ABSTRACT
DIEP flap has become the gold standard method for patients undergoing autologous breast reconstruction; however, previous surgery or scars in the abdominal area have been considered a relative contraindication for the use of abdominal tissue. Longitudinal midline abdominal scars may be specially problematic because of the poor midline crossover of blood and the high risk of necrosis of the distal flap. Patients with small breast may be easily reconstructed with hemi-DIEP flap; however, patients with large breast need more tissue available. Our aim is to report a modification of a 'fleur-de-lis pattern' for a breast reconstruction in a patient with previous abdominal surgery and large breast. The post-operative course was uneventful, flap did not show blood supply compromise, volume and symmetry are preserved after 6 months post-operative and donor site morbidity has not been observed. This modification may be very useful to avoid complications related to poor blood supply associated with scar tissues. Careful pre-operative planning and the transfer of only well-vascularised tissue are essential for a successful reconstruction.
ABSTRACT
BACKGROUND: The effects of postoperative radiotherapy on free flap-based breast reconstruction are still controversial. Poor outcomes, breast distortion, and fat necrosis have been traditionally documented. The aim of this study was to evaluate whether adjuvant radiotherapy affects the quality of life, satisfaction, and cosmetic result in patients undergoing immediate breast reconstruction with autologous free flap. METHODS: Between January of 2013 and December of 2016, 230 patients underwent mastectomy with immediate free flap reconstruction at the authors' institution. Patients were divided into two groups depending on whether they received postmastectomy radiotherapy. Quality of life measured with the BREAST-Q questionnaire, self-reported aesthetic outcomes, and general satisfaction were assessed and compared. Fat necrosis of the flap and its severity were also analyzed as the main surgical outcomes. RESULTS: Mean follow-up time after reconstruction was 23 months (range, 6 to 48 months). No significant difference in quality of life or satisfaction scores were found between patients that underwent postmastectomy radiotherapy and patients who did not receive adjuvant radiotherapy. There were no significant differences in rates of fat necrosis between the groups (11.1 percent versus 13.76 percent; p = 0.75). CONCLUSIONS: Postmastectomy radiotherapy in patients undergoing immediate breast reconstruction with free flaps does not seem to affect quality of life, satisfaction with the outcome, or the cosmetic result as perceived by the patients. The potential need for postoperative radiotherapy should not hinder women from the benefits of autologous immediate breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Subject(s)
Breast Neoplasms/therapy , Free Tissue Flaps , Mammaplasty/methods , Patient Satisfaction , Quality of Life , Abdomen/surgery , Adult , Aged , Breast Neoplasms/psychology , Cross-Sectional Studies , Female , Follow-Up Studies , Humans , Mastectomy , Middle Aged , Radiotherapy, Adjuvant , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
Pilomatrix carcinoma is a rare cutaneous tumor derived from follicular matrix cells. It may arise de novo or from a malignant transformation of a pilomatrixoma. The latter process has been associated with impaired immune system surveillance of the host caused by UV radiation or the onset of an underlying malignant neoplasm. We report a case of a 58-year-old man presenting with a long-standing pilomatrix carcinoma on the inner right leg after 10 years of repeated curettage of the lesion, concurrent with a high-grade B-cell lymphoma on the same extremity. We describe a rare association which highlights the necessity of close follow-up of patients with long-standing malignant skin tumors.
