Breast reconstruction: a quality measure for breast cancer care?

Parallel to its life-threatening nature, breast cancer can affect physical integrity, having a psychosocial impact on patients. Determining the optimal proportion of patients who should undergo breast reconstruction after cancer surgery represents a complex task. What seems to be unquestionable is that the ability to offer reconstruction and a wide range of surgical options plays an important role in current breast cancer management. The multidisciplinary approach is a paramount aspect not only for a successful oncologic treatment, but also for improving patient quality of life.

Ectodermal dysplasia with amastia: a case of one-step reconstruction.

Background. Female patients presenting amastia associated with ectodermal dysplasia are not frequently encountered, but they are of great clinical interest and surgically demanding. Traditionally, skin alterations related to Ectodermal Dysplasia have addressed plastic surgeons to perform a two-stage approach in amastia associated with this congenital pathologic condition. This article describes an alternative method for correcting this deformity trough a mammary reconstruction in one surgical stage. Materials and Methods. We report a case of 26-year-old female patient with bilateral amastia associated with ectodermal dysplasia. Amastia in this patient was treated with implantation of subpectoral silicone gel prostheses, without previously breast tissue expansion. Results. At 18 months of follow-up after surgey, there were no complications and excellent cosmetic results were achieved. Patient and surgeon satisfaction was high and the patient underwent a bilateral areola-tattoo. Conclusions. One-stage mammary reconstruction have showed to be a reliable and effective technique also when amastia is associated with Ectodermal Dysplasia, suggesting a still satisfying biomechanical performance of the skin in this pathology.

Correlation between complication rate and perioperative risk-factors in superior pedicle reduction mammaplasty: our experience in 127 patients.

Reduction mammaplasty, one of the most common plastic surgery procedures, has been shown to confer significant sustained health benefits for patients with symptomatic breast enlargement providing a remedy for back, neck, and shoulder pain. Unfortunately, operations of breast reduction may lead to patient dissatisfaction for poor aesthetic outcome due to complications. Complications, including infection, hematoma, seroma, dehiscence, fat necrosis, and skin loss, may occur in as many as 50% of patients. Unacceptable scarring has also been reported. Complication data revealed several significant features, although there isn't much objective evidence to support that. Over the period 2004-2008, 127 consecutive patients were admitted for breast reduction surgery, data have been analyzed retrospectively to determine whether any correlation could be found between complication rate and perioperative risk-factors using a multifactorial ANOVA F-test. Analysis of variables associated with complications showed that, after adjusting for age and smoking status, only BMI was associated with any complication (p < 0.05). By power analysis, based on a comparison of three proportions, a power of 92% with a significance level of 0.05 was found for the hypothesis that the outcomes of the procedures depends on BMI.

Correction of cicatricial ectropion by autologous fat graft.

BACKGROUND: Over the past few years, treatment of burn scars with lipofilling has shown encouraging clinical results in terms of texture, color, softness, and quality of skin patterns. This clinical application has been widened to include treatment for scars resulting from surgical correction of cicatricial ectropion. In fact, although standard surgery with flaps and skin grafts can grant significant functional and cosmetic improvements, these often are not complete because of secondary surgical scars. METHODS: The case of a 43-year-old man with cicatricial outcomes from chemical burns and subsequent surgical repair of medial ectropion in the lower eyelid is reported. The scar area was treated with injection of adipose tissue harvested from abdominal subcutaneous fat and processed according to Coleman's technique. RESULTS: At the 1-year follow-up assessment after lipostructure, the patient no longer reported xeroftalmia and epiphora. He had experienced complete functional recovery with excellent cosmetic results. CONCLUSIONS: Lipostructure of cicatricial ectropion seems to complete and improve the results of the standard surgical approach, and its long-lasting benefits are in keeping with the theoretical basis of this procedure.

Statistical approach in alginate membrane formulation for cell encapsulation in a GMP-based cell factory.

A cell encapsulation technology in alginate has been developed with the aim of obtaining cell controlled release or three-dimensional cultures. The aim of this work is to verify the predictability of alginate capsules for large-scale production by Good Manufacturing Practice (GMP) standardized procedures in a cell factory. A cell-free capsule model was performed following the GMP guidelines: an opaque agent suspension in a bivalent cation solution (Ca(2+), Ba(2+), Sr(2+)) was dropped in a sodium alginate solution, obtaining capsules presenting a liquid core surrounded by a gel alginate membrane. The concentration of the ion, and the treatment with protamine, can considerably vary the characteristics of the capsules (weight, whole diameter, core diameter, gel capsule thickness, capsule strength). It is therefore possible to optimize the performance of the capsules, relating the molecular structure and size of the polymeric membrane to the desired functional properties. Technological resources are available for large-scale cell encapsulation intended for advanced therapies (gene therapy, somatic cell therapy and tissue engineering) in a cell factory, following GMP guidelines.