause.

Bilateral florid papillomatosis of the nipple: an unusual indicator for metachronous breast cancer development-a case report.

Adenoma or florid papillomatosis of the nipple (FPN) is a rare benign disease which has histopathological features similar to those of a mammary papillary carcinoma. Here, we report a rare case of bilateral florid papillomatosis of the nipple and breast cancer, with a literature review.

A case of unilateral keloid after bilateral breast reduction.

Keloid scar is a manifestation of abnormal wound healing in predisposed individuals. Many treatment modalities have been tried with varying degrees of success. Radiotherapy is one such modality that is widely recognised. We present a case report and literature review based on a patient who developed unilateral keloid scarring following bilateral breast reduction surgery. Some 4 years previously, she had undergone breast conserving surgery followed by adjuvant radiotherapy for breast cancer. After her breast reduction surgery, she developed keloid scarring on the non-irradiated breast only. This case highlights a possible 'preventative' effect of radiotherapy in keloid formation.

An oncoplastic technique to reduce the formation of lateral 'dog-ears' after mastectomy.

BACKGROUND: Lateral skin folds or 'dog-ears' are frequent following mastectomy, particularly in patients with large body habitus. METHODS: We describe a method of modifying the mastectomy incision and suturing to eliminate these lateral 'dog-ears'. CONCLUSION: This surgical technique, as compared to others described in the literature, is simple, does not require additional incisions and is cosmetically acceptable to the patient.

Current use of antibiotic prophylaxis in breast surgery: a nationwide survey.

There is currently no consensus regarding the use of antibiotic prophylaxis in breast surgery. This postal survey aimed to establish the current practice in perioperative antibiotic use for breast surgery in the United Kingdom. Questionnaires were sent to 406 breast surgeons, enquiring about antibiotic use for common breast procedures. A total of 266 completed questionnaires were returned (65.5%). Over 80% of surgeons who performed breast augmentations, myocutaneous flap reconstructions and implant reconstructions used antibiotic prophylaxis. Up to 33% used antibiotic prophylaxis for wide local excisions (WLEs), mastectomies and axillary surgery for breast cancer, while 62% and 45% used antibiotics for breast reductions and duct excisions, respectively. The most common antibiotic used was co-amoxiclav. The variation in practice regarding antibiotic prophylaxis in breast surgery reflects the lack of reliable evidence for its efficacy. Further randomised controlled trials are required, taking into consideration specific risk factors affecting postoperative infection rate for breast surgery.

The role of tamoxifen in the management of gynaecomastia.

Gynaecomastia affects half of the male population at some stage in their life. Only a small proportion of them would require treatment for cosmetic appearance or to relieve pain and tenderness. Recently, tamoxifen has shown some promising results in the management of gynaecomastia. To assess the efficacy of tamoxifen, we carried out a retrospective study of all men treated for gynaecomastia with particular emphasis on those treated medically. Men with painful gynaecomastia were given 10 mg of tamoxifen for 3 months. Response to treatment was categorised as good, moderate and no response. Thirteen men (median age 36) were placed on tamoxifen. Ten patients responded well to tamoxifen. One patient developed calf tenderness and stopped the medication. No other adverse effects were reported. Two patients could not be followed up. Tamoxifen appears safe and effective in men with painful idiopathic or physiological gynaecomastia and should be considered as an initial option before contemplating surgery.