Assuntos
Neoplasias da Mama/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Mastectomia Segmentar , Pessoa de Meia-Idade , Bloqueio Nervoso , Dor Pós-Operatória , Estudos Prospectivos , Adulto JovemRESUMO
INTRODUCTION: One-stage implant-based breast reconstruction has been recently improved by the introduction of biological [acellular dermal matrix (ADM)] and synthetic meshes. Advantages of ADMs in implant-based breast reconstruction derive from the expansion of the space available for the direct positioning of an implant, but their use could be associated with several complications. Although the majority of complications can be easily managed, mistakes in dealing with the first clinical signs of a potential adverse event can lead to implant loss. CASE PRESENTATION: We report a case of ADM/implant exposure following NAC-sparing mastectomy and immediate implant-based reconstruction, successfully managed with an innovative staged treatment using negative pressure wound therapy, which allowed a rapid re-positioning of the prosthesis after complete clearance of bacteria from the implant pocket. DISCUSSION: The safest strategy to manage implant exposure and concomitant bacterial growth is reported to be implant removal and delayed re-positioning after several months, following prolonged targeted antibiotic therapy. Our case shows how a short-time implant re-positioning following implant removal for implant exposure could be successfully pursued thanks to the shrewd use of negative pressure wound therapy with great advantages in terms of patient satisfaction and post-operative quality of life, offering women experiencing this complication the option of not delaying reconstruction for months after resolution of the complication, potentially avoiding major surgical procedures such as autologous tissue reconstructions. LEVEL OF EVIDENCE V: 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 .
Assuntos
Implante Mamário/efeitos adversos , Mastectomia Subcutânea/métodos , Tratamento de Ferimentos com Pressão Negativa/métodos , Falha de Prótese , Infecção da Ferida Cirúrgica/cirurgia , Implante Mamário/métodos , Implantes de Mama/efeitos adversos , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Remoção de Dispositivo , Feminino , Seguimentos , Humanos , Mamoplastia/efeitos adversos , Mamoplastia/métodos , Pessoa de Meia-Idade , Período Pós-Operatório , Reoperação/métodos , Infecção da Ferida Cirúrgica/diagnóstico , Cicatrização/fisiologiaRESUMO
BACKGROUND: True carcinosarcoma of the breast is an extremely rare condition, accounting for 0.08-0.2% of all breast malignancies. The correct definition of this tumor requires both a carcinomatous component and a malignant non-epithelial component of mesenchymal origin, without evidence of a transition zone between the two elements. CASE PRESENTATION: We present a case of a 49-year-old woman presenting with a 4cm mass at the level of her left breast upper-outer quadrant with a histologic diagnosis of true carcinosarcoma of the breast. DISCUSSION: The most appropriate therapeutic regimens for breast carcinosarcoma are still unclear because of the rarity of this condition, but Breast Conserving Treatment (BCT) followed by adjuvant chemotherapy seems to provide a prognosis equalling that of usual Invasive Ductal Carcinoma of the breast.
