Fertility preservation parameters in patients with haematologic malignancy: a systematic review and meta-analysis.

Patients with haematologic malignancies represent one of the most common groups referred for fertility preservation before gonadotoxic oncological treatment. The aim of this systematic review and meta-analysis was to evaluate the effect of haematologic cancer on ovarian reserve and response to ovarian stimulation compared with healthy controls. A total of eight observative studies were included in the final quantitative analysis. Despite a younger age (mean difference -4.17, 95% CI -6.20 to -2.14; P < 0.0001), patients with haematologic malignancy had lower serum anti-Müllerian hormone levels compared with the control group (MD -1.04, 95% CI -1.80 to -0.29; P = 0.007). The marginally higher total recombinant FSH dose (MD 632.32, 95% CI -187.60 to 1452.24; P = 0.13) and significantly lower peak oestradiol serum level (MD -994.05, 95% CI -1962.09 to -26.02; P = 0.04) were demonstrated in the study group compared with the healthy controls. A similar number of retrieved oocytes were achieved in both groups (MD 0.20, 95% CI -0.80 to 1.20; P = 0.69). In conclusion, haematologic malignancies may detrimentally affect ovarian function manifesting in decreased AMH serum levels despite a younger age compared with healthy controls. This effect can be overcome by the application of relevant IVF protocols and stimulation doses to achieve an adequate oocyte yield.

BREAST-Q Patient-reported Outcomes in Different Types of Breast Reconstruction after Fat Grafting.

Breast reconstruction after mastectomy improves patient quality of life. Independently of the type of reconstruction, ancillary procedures are sometimes necessary to improve results. Fat grafting to the breast is a safe procedure with excellent results. We report patient-reported outcomes using the BREAST-Q questionnaire after autologous fat grafting in different types of reconstructed breasts. Methods: We performed a single-center, prospective, comparative study that compared patient-reported outcomes using the BREAST-Q in patients after different types of breast reconstruction (autologous, alloplastic, or after breast conserving) who subsequently had fat grafting. Results: In total, 254 patients were eligible for the study, but only 54 (68 breasts) completed all the stages needed for inclusion. Patient demographic and breast characteristics are described. Median age was 52 years. The mean body mass index was 26.1 ± 3.9. The mean postoperative period at the administration of BREAST-Q questionnaires was 17.6 months. The mean preoperative BREAST-Q was 59.92 ± 17.37, and the mean postoperative score was 74.84 ± 12.48 (P < 0.0001). There was no significant difference when divided by the type of reconstruction. Conclusion: Fat grafting is an ancillary procedure that improves the outcomes in breast reconstruction independently of the reconstruction type and heightens patient satisfaction, and it should be considered an integral part of any reconstruction algorithm.

Novel Biomarkers and Therapeutic Targets for Melanoma.

Malignant melanoma is one of the most common cancers in the world. In the disease's early stages, treatment involves surgery, in advanced stages however, treatment options were once scarce. There has been a paradigm shift in advanced melanoma treatment with the introduction of immunotherapy and targeted therapies. Understanding the molecular pathways and their pathologic counterparts helped identifying specific biomarkers that lead to the development of specific targeted therapies. In this review we briefly present some of these markers and their relevance to melanoma treatment.

Analysis of Allergan's Biocell Implant Recall in a Major University Breast Center.

BACKGROUND: In May 2019, Health Canada released a national recall of all macrotextured breast implants that later became international in July 2019 regarding increasing accounts of suspected breast implant-associated anaplastic large cell lymphoma. In Canada, this recall targeted Allergan's Biocell implants. This report presents the postmortem of this comprehensive single-center recall, which had to be undertaken in a limited time. METHODS: Four months after the beginning of the recall, the authors analyzed the transcript of meetings to characterize the team assembled during the recall. Then, to reconstruct the systemic work plan as well as the crucial steps and actors of the recall process, a chronologic table of the 5 meetings held during the recall, agendas and transcripts of every meeting, electronic correspondences, and other documents created during the recall were consulted. RESULTS: Between 1996 and 2018, 1260 women were affected by the recall, meaning that they received Allergan's macrotextured implants. Ninety-two patients underwent explantation of the device or will undergo implant explantation. To this day, no patient was diagnosed with breast implant-associated anaplastic large cell lymphoma. CONCLUSIONS: Our center's experience highlights the utmost importance of building a national breast implants registry. We recommend breast centers to develop preestablished crisis centers and train staff to better prepare for future device recalls and minimize waste of time. Finally, we believe that implants should be identified based on the characteristics rather than their brand name.

Post-burn breast reconstruction using an artificial dermis-a long-term follow-up.

BACKGROUND: Full thickness burns of the chest in childhood are a devastating problem that requires challenging reconstructive options. Integra is a bilaminate artificial dermis composed of shark chondroitin 6-sulfate and bovine collagen. The dermal matrix serves as a scaffold for fibroblasts and endothelial cells. Vascularization of the matrix begins after 2-3 weeks, and eventually, the matrix incorporates with the tissue to create a new dermis. The main advantage of the Integra is that the neodermis is of the same quality as a native dermis. CASE PRESENTATION: In this case report, we present post-burn breast reconstruction of a 12-year-old girl using Integra, with a long follow-up of 7 years. To the best of our knowledge, there is no published follow-up of breast development after reconstruction with Integra from its beginning point at the age of puberty until after the growing process has terminated. CONCLUSIONS: Integra is a reliable reconstructive tool for burned breast. If done before puberty, it can help in getting normal developing tissue with satisfying esthetic results of size, shape and symmetry.

Analysis of 109 Consecutive Explanted Breast Implants: Correlation Between Suspected Implant Rupture and Surgical Findings.

INTRODUCTION: The use of breast implants is on the rise due to increases in breast reconstructive and aesthetic surgery. Implant rupture is a possible complication. Among assessment modalities for implant rupture detection, MRI is considered the gold standard. METHODS: We conducted a prospective analysis of 57 women after breast augmentation or postmastectomy reconstruction (109 implants), admitted to our department between 2010 and 2015 due to suspected implant rupture. We correlated surgical findings with symptoms, physical examination, imaging, and device specifications. RESULTS: Seventy-four explanted implants were preoperatively suspected as ruptured. Over a third were intact and unjustifiably explanted. MRI evaluation was the most accurate modality. Interestingly, 61 % of ruptured implants were left-sided. Patient's age, comorbidities, smoking, medications, presenting symptoms, implant duration, and volume did not correlate with implant rupture. CONCLUSIONS: Our study confirmed preexisting data regarding the importance of imaging diagnosis, with MRI being the most accurate modality in both diagnosing and ruling out implant rupture. Interestingly, our study showed that MRI was accurate in detecting all intact implants, unlike lower detection rates reported in previous studies, thus preventing unnecessary explantation. Another unique finding was that the left-sided implants were significantly prone for rupture. As iatrogenic damage is the most common cause of implant rupture, with most surgeons being right-handed, awareness during surgery must be augmented, with further investigation required for potential causes of this unexpected difference. Our study emphasizes the importance of understanding the causes of rupture and the need for evidence-based indications regarding imaging and replacement of implants. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[Reconstruction in plastic surgery using osmotic tissue expanders].

BACKGROUND: Tissue expander is a major reconstructive modality. Its main disadvantages include: long and inconvenient period of inflation with temporary deformity of the surrounding tissue. Osmotic expander was developed in order to eliminate some of these limitations. It is a self-filling device which absorbs fluids in order to achieve tissue expansion faster. PURPOSE: We present our experience with 28 consecutive cases of tissue reconstruction using osmotic expanders. We wish to emphasize the main advantages and limitations of this device. METHODS: The present study was launched in May 2008, until April 2014, for twenty eight patients, median age 26 years with reconstructions using an osmotic expander (total of 35 expanders). The reasons for using tissue expander included large congenital nevi (75%) and scars. RESULTS: In all of the cases, the operative and post-operative management was uneventful. During the expansion period, there were 2 outpatient clinical visits. The average expansion time was 9 weeks. In 11% (three patients) there was partial extrusion of the expander. In all other cases there were no complications and the final aesthetic results were satisfying. DISCUSSION: Osmotic expander is an advanced modality for tissue reconstruction. The final shape and size are precisely predictable. Its initial small size allows for a small surgical incision and short overall operating time. The expansion period is shorter and more convenient for the patient. Its main disadvantage includes the inability to control the filling rate and the need to remove the expander in case of damage to the overlying tissue. CONCLUSION: Osmotic expander is a reliable tool for tissue expansion. It allows for a satisfying aesthetic result in a shorter period of time and with less inconvenience to the patient.