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Prophylaxis mastectomy

Julius C Mwita, Sajini Souda, Mgaywa G M D Magafu, Amos Massele, Brian Godman, Michael Mwandri
OBJECTIVES: Antibiotic prophylaxis in surgery is known to reduce the rate of surgical site infections (SSI) as well as shorten hospital stay. However, there is currently a scarcity of data on antibiotic prophylaxis and SSIs among African countries including Botswana. Consequently, this study aimed to address this. METHODS: A prospective study involving 400 patients was carried out at a leading tertiary hospital in Botswana from 2014-2015. Patients' demographic information, type of surgery performed and peri-operative use of antibiotics were documented...
March 23, 2018: Hospital Practice (Minneapolis)
Clara Nan-Hi Lee, Michael Patrick Pignone, Allison M Deal, Lillian Blizard, Caprice Hunt, Ruth Huh, Yuen-Jong Liu, Peter Anthony Ubel
Importance: Making a good decision about breast reconstruction requires predicting how one would feel after the procedure, but people tend to overestimate the impact of events on future well-being. Objective: To assess how well patients predict future well-being after mastectomy, with or without immediate reconstruction, with the following a priori hypotheses: Patients will overestimate the negative impact of mastectomy and positive impact of reconstruction, and prediction accuracy will be associated with decision satisfaction and decision regret...
April 18, 2018: JAMA Surgery
Denise M Kenna, Busayo B Irojah, KimberLee Mudge, Kendra Eveler
BACKGROUND: Breast reconstruction with tissue expanders is the most common mode of reconstruction following mastectomy. Infection necessitating tissue expander removal is a significant complication leading to patient distress and increased health care costs. METHODS: Over 3 years, 127 breast reconstructions with tissue expanders were performed by a single surgeon. Fifty-nine of these reconstructions were performed using a standardized protocol in which patients washed with chlorhexidine several days before surgery and received intravenous antibiotics preoperatively...
April 2018: Plastic and Reconstructive Surgery
Arash Momeni, Justin P Fox
BACKGROUND: Venous thromboembolism (VTE) remains a serious complication after the surgical treatment of breast cancer. Contemporary guidelines limit VTE chemoprophylaxis to the period of hospitalization. We conducted this study to evaluate the frequency of postdischarge VTE among surgically treated breast cancer patients and identify patient level factors associated with postdischarge VTE. METHODS: Using Arkansas, Florida, Nebraska, and New York state inpatient databases, we conducted a retrospective cohort study of adult women who underwent surgical treatment for breast cancer between October 1, 2008, and September 30, 2013...
February 2018: Annals of Plastic Surgery
Apresh Singla, Animesh Singla, Eric Lai, David Caminer
Immediate breast reconstruction is an acceptable treatment option after mastectomy for prophylaxis of early breast cancer. Different options exist for implant placement, incision technique, patient suitability, and institutional experience. This article is a case series exploring the feasibility and outcomes of patients undergoing immediate breast reconstruction using skin-sparing mastectomy without mesh or acellular dermal matrix (ADM) and with a vertical inframammary incision. METHODS: A single-institution retrospective analysis was performed for all patients who underwent immediate single-stage reconstruction with subcutaneous silicon implants without ADM between 2009 and 2014 inclusive...
July 2017: Plastic and Reconstructive Surgery. Global Open
Michael Sorkin, Ji Qi, Hyungjin M Kim, Jennifer B Hamill, Jeffrey H Kozlow, Andrea L Pusic, Edwin G Wilkins
BACKGROUND: Acellular dermal matrix has gained widespread acceptance in immediate expander/implant reconstruction because of perceived benefits, including improved expansion dynamics and superior aesthetic results. Although previous investigators have evaluated its risks, few studies have assessed the impact of acellular dermal matrix on other outcomes, including patient-reported measures. METHODS: The Mastectomy Reconstruction Outcomes Consortium Study used a prospective cohort design to evaluate patients undergoing postmastectomy reconstruction from 10 centers and 58 participating surgeons between 2012 and 2015...
December 2017: Plastic and Reconstructive Surgery
Sufang Yang, Guohua Liu, Danling Tang, De Cai
PURPOSE: The efficacy of antibiotic prophylaxis for the prevention of surgical site infection (SSI) after breast cancer surgery remains uncertain. The authors of a recent Cochrane meta-analysis based on 15 randomized trials were unable to draw a definitive conclusion. The purpose of this study was to determine the effectiveness of prophylactic antibiotics for the prevention of SSI after breast cancer surgery and the risk factors for SSI. METHODS: Breast cancer patients who underwent mastectomy at the authors' institution were enrolled in this study...
September 2017: Journal of Craniofacial Surgery
Clara Nan-Hi Lee, Allison M Deal, Ruth Huh, Peter Anthony Ubel, Yuen-Jong Liu, Lillian Blizard, Caprice Hunt, Michael Patrick Pignone
Importance: Breast reconstruction has the potential to improve a person's body image and quality of life but has important risks. Variations in who undergoes breast reconstruction have led to questions about the quality of patient decisions. Objective: To assess the quality of patient decisions about breast reconstruction. Design, Setting, and Participants: A prospective, cross-sectional survey study was conducted from June 27, 2012, to February 28, 2014, at a single, academic, multidisciplinary oncology clinic among women planning to undergo mastectomy for stage I to III invasive ductal or lobular breast cancer, ductal carcinoma in situ, or prophylaxis...
August 1, 2017: JAMA Surgery
Mary Linton Peters, Judy E Garber, Nadine Tung
Current guidelines recommend that all women with ovarian cancer undergo germline genetic testing for BRCA1/2. Increasingly, genetic testing is being performed via panels that include other genes that confer a high or moderate risk of breast cancer. In addition, many women with a family history of breast or ovarian cancer are not found to have a mutation, but may have increased risk of breast cancer for which surveillance and risk reduction strategies are indicated. This review discusses how to assess and manage an increased risk of breast cancer through surveillance, preventive medications, and risk-reducing surgery...
July 2017: Gynecologic Oncology
Laura J Havrilesky, Haley A Moss, Junzo Chino, Evan R Myers, Noah D Kauff
OBJECTIVE: To estimate the survival benefit and cost-effectiveness of performing hysterectomy during risk-reducing salpingo-oophorectomy (RRSO) for BRCA1 mutation carriers. METHODS: Based on a recent prospective cohort study indicating an elevated incidence of serous/serous-like uterine cancers among BRCA1 mutation carriers, we constructed a modified Markov decision model from a payer perspective to inform decisions about performance of hysterectomy during RRSO at age 40...
June 2017: Gynecologic Oncology
Edwin G Wilkins, Jennifer B Hamill, Hyungjin M Kim, John Y Kim, Richard J Greco, Ji Qi, Andrea L Pusic
OBJECTIVE: In postmastectomy reconstruction, procedure choice is heavily influenced by the relative risks of the various options. This study sought to evaluate complications in a large, multicenter patient population. SUMMARY OF BACKGROUND DATA: Previous studies have reported widely varying complication rates, but have been limited by their single center designs and inadequate controlling for confounders in their analyses. METHODS: Eleven sites enrolled women undergoing first time, immediate, or delayed reconstruction following mastectomy for cancer treatment or prophylaxis...
January 2018: Annals of Surgery
Ian N Olver
Modifiable lifestyle factors may reduce the risk of developing breast cancer. Obesity is associated particularly with post-menopausal breast cancer. Diet is important, and exercise equivalent to running for up to 8 hours each week reduces the risk of breast cancer, both in its own right and through reducing obesity. Alcohol consumption may be responsible for 5.8% of breast cancers in Australia and it is recommended to reduce this to two standard drinks per day. Drinking alcohol and smoking increases the risk for breast cancer and, therefore, it is important to quit tobacco smoking...
November 21, 2016: Medical Journal of Australia
Beata Szutowicz-Wydra, Jacek Wydra, Wiesław J Kruszewski, Maciej Ciesielski, Mariusz Szajewski, Jakub Walczak, Rita Hansdorfer-Korzon
Breast cancer often requires combined oncologic treatments, the base of which is surgery. Quality of life (QoL) after each surgical procedure may influence the process of decision making among women, who qualify for multiple oncological strategies. Our knowledge about QoL in breast cancer patients is derived from comparative studies. Results may differ, depending on country, culture, and societal relations. The aim of the study was to investigate the quality of life of Polish patients treated with breast-conserving therapy (BCT) or mastectomy with breast reconstruction...
October 1, 2016: Polski Przeglad Chirurgiczny
Frederick L Moffat, Danny Yakoub
The purpose of this study is to assess the consequences for breast cancer patients of the trend away from breast conservation in favor of bilateral and contralateral mastectomy. The methods are followed from the review of the literature from 1991 to 2015. Breast-conserving surgery and sentinel lymph node biopsy, introduced into mainstream practice in the 1980s and 1990s, respectively, are now the standard of care for early-stage breast cancer. Disruptive change has unexpectedly supervened in the guise of bilateral mastectomy for cancer or prophylaxis and contralateral prophylactic mastectomy...
August 2016: Breast Cancer Research and Treatment
Jennifer Sabino, Donald J Lucas, Craig D Shriver, Amy E Vertrees, Ian L Valerio, Devinder P Singh
Immediate reconstruction after the surgical treatment of breast cancer has increased in the last decade. The purpose of this study is to use the National Surgical Quality Improvement Program database to analyze long-term trends in breast reconstruction. Women who underwent mastectomy for invasive or in situ breast cancer or prophylaxis between 2005 and 2011 were selected from the National Surgical Quality Improvement Program database. Trends and predictors for reconstruction were explored. In 44,410 women identified, immediate reconstruction increased from 30...
June 2016: American Surgeon
Manisha Bahl, Irene J Pien, Kate J Buretta, E Shelley Hwang, Rachel A Greenup, Sujata V Ghate, Scott T Hollenbeck
BACKGROUND: Nipple-areola complex (NAC) and skin flap ischemia and necrosis can occur after nipple-sparing mastectomy (NSM). The purpose of this study was to correlate vascular findings on MRI with outcomes in patients who underwent NSM. STUDY DESIGN: Female patients at a single institution who underwent NSM and had a preoperative breast MRI between 2010 and 2014 were identified. Medical records were reviewed for patient demographics, surgical factors, and complications...
August 2016: Journal of the American College of Surgeons
Mark Sisco, Katharine A Yao
Increasing numbers of women are undergoing nipple-sparing mastectomy, and evidence to support its use for cancer treatment and prophylaxis is expanding. An understanding of technical aspects and pitfalls of the procedure is paramount to ensure that the best results are attained. J. Surg. Oncol. 2016;113:883-890. © 2016 Wiley Periodicals, Inc.
June 2016: Journal of Surgical Oncology
Carlos A Martinez, Scott M Reis, Erika A Sato, Sean G Boutros
UNLABELLED: Ischemia of the nipple-areola complex (NAC) and periareolar tissue is commonly seen following tissue-preserving mastectomies for small invasive and noninvasive cancers. The nipple-areola preserving mastectomy is a multistage procedure in which the NAC and central mastectomy flap tissue is surgically delayed to improve the survivability in patients undergoing mastectomies followed by reconstruction. METHODS: We conducted a retrospective chart review of 20 patients undergoing the 2-stage nipple-areola preserving mastectomy: the first stage comprised undermining the NAC and raising the breast skin flaps, with placement of a silicone sheet in the dissected pocket...
October 2015: Plastic and Reconstructive Surgery. Global Open
Nai-Si Huang, Jiong Wu
OBJECTIVE: To evaluate the oncologic safety of nipple-sparing mastectomy (NSM) for breast cancer patients based on current literature. DATA SOURCES: A comprehensive literature search of Medline, Embase databases was conducted for studies published through March 2014. STUDY SELECTION: Our search criteria included English-language studies that focused on NSM at nipple-areola complex (NAC) involvement, patient selection, and recurrence. Prophylaxis NSM, case series or reports that based on very small population were excluded...
August 20, 2015: Chinese Medical Journal
Stephanie L Koonce, Brian Giles, Sarah A McLaughlin, Galen Perdikis, James Waldorf, Valerie Lemaine, Sarvam TerKonda
BACKGROUND: Solid organ transplant patients frequently develop posttransplant malignancies including breast cancer. They may desire breast reconstruction after mastectomy, which could potentially be complicated by their transplant status, immunosuppressive regimen, and previous operations. We review our experience with patients who have undergone solid organ transplant and subsequent breast reconstruction after mastectomy METHODS: After institutional review board approval, we queried our prospective breast reconstruction and solid organ transplant databases for corresponding patients...
September 2015: Annals of Plastic Surgery
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