Risk of residual breast tissue after skin-sparing mastectomy.

Skin-sparing mastectomy (SSM) is an accepted surgical option for breast cancer treatment. SSM allows for preservation of the skin envelope and improved cosmesis. Despite initial concerns, large series have not revealed higher recurrence rates. There is, however, a paucity of data regarding the rates of residual breast tissue (RBT) left behind after SSM, what factors influence this, and the oncologic implications of RBT. Retrospective review identified 288 total mastectomies. Patients who had undergone SSM with excision of additional skin for reconstructive purposes, either at the initial oncologic surgery or at subsequent revision, were included in the final study group. Pathologic analysis was performed to evaluate excised skin. Data regarding demographics, tumor type, and treatment were collected. Comparison between patients who had pathologically confirmed RBT in the excised skin and those who did not was performed. Of 288 total mastectomies, 92 were SSM's, and 66 had skin specimens removed for nononcologic reasons, of these, 4 (6%) had RBT. Age at diagnosis (p = 0.806), BMI (p = 0.531), tumor size (p = 0.922), and estrogen receptor status (p > 0.999) did not contribute to increased RBT risk. At median follow-up of 33.5 months, there have been no recurrences. In addition, cost analysis reveals it is likely not cost-effective to perform pathologic evaluation of these specimens. SSM, performed at an academic medical center by fellowship-trained surgeons, has a very low rate of RBT, and does not compromise oncologic outcomes. Routine pathologic assessment of these skin specimens, removed for nononcologic reasons, may not be required.

Randomized trial comparing 2 fiber regimens for the reduction of symptoms of constipation.

OBJECTIVE: : This study aimed to compare the effects of a special bowel recipe with psyllium on symptoms of constipation. METHODS: : Women with symptoms of constipation were randomized to 6 weeks of either psyllium or a special bowel recipe. Patients completed a constipation scoring questionnaire and recorded characteristics of each bowel movement. RESULTS: : A total of 53 participants completed prestudy and poststudy constipation scoring questionnaires. Both groups demonstrated improvement in constipation scores (psyllium: 13.9 ± 4.7 to 9.0 ± 4.6, P < 0.001; recipe: 13.6 ± 4.1 to 8.5 ± 5.0, P < 0.001). Mean differences in pretreatment and posttreatment constipation scores were not statistically different between the 2 groups.Subjects taking the bowel recipe strained only 20% of the time compared with those using psyllium who strained 57% of the time (P = 0.007). Other symptoms improved from baseline, but the majority was not different between treatment groups. CONCLUSIONS: : The bowel recipe demonstrated no significant difference in efficacy to pure fiber.

Diagnostic breast evaluation: when to refer and what the results really mean.

Diagnostic breast imaging is an important tool in evaluating abnormal physical examination findings and assessing incomplete screening mammographic results. It is imperative for primary care providers to be knowledgeable regarding which patients would benefit from this evaluation to provide optimal healthcare.