Polycyclic Aromatic Hydrocarbons and Breast Cancer: A Review of the Literature.

Polycyclic aromatic hydrocarbons (PAHs) exist and persist in the atmosphere due to the incomplete combustion of fossil fuels, and are established human carcinogens. The influence of PAHs on the development of breast cancer, the most commonly diagnosed cancer in women worldwide, remains unclear. As established risk factors only account for approximately 41% of the breast cancer cases in the USA, researchers have sought to uncover environmental factors involved in breast cancer development. The breasts are particularly susceptible to aromatic carcinogenesis, and the implementation of biomarkers has provided promising insights regarding PAH-DNA adducts in breast cancer. The use of biomarkers measuring PAH-DNA adducts assesses exposure to eliminate the bias inherent in self-reporting measures in case-control studies investigating the link between PAHs and cancer. Adduct levels reflect exposure dose as well as how the body responds to this exposure, which is partially attributable to genetic variability. Evidence suggests that exposure to PAHs has a causational effect on breast cancer in humans, yet this interaction is not clearly understood. In vitro and animal-based studies have consistently revealed that exposure to PAHs deleteriously affects breast tissue, but there is no definitive link between these compounds and breast cancer.

A Comparison of Elliptical Mastectomy to Inverted-T Pattern Mastectomy in Two-Stage Prosthetic Breast Reconstruction.

BACKGROUND: Patients with large or ptotic breasts undergoing mastectomy followed by tissue expander/implant-based reconstruction may benefit from a Wise (inverted-T) pattern reduction mammaplasty incision compared with the traditional horizontal elliptical incision. The authors compared these two groups of patients with regard to complication rates and outcomes. METHODS: Sixty-nine patients (117 breasts) were identified who underwent Wise pattern mastectomy and two-stage reconstruction. A control group of 89 patients (136 breasts) who underwent reconstruction after horizontal elliptical mastectomy were selected over the same period. Patient demographics, clinical characteristics, and complication rates were recorded and analyzed statistically. RESULTS: Patient demographics (age, body mass index, diabetes, smoking, and irradiation history) and clinical characteristics (laterality, expander size and fill volume, and time to expansion) were similar, with the exception of body mass index (control, 26.7 kg/m; inverted-T, 28.7 kg/m; p = 0.04) and mean intraoperative fill volume (control, 158.7 cc; inverted-T, 196.9 cc; p = 0.02). Of all complications (infection, seroma, flap necrosis, expander loss, and salvage), only the rate of mastectomy flap necrosis was significantly greater (p = 0.002) in patients undergoing inverted-T mastectomy (25.6 percent versus 11.0 percent). This difference did not result in a significantly higher rate of expander loss or need for salvage surgery. CONCLUSIONS: The inverted-T mastectomy approach can be performed safely with acceptable complication rates. When compared with an internal control group, complication rates were similar, with the exception of mastectomy flap necrosis. Despite a higher rate of flap necrosis, 91 percent of inverted-T patients successfully completed the expansion process. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

A novel use of integra™ bilayer matrix wound dressing on a pediatric scalp avulsion: a case report.

OBJECTIVE: Soft tissue injuries with full-thickness skin involvement not amenable to local flaps may be treated with dermal matrices and subsequent skin grafting. METHODS: A pediatric patient presented with a 50-cm(2) scalp avulsion down to periosteum and outer cranial table post-vehicular trauma. After cultivating healthy cranial neodermis with Integra Bilayer Matrix Wound Dressing, a novel modification of treatment protocol was attempted by removal of the silastic layer. RESULTS: Neodermis transformation to granulation tissue followed by contraction of the wound reduced alopecia while also eliminating the need for a split-thickness skin graft to the area. CONCLUSION: A novel modification of treatment protocols utilizing acellular dermal matrices improved aesthetic outcomes and may present a cost-, time-, and procedure-sparing treatment option for avulsion injuries.