Randomized controlled trial comparing health-related quality of life in patients undergoing vertical scar versus inverted T-shaped reduction mammaplasty.

BACKGROUND: There is controversy regarding the superiority of the vertical scar reduction technique versus the inverted T-shaped reduction technique for breast reduction surgery. METHODS: Two hundred fifty-five patients were randomized to either the vertical scar reduction or inverted T-shaped reduction technique immediately before surgery over a 5-year period. Patients completed the Health Utilities Index Mark 3, Short Form-36, Breast-Related Symptoms Questionnaire, and Multidimensional Body-Self Relations Questionnaire at 1 week preoperatively and 1, 6, and 12 months postoperatively. Data were treated according to intention-to-treat principles. The primary outcome was the difference in the change in Health Utilities Index Mark 3 score from baseline to 12 months postoperatively between the two techniques. RESULTS: Patients undergoing either technique gained a statistically significant and clinically important improvement from baseline to 1 year postoperatively in the Health Utilities Index Mark 3 (vertical scar reduction, 0.81, 0.16 to 0.87, 0.19; inverted T-shaped reduction, 0.79, 0.20 to 0.89, 0.15) and the Breast-Related Symptoms Questionnaire (vertical scar reduction, 50.26, 12.98 to 95.59, 9.36; inverted T-shaped reduction, 50.06, 12.50 to 94.09, 9.86). No difference in mean change in scores from baseline to 12 months postoperatively was seen in any of the quality of life questionnaires between the techniques. CONCLUSIONS: There was a clinically important improvement between baseline and 1 year postoperatively in both groups in the Health Utilities Index Mark 3 and the Breast-Related Symptoms Questionnaire. The authors conclude that the techniques are similar when quality of life is the outcome of interest. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Does the presence of an implant including expander with internal port alter radiation dose? An ex vivo model.

BACKGROUND: There is a lack of literature examining the dosimetric implications of irradiating breast implants and expanders with internal ports inserted at the time of mastectomy. OBJECTIVE: To determine whether the presence of breast expanders with port in saline or silicone implants affect the dose uniformity across the breast when irradiated with various photon and electron energies. METHODS: One tissue-equivalent torso phantom with overlying tissue expanders in saline or silicone implants were irradiated using tangential fields with 6 MV and 18 MV photons and 9 MeV and 12 MeV electrons. All dose measurements were performed using thermoluminescent dosimeters (TLDs). The TLDs were arranged around the port and the perimeters of either the expander, or saline or silicone implant. Comparisons of measured radiation doses, and between the expected and measured doses of radiation from the TLDs on each prosthesis, were performed. Data were analyzed using two-tailed t tests. RESULTS: There were no differences in TLD measurements between the expander and the saline implant for all energy modalities, and for the expected versus actual measurements for the saline implant. Higher than anticipated measurements were recorded for a significant number of TLD positions around the silicone implants. CONCLUSIONS: Radiation doses around saline implants or expanders with internal port were unaltered, whereas dose recordings for silicone implants were higher than predicted in the present laboratory/ex vivo study.

HISTORIQUE: Peu de publications portent sur les conséquences dosimétriques de la radiation d'implants mammaires et d'expandeurs à port interne insérés au moment de la mastectomie. OBJECTIF: Déterminer si la présence d'expandeurs mammaires à port dans des implants remplis de solution saline ou de gel de silicone nuit à l'uniformité de la dose de diverses énergies de photons et d'électrons irradiée sur le sein. MÉTHODOLOGIE: Les chercheurs ont utilisé un fantôme thoracique équivalant au tissu pourvu d'implants remplis de solution saline ou de gel de silicone avec expandeur et l'ont irradié de champs tangentiels à photons de 6 MV et 18 MV et à électrons de 9 MeV et 12 MeV. Ils ont mesuré toutes les doses à l'aide de dosimètres thermoluminescents (DTL). Ces DTL étaient placés autour du port et des périmètres de l'expandeur ou de l'implant rempli de solution saline ou de gel de silicone. Ils ont comparé les doses de radiation mesurées, ainsi que les doses de radiation prévues par rapport aux doses mesurées à l'aide des DTL sur chaque prothèse. Ils ont analysé les données à l'aide de deux tests t bilatéraux. RÉSULTATS: Les chercheurs n'ont constaté aucune différence entre l'expandeur et l'implant rempli de solution saline et entre les mesures prévues et réelles de l'implant rempli de solution saline pour ce qui est des modalités d'énergie dans les mesures de DTL. Ils ont obtenu des mesures plus élevées que prévu à l'égard de nombreuses positions des DTL autour des implants remplis de gel de silicone. CONCLUSIONS: Les doses de radiation autour des implants remplis de solution saline ou des expandeurs à port interne ne changeaient pas, tandis que les doses enregistrées pour les implants remplis de gel de silicone étaient plus élevées que prévu dans la présente étude de laboratoire ex vivo.

The Koebner phenomenon and breast reconstruction: Psoriasis eruption along the surgical incision.

The present report describes a recent case of recurrent infection in a breast reconstruction patient with a history of psoriasis. Following surgery, the patient developed psoriatic plaques along the incision scars. This phenomenon is known as Koebnerization, and has been found to affect surgical incisions. Cases of psoriatic patients being denied surgical procedures because of their inherent risk to Koebnerize have been previously reported. Similarly, such patients have been denied surgical procedures because of their increased risk of infection. The present case and literature review on this subject is described.

Primary cutaneous B-cell lymphoma: Role of surgery.

PURPOSE: To evaluate the role of surgery in patients diagnosed with primary cutaneous B-cell lymphoma (PCBCL) - a rare disease entity. The authors offer a rationale for the use of primary surgical excision in the treatment of isolated cutaneous lymphomas. METHODS: A literature review examining the use of primary surgical excision in the treatment of PCBCL was conducted. The lymphoma database at the Juravinski Cancer Centre (Hamilton, Ontario) was searched from January 1995 to July 2008, generating a list of 4924 patients. A simulated computer program was subsequently designed to search for all possible PCBCLs. A retrospective chart review was then conducted on the new list of 1325 patients, identifying 25 patients diagnosed with PCBCL. RESULTS: The mean age of the 25 patients with PCBCL was 59.9 years; nine (36%) were treated with surgery, and sixteen (64%) with radiation. The average follow-up period for patients was 3.6 years. Twenty-four of the 25 patients were completely cured, with only one patient recurring in the radiation subgroup. There were no complications in the surgery subgroup. There were two local complications in the radiation subgroup consisting of chronic ulcerations. CONCLUSIONS: Primary surgical excision is an effective management option in the treatment of PCBCL, particularly the marginal zone and follicle centre subtypes.

Scalp expansion with the Canica Wound Closure System: First case report.

The closure of difficult wounds has been an ongoing challenge to the plastic and reconstructive surgeon. New techniques and technology have created innovative methods for this clinical and surgical problem. The Canica Wound Closure System is an external system of tissue expansion that has previously been shown to be successful for delayed abdominal and extremity fasciotomy closures. The hair-bearing scalp is unique in that no other tissue in the human body can adequately simulate it. The first known case in North America of a patient in whom the Canica Wound Closure System was used for the successful closure of a large scalp defect following a resection for a Clark level V melanoma is presented.