scholarly journals Attachment distribution of pectoral muscle origins identified in dual-plane breast implant insertion

2020 ◽  
Vol 47 (2) ◽  
pp. 160-164
Author(s):  
Su Bong Nam ◽  
Kyung Ho Song ◽  
Jung Yeol Seo ◽  
June Seok Choi ◽  
Tae Seo Park ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Breast Implant ◽  
Pectoralis Major Muscle ◽  
Pectoral Muscle ◽  
Augmentation Mammoplasty ◽  
Dual Plane ◽  
Reconstruction Surgery ◽  
Additional Information ◽  
Implant Placement ◽  
The Right

Background Implant-based dual-plane augmentation mammoplasty requires accurate separation of the pectoralis major muscle (PMM) at its origins. The authors identified the PMM origins during breast reconstruction surgery with the goal of providing additional information on subpectoral implant insertion for reconstructive or aesthetic purposes.Methods This study was conducted on 67 patients who underwent breast reconstruction surgery at the breast center of our hospital between November 2016 and June 2018. In total, 34 left and 39 right hemithoraces were examined. The left and right hemithoraces were each divided into 15 zones to determine the percentage of PMM attachments in each zone. The distribution of PMM origins in each zone was examined to identify any statistically significant differences.Results There were no statistically significant differences in the origins of the PMM between the right and left hemithoraces. The percentage of attachments increased moving from the fourth to the sixth rib and from the lateral to the medial aspect.Conclusions The anatomical findings of this study could be used as a reference for accurate dissection of the origins of the PMM for the preparation of the subpectoral pocket for subpectoral implant placement.

scholarly journals Elaboration of a clinical-surgical model of sparing radiotherapy of pectoral muscles and anterior thoracic wall in patients submitted to skin and nipple preserving mastectomy with immediate breast reconstruction

Mastology ◽  
2020 ◽  
Vol 30 (Suppl 1) ◽  
Author(s):  
Maximiliano Cassilha Kneubil
Keyword(s):  
Breast Reconstruction ◽  
Recurrence Rate ◽  
Breast Implant ◽  
Pectoral Muscle ◽  
Target Volume ◽  
Immediate Breast Reconstruction ◽  
Clinical Staging ◽  
Thoracic Wall ◽  
Surgical Model ◽  
Major Pectoral Muscle

Introduction: The rates of adenomastectomy with immediate breast reconstruction (IBR) in patients with breast cancer (BC), in its early stage, are increasing. Lately, the number of patients who undergo radiotherapy (RT) in this scenario has also increased, since patients submitted to mastectomy who present a compromised axillary lymph node already can have clinical benefits from RT. The routine irradiation of muscles in the anterior thoracic wall generates many complications in patients submitted to mastectomy with IBR. In the literature, the local recurrence rate in the general muscle is of approximately 0.6%. The essential point that comes to light is that the 0.6% recurrence rate justifies the routine irradiation of the major pectoral muscle in patients who underwent mastectomy with IBR. The selection of initial BC tumors distant from the major pectoral muscle can eventually spare the pectoral muscle in the planning of the target volume in RT, thus considerably reducing the postoperative complication rates, such as capsular contracture. The ESTRO (European Society for Radiotherapy and Oncology) guidelines recommend sparing the major pectoral muscle, considering the anterior surface of the major pectoral muscle as the dorsal edge in the planning of the target volume of the thoracic wall. The recommendation is: unless the invasion has been demonstrated (tumor stage T4a and T4c), there is no reason to include the major pectoral muscle and the ribs in the thoracic wall in the routine, while planning the target volume. In this context, we elaborated a new radiosurgery model called CHRISTMAS (Chest muscle spaRIng post-MAStectomy radiotherapy). Objective: To elaborate a clinical-surgical model of Sparing Radiotherapy of Major Pectoral Muscle and Anterior Thoracic Wall in patients submitted to adenomastectomy with IBR. Methods: We selected a patient with BR, clinical staging T1N1, more than 2 cm away from the major pectoral muscle, in the Mastology service of Hospital Tacchini. This patient was submitted to adenomastectomy with IBR with expander. Intraoperative radiotherapy with electrons was performed in the nipple-areolar complex, with posterior adjuvant RT of lymph chains through intensity-modulated RT (IMRT), sparing the tissue adjacent to the breast implant (pectoral muscle to nipple level, minor pectoral muscle and anterior thoracic wall). Results: The patient evolved without complications.This new technique has drastically reduced the irradiation rate of the tissue adjacent to the breast implant, besides lungs, pleura and heart. Conclusion: The CHRISTMAS radiosurgery model is technically viable, regarding logistics and radiotherapy planning, and is part of a research project of our institution, in which patients with indication for adenomastectomy, IBR and adjuvant RT with initial BC, distant from the pectoral muscle, will be randomized for conventional RT versus the CHRISTMAS model, comparing the complication and locoregional recurrence rates.

scholarly journals The New Method of Pocket Forming for Breast Implant Placement in Augmentation Mammaplasty: Dual Plane Subfascial

2019 ◽  
Vol 73 (3) ◽  
pp. 178 ◽  
Author(s):  
Reuf Karabeg ◽  
Malik Jakirlic ◽  
Amela Karabeg ◽  
Danijela Crnogorac ◽  
Ilijas Aslani
Keyword(s):  
Breast Implant ◽  
Augmentation Mammaplasty ◽  
New Method ◽  
Dual Plane ◽  
Implant Placement

scholarly journals Chronic osteomyelitis as a complication from mycobacteriosis after breast implant

Mastology ◽  
2020 ◽  
Vol 30 (Suppl 1) ◽  
Author(s):  
Márcia Portela Melo ◽  
Luiza Guimaraes de Magdalena ◽  
Marcelo Wainberg Jeffman ◽  
Murilo de Lima Brazan ◽  
Jose Antonio Crespo Cavalheiro
Keyword(s):  
Antibiotic Therapy ◽  
Chronic Osteomyelitis ◽  
Breast Implant ◽  
Breast Implants ◽  
Surgical Instruments ◽  
Augmentation Mammoplasty ◽  
Human Beings ◽  
Bacteriological Test ◽  
The Right ◽  
The Impact

Introduction: Infection is one of the most feared complications in surgeries with the inclusion of breast implants, associated with the need for new procedures and aesthetic compromise. The agents that are most associated with this conditions are the ones that colonize the skin, such as Staphylococcus aureus and Coagulase-negative staphylococci. Case Report: We described the case of a 25-year old patient, who came to our service after an augmentation mammoplasty performed about 60 days before in a hospital in the countryside. She reported bilateral seroma and extrusion of the right breast implant on the 14th postoperative day, being submitted to antibiotic therapy and a new procedure for site review, with the placement of new implants, bilaterally. When she came to our service, on the 45th day after the exchange of implants, she presented with pain, fever, hyperemia and drainage of the purulent secretion in the operative wounds with extrusion of the implants. In the transoperative period, after the changes were identified, on the 3rd, 4th and 5th costal arches to the right, suggestive of osteomyelitis, associated with partial necrosis of the intercostal muscles and pectoralis minor. The bacteriological test of the periprosthetic secretion was bilaterally positive for mycobacteruim abscessus, and the anatomopathological study of the right costal arch biopsy was compatible with chronic osteomyelitis. The patient presented favorable clinical evolution after the removal of the implants and antibiotic therapy. Discussion: Mycobacteria are opportunistic organisms, which hardly cause diseases in human beings. Despite being uncommon, the infection of breast implants by mycobacteria can be associated with the contamination of surgical instruments and immunosuppression of the host. The infection can be similar to those caused by more common agents. In many cases, it presents with the later onset of symptoms. Prophylaxis and antisepsis, including special care regarding the protocols of sterilization of surgical instruments, are still the main factors associated with the impact of this type of complication in surgeries with breast implants.

scholarly journals Prepectoral Breast Reconstruction

2019 ◽  
Vol 33 (04) ◽  
pp. 236-239
Author(s):  
Jordan Kaplan ◽  
Ryan D. Wagner ◽  
Tara L. Braun ◽  
Carrie Chu ◽  
Sebastian J. Winocour
Keyword(s):  
Breast Reconstruction ◽  
Patient Selection ◽  
Breast Implant ◽  
Evidence Based ◽  
Complication Rates ◽  
Implant Placement ◽  
Technological Advances ◽  
Operative Planning ◽  
Initial Results

AbstractPrepectoral breast reconstruction was first done in the early 1960s; however, while initial results were promising, high complication rates led surgeons to move toward submuscular implant placement. We soon came to find that submuscular implant placement was not without its own set of drawbacks. Surgeons have since revisited the efficacy of prepectoral breast reconstruction in light of new surgical and technological advances. Following these advancements, complication profiles for prepectoral breast reconstruction have drastically improved. Despite this change, surgeons recognize that prepectoral implant placement is not for everyone and patient selection is critical to success. As increasing numbers of these procedures continue to be done, we must now look to conduct direct comparisons between submuscular and prepectoral breast implant placement so that surgeons can make evidence-based decisions on patient selection and operative planning.

scholarly journals Implant Replacement or Removal: What Happens after Capsular Contracture? A German Study Examining Breast Implant Revision Surgery and Patient Choices in 946 Cases

Breast Care ◽  
2020 ◽  
pp. 1-8
Author(s):  
Shafreena Kühn ◽  
Mara Anna Georgijewitsch ◽  
Andrej Wehle ◽  
Moritz Billner ◽  
Lara Küenzlen ◽  
...  
Keyword(s):  
Breast Reconstruction ◽  
Revision Surgery ◽  
Breast Implant ◽  
Capsular Contracture ◽  
Implant Removal ◽  
Single Center ◽  
Autologous Breast Reconstruction ◽  
Implant Placement ◽  
In Situ Implant

<b><i>Introduction:</i></b> Capsular contracture most often leads to implant revision surgery for aesthetic or reconstructive purposes. However, little is known about which operation is chosen when revision surgery has to be performed. We performed analysis of revision indications and performed revision surgery considering implant removal or replacement and additional surgical procedures. To our knowledge, this study presents the largest German single-center analysis regarding implant revision surgery after the onset of complications. <b><i>Methods:</i></b> Retrospective 10-year data analysis of a single-center population undergoing breast implant revision surgery. <b><i>Results:</i></b> Capsular contracture was the most frequent finding before reoperation, both removal and replacement (<i>p</i> &#x3c; 0.05). It was linked to longer duration of in situ implant placement (<i>p</i> &#x3c; 0.05) and more frequently in reconstructive patients (<i>p</i> &#x3c; 0.05). Implant replacement was performed more often before definite implant removal for reconstructive patients (<i>p</i> &#x3c; 0.05). Mean duration of in situ implant placement before definite removal was lower for reconstructive patients (<i>p</i> = 0.005). Overall reconstructive patients were older than aesthetic patients (<i>p</i> &#x3c; 0.05). After implant removal, 61.7% of aesthetic patients chose to undergo mastopexy, 54.7% of reconstructive patients opted for autologous breast reconstruction, and 25.4% did not choose an additional surgical procedure after implant removal. <b><i>Conclusion:</i></b> Significant differences are observed for reconstructive and aesthetic patients regarding indication leading to revision surgery, time of revision surgery, and the type of performed revision surgery itself. After implant removal, more than 60% of aesthetic patients undergo mastopexy, more than half of reconstructive patients choose autologous breast reconstruction, and over a quarter of patients choose no additional surgical procedures.

scholarly journals Stacked Deep Inferior Epigastric Perforator Free Flaps with Immediate Implant Placement for Unilateral Breast Reconstruction

2017 ◽  
Vol 02 (01) ◽  
pp. e72-e74
Author(s):  
Keith Hood ◽  
Nishant Kumar ◽  
Stephane Braun ◽  
Kent Higdon
Keyword(s):  
Breast Reconstruction ◽  
Capsular Contracture ◽  
Free Flaps ◽  
Left Breast ◽  
Diep Flap ◽  
Augmentation Mammoplasty ◽  
Aesthetic Result ◽  
Implant Placement ◽  
Deep Inferior Epigastric Perforator ◽  
Immediate Implant

Background Autologous flaps can be used in combination with prosthesis in postmastectomy breast reconstruction. The deep inferior epigastric perforator (DIEP) flap is considered the preferred choice among autologous tissue transfer techniques. In patients with a breast volume asymmetry, there are several options for attaining an optimal reconstructive and aesthetic result. Methods This report presents a patient who underwent a combination of reconstructive techniques to achieve volumetric symmetry. Results The patient had a previous bilateral augmentation mammoplasty, was then treated for left breast carcinoma with a lumpectomy and radiation, and since that time had a recalcitrant left capsular contracture despite multiple operative interventions. The patient ultimately chose to have autologous left breast reconstruction and a stacked DIEP flap with simultaneous implant placement was performed. Conclusion In cases of significant volumetric asymmetry, a stacked DIEP flap in combination with a prosthesis is a novel and safe solution.

scholarly journals The chondrocoracoideus muscle: a rare anatomical variant of the pectoral area

2018 ◽  
Vol 46 (2) ◽  
pp. 155
Author(s):  
Dionysios Venieratos ◽  
Alexandros Samolis ◽  
Maria Piagkou ◽  
Stergios Douvetzemis ◽  
Alexandrina Kourotzoglou ◽  
...  
Keyword(s):  
Muscle Development ◽  
Biceps Brachii ◽  
Pectoralis Major Muscle ◽  
Deltoid Muscle ◽  
Pectoral Muscle ◽  
Current Case ◽  
Anatomical Variant ◽  
Male Cadaver ◽  
The Right ◽  
Old Greek

<div class="WordSection1"><p><strong>Objective</strong>. The study adds important information regarding the descriptive anatomy of a very rarely reported unilateral chondrocoracoideus muscle (of Wood). Additionally it highlights the concomitant muscular and neural alterations. <strong>Case report. </strong>The current case presents the occurrence of a chondrocoracoideus muscle situated left-sided, as an extension of the abdominal portion of the pectoralis major muscle (PM). The chondrocoracoideus coexisted with a contralateral atypical PM, partially blended with the clavicular fibers of the deltoid muscle. There was an accessory head of the biceps brachii while the palmaris longus was absent on the right side of a 78-year-old Greek male cadaver. <strong>Conclusion</strong>. The above mentioned muscular abnormalities are shown as disturbances of embryological pectoral muscle development, and their documentation is essential in order to increase awareness among clinicians of their potential impact on the diagnosis and treatment of several pathologies.</p></div>

scholarly journals Determination of the order of fractional derivative for subdiffusion equations

2020 ◽  
Vol 23 (6) ◽  
pp. 1647-1662
Author(s):  
Ravshan Ashurov ◽  
Sabir Umarov
Keyword(s):  
Fractional Derivative ◽  
Fixed Time ◽  
Time Instant ◽  
Observation Data ◽  
Additional Information ◽  
Fractional Modeling ◽  
Time Fractional Derivative ◽  
The Right ◽  
Right Order

Abstract The identification of the right order of the equation in applied fractional modeling plays an important role. In this paper we consider an inverse problem for determining the order of time fractional derivative in a subdiffusion equation with an arbitrary second order elliptic differential operator. We prove that the additional information about the solution at a fixed time instant at a monitoring location, as “the observation data”, identifies uniquely the order of the fractional derivative.

Functional and autoradiographic characterization of dopamine D2-like receptors in the guinea pig heart

2002 ◽  
Vol 80 (6) ◽  
pp. 578-587 ◽  
Author(s):  
María de Jesús Gómez ◽  
Guy Rousseau ◽  
Réginald Nadeau ◽  
Roberto Berra ◽  
Gonzalo Flores ◽  
...  
Keyword(s):  
Guinea Pig ◽  
Western Blot ◽  
Dopamine Receptors ◽  
Negative Inotropic Effect ◽  
Cyclase Activity ◽  
Inotropic Effect ◽  
Receptor Subtypes ◽  
Guinea Pig Heart ◽  
Additional Information ◽  
The Right

Dopamine receptors include the D1- (D1 and D5 subtypes) and D2-like (D2, D3, and D4 subtypes) families. D1-like receptors are positively and D2-like receptors negatively coupled to the adenylyl cyclase. Dopamine D2-like (D4 subtype) receptors have been identified in human and rat hearts. However the presence of D2 and D3 receptor subtypes is unclear. Furthermore, their role in cardiac functions is unknown. By autoradiographic studies of guinea pig hearts, we identified D3 and D4 receptors, using the selective radioligands [3H]-7-OH-DPAT and [3H]emonapride (YM-09151-2 plus raclopride). Western blot analysis confirmed D3 and D4 receptors in the right and left ventricle of the same species. Selective agonists of D3 and D4 receptors (±)-7-OH-DPAT and PD 168 077 (10–9 to 10–5 M, respectively) induced a significant negative chronotropic and inotropic effect in the isolated guinea pig heart preparation. Negative inotropic effect induced by PD 168 077 was associated with an inhibition in cyclase activity. No changes in cyclase activity were found with (±)-7-OH-DPAT. The aim of this study is to support the presence of D3 and D4 receptors in the heart. Although our results suggest that D3 and D4 receptors are functionally active in the heart, we need additional information with an antagonist and an agonist of improved potency and selectivity to understand the respective roles of D3 and D4 receptors in the cardiac functions.Key words: Dopamine receptors (D2, D3, D4 subtypes), autoradiography, Western blot, cAMP, heart.

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