Mastectomy

Background: The aim of this study was to evaluate the effects of kinesiophobia, quality of life, and home exercise programs on women with upper extremity lymphedema. Methods: A total of 62 women with lymphedema after breast cancer treatments were provided a protocol of complete decongestive therapy (CDT). This protocol involved manual lymphatic drainage (MLD), compression garments, skin care, and remedial exercises. The women were taken to a 12-week therapy program once per day, 3 days per week. A home program, consisting of compression bandage exercises, skin care and walking was recommended. Absolute volume and percentage of volume of the lymphedema were compared before and after treatment. The kinesiophobia, quality of life, and home-based program were assessed before and after physiotherapy. Results: Strong correlations were found between the severity of edema and fear of movement. There was a significant negative relationship among the fear of movement, quality of life, and home-based exercises program. Mean initial lymphedema volume was 925 ml, and the percentage of lymphedema was 47.1%. After decongestive physiotherapy, the lymphedema volume and percentage were 510 ml and 21.3% (P < 0.05), respectively. There was also a trend toward improvement in general well-being (P < 0.05). Conclusion: In upper extremity lymphedema, the use of complex physiotherapy programs (CDP) can decrease edema and fear of activity, and increase the quality of life.

Modulation of cellular antigens in chronically infected CEM cells by HTLV-IIIB. 0-propiolactone-treated cells were acetone-fixed and stained with monoclonal antibodies; hence membrane and cytoplasmic antigen is detected. Filled columns, infected; hatched columns, uninfected cells. Similar results were obtained by flow cytometnc analysis of intact cells. in pathogenicity among virus variants between and within HIVinfected individuals and AIDS patients.4

Clinical trials conducted over the last two decades have demonstrated that 5 years of treatment with tamoxifen (TAM) after local treatment in postmenopausal patients with positive hormone receptor early breast cancer improves disease-free survival and overall survival. More recently, aromatase inhibitors (AI) have been tested in several randomized clinical trials in this setting. The studies have tested either AI versus TAM or different sequential approaches combining the two agents. While the most effective strategy remains to be determined, overall, incorporation of AI resulted in better diseasefree survival, particularly in the worstprognosis subgroup of patients. In addition, long-term treatment with AI was, in general, well tolerated. However, mature results are needed in order to be able to assess the effect in overall survival. The authors of this supplement paper include the key points of roundtable presentations and discussions of hormonal therapy in breast cancer by topic.

Background and purpose: Investigation of the use of TomoTherapy and TomoDirect versus conventional radiotherapy for the treatment of post-operative breast carcinoma. This study concentrates on the evaluation of the planning protocol for the TomoTherapy and TomoDirect TPS, dose verification and the implementation of in vivo dosimetry. Materials and methods: Eight patients with different breast cancer indications (left/right tumor, axillary nodes involvement (N+)/no nodes (N0), tumorectomy/mastectomy) were enrolled. TomoTherapy, Tomo-Direct and conventional plans were generated for prone and supine positions leading to six or seven plans per patient. Dose prescription was 42 Gy in 15 fractions over 3 weeks. Dose verification of a TomoTherapy plan is performed using TLDs and EDR2 film inside a home-made wax breast phantom fixed on a randoalderson phantom. In vivo dosimetry was performed with TLDs. Results: It is possible to create clinically acceptable plans with TomoTherapy and TomoDirect. TLD calibration protocol with a water equivalent phantom is accurate. TLD verification with the phantom shows measured over calculated ratios within 2.2% (PTV). An overresponse of the TLDs was observed in the low dose regions (<0.1 Gy). The film measurements show good agreement for high and low dose regions inside the phantom. A sharp gradient can be created to the thoracic wall. In vivo dosimetry with TLDs was clinically feasible. Conclusions: The TomoTherapy and TomoDirect modalities can deliver dose distributions which the radiotherapist judges to be equal to or better than conventional treatment of breast carcinoma according to the organ to be protected.

The research of body image among breast cancer patients is characterized by some limitations, such as the lack of longitudinal studies or the absence of a multidimensional perspective of body image. This study intends to overcome these limitations, by examining the evolution of body image dimensions (investment, emotions and evaluations) from the period of surgery (T1) to 6-months after the treatment’s ending (T2). It also aims to explore the predictors of body image at T2 and, simultaneously, the predictive role of initial body image to psychosocial adjustment at T2.A total of 56 breast cancer patients participated in both assessments and completed a battery of instruments that included measures of body image dimensions (appearance investment, self-consciousness of appearance, shame and appearance satisfaction) and psychosocial adjustment (quality of life and emotional distress).Within the dimensions of body image, only shame increased over time. In general, initial levels of investment predicted subsequent body image dimensions and having a mastectomy done was associated with higher shame and lower appearance satisfaction at T2. Initial body image did not predict later adjustment, with the exception of depression, where appearance investment played a relevant role.Our findings contributed to the advance of knowledge in this area, providing relevant data about the evolution of body image dimensions, its predictors and its predictive role on psychosocial adjustment among breast cancer patients. This study also suggested some clinical implications that can assist health professionals to implement strategies focused on body image throughout the disease.

BACKGROUNDAngiosarcoma of the breast is a rare entity. The objectives of this study were to evaluate prognostic factors and determine outcomes in a large contemporary series of patients.Angiosarcoma of the breast is a rare entity. The objectives of this study were to evaluate prognostic factors and determine outcomes in a large contemporary series of patients.METHODSClinical and pathologic factors were analyzed in all patients with angiosarcoma of the breast treated between 1990 and 2003. Overall survival (OS) and disease-free survival (DFS) were estimated using the methods of Kaplan and Meier. Multivariate analyses were performed to evaluate prognostic factors.Clinical and pathologic factors were analyzed in all patients with angiosarcoma of the breast treated between 1990 and 2003. Overall survival (OS) and disease-free survival (DFS) were estimated using the methods of Kaplan and Meier. Multivariate analyses were performed to evaluate prognostic factors.RESULTSFifty-five women with angiosarcoma of the breast were identified. The median age was 49.1 years, and the median follow-up time was 3.7 years. The median OS and DFS were 2.96 years and 2.26 years, respectively. For the 32 patients with primary angiosarcoma of the breast 5-year OS was 59%. Twenty-three (42%) patients had received prior radiation therapy for the treatment of breast cancer. These patients with radiation therapy-associated angiosarcoma were on average 30 years older and less likely to present with distant metastatic disease than patients presenting with radiation-naive angiosarcoma of the breast. Although radiation-naive patients appeared to have had better early DFS and OS, the Kaplan–Meier curves were not statistically different between patients with radiation therapy-associated disease and radiation therapy-naive patients. On multivariate analysis, tumor recurrence (P = 0.006) was the only significant adverse prognostic factor noted for OS.Fifty-five women with angiosarcoma of the breast were identified. The median age was 49.1 years, and the median follow-up time was 3.7 years. The median OS and DFS were 2.96 years and 2.26 years, respectively. For the 32 patients with primary angiosarcoma of the breast 5-year OS was 59%. Twenty-three (42%) patients had received prior radiation therapy for the treatment of breast cancer. These patients with radiation therapy-associated angiosarcoma were on average 30 years older and less likely to present with distant metastatic disease than patients presenting with radiation-naive angiosarcoma of the breast. Although radiation-naive patients appeared to have had better early DFS and OS, the Kaplan–Meier curves were not statistically different between patients with radiation therapy-associated disease and radiation therapy-naive patients. On multivariate analysis, tumor recurrence (P = 0.006) was the only significant adverse prognostic factor noted for OS.CONCLUSIONSIn this series of 55 patients with angiosarcoma of the breast, radiation therapy-naive angiosarcomas occurred in younger patients, but they behaved similarly to radiation therapy-associated angiosarcomas. Cancer 2005. © 2005 American Cancer Society.In this series of 55 patients with angiosarcoma of the breast, radiation therapy-naive angiosarcomas occurred in younger patients, but they behaved similarly to radiation therapy-associated angiosarcomas. Cancer 2005. © 2005 American Cancer Society.

Incorporating various new and conventional risk factors, the 2005 St Gallen risk categorization is a potentially useful prognostic tool for breast cancers. We conducted a retrospective study to evaluate its application in Hong Kong. Of the 902 included female breast cancers with median follow-up of 5.4 years, 7%, 63% and 30% patients were classified as low-, intermediate-and high-risk categories, respectively. Their corresponding 5-year distant disease-free survivals (DDFS) were 100%, 92% and 72%, respectively (po0.00005). In the intermediate-risk category, node-positive patients had marginally inferior 5-year DDFS than node-negative patients (89% vs. 93%, p ¼ 0.0551). In the high-risk category, patients having HER2 overexpressed tumors and 1-3 positive nodes had significantly better DDFS than other patients with X4 positive nodes (89% vs. 65%, p ¼ 0.0001). Overall, the 2005 St Gallen risk categorization had high prognostic value. However, the impact of HER2 overexpression might be affected by reproducibility of HER2 tests. r

A significant proportion of patients will report changes in their memory and in their ability to concentrate and focus their attention during chemotherapy. Studies that have used standardized neuropsychological assessments during or shortly after treatment (within 6 months) have documented cognitive dysfunction in 48%-95% of patients undergoing high-dose and standard-dose chemotherapy. 5-8 In addition to chemotherapy, there are multiple factors that can contribute to the acute cognitive effects of chemotherapy, including emotional distress associated with cancer diagnosis and treatment, sedation, antinausea pain medications, anemia, fatigue, menopause, hypercortisolism, adrenal insufficiency, Cognitive side effects of systemic chemotherapy have become an increasing concern among breast cancer survivors, their families, and health care professionals. A growing body of research supports the hypothesis that chemotherapy can produce long-term cognitive changes in at least a subgroup of cancer survivors. We review evidence implicating systemic chemotherapy as the cause of cognitive changes; describe the limitations due to lack of longitudinal studies and gaps in knowledge (ie, no clear mechanism by which chemotherapy can produce cognitive changes has been proposed); discuss possible factors like age, intelligence quotient/education, and psychological, genetic, and hormonal factors that might increase risk for chemotherapy-induced cognitive changes; and outline future directions for research. Such future research includes large-scale, longitudinal studies of pretreatment neuropsychological assessments, use of imaging techniques and the development of animal models to study the mechanisms of chemotherapy-induced changes in cognitive functioning, and the development of interventions to prevent or reduce the negative cognitive effects of chemotherapy.

n Abstract: This study aimed to determine the effects of demographic, clinical, and therapeutic variables in development of seromas. The relation between development of seromas and age, preference for surgery, tumor size, existence of axillary lymph nodes and lymph nodal metastases, number of lymph nodes removed, type of surgical equipments used, drainage duration, drainage flow rate, and whether or not neoadjuvant chemotherapy was received; dead volume was reduced; or pressure garment was used in patients who received surgery due to breast cancer between 2000 and 2005 years. Mean age of 119 patients included in the study was 53.13 ± 13.26 (range 26-79). Seromas were observed in 17 (14.28%) patients. In multivariate logistic regression analysis an association of postoperative seroma formation was noted with a drainage flow rate greater than 50 mL ⁄ day after 48th hours following breast surgery (p = 0.007), while other variables investigated herein are not associated with development of seromas. We conclude that a drainage flow rate greater than 50 mL ⁄ day after 48th hours is a predicting factor for seroma formation in breast cancer patients. Thus, we do not recommend terminating the drainage before flow rate at 48 hours is seen and daily drainage is lower than acceptable limit. n

Background Nipple-sparing mastectomy (NSM) via an inframammary (IM) incision has been described for selected patients with breast cancer. However, the application of sentinel lymph node (SLN) mapping via an IM incision for NSM has yet to be reported. The objective of this study is to determine the technical feasibility of performing SLN through an IM incision without making an axillary counterincision. Methods We retrospectively reviewed our single-institutional experience with SLN biopsy and NSM through IM incisions between January 2006 and March 2008. Clinicopathologic factors were analyzed regarding indications, technical details, postoperative morbidity, and follow-up. Results Fifty-two patients underwent 87 NSM through an IM incision (17 unilateral, 35 bilateral) with immediate reconstruction and SLN biopsy. Indications for surgery included invasive breast cancer (n = 21), ductal carcinoma in situ (DCIS) (n = 18), and prophylactic (n = 48). Mean tumor size of invasive carcinoma was 2.1 cm. The mean mastectomy specimen weight was 437 g. Subareolar injection consisted of blue dye (n = 43), technetium sulfur colloid (n = 2), or combination injection (n = 42). SLN biopsy through an IM incision was successfully performed in 84 of 87 cases (96.6%). A mean of 2.8 SLN were removed with a positive sentinel node encountered in 8 of 21 patients (38%) with invasive cancer. No complications were observed regarding the SLN portion of the operation. With a median follow-up of 6.5 months (range, 0.4–23 months), there have been no axillary local recurrences. Conclusion SLN biopsy can be performed through an IM incision during a NSM, avoiding a secondary axillary incision.

Phantom breast syndrome (PBS) represents the experience of the continued presence of the breast, after mastectomy. Our aim was to assess PBS appearance by means of a structured questionnaire and to look into possible associations to disease and treatment parameters, in 105 women with breast cancer treated by mastectomy. PBS was recorded in 22.9% of the patients. In the majority of cases phantom experience had the size (88.9%), shape (76.5%) and weight (64.7%) of the normal breast and was localised in the entire breast (50%). Concerning disease parameters, no association with primary tumour size (T) or lymph node status was detected, but interestingly, in situ breast cancer (DCIS) was found to be more frequently associated with PBS, compared with invasive tumours. No significant associations of PBS with previous sensory experiences of the breast, radiotherapy or systemic treatment were assessed. The results are interpreted within the frame of Melzack&#39;s theory of a neuromatrix, as...

The aim of immediate breast reconstruction is to improve well-being and quality of life for women undergoing mastectomy for breast cancer. This prospective study used the SF-36 Health Survey questionnaire to assess quality of life before and 12 months after mastectomy and immediate breast reconstruction together with patients' expectations of and satisfaction with the immediate breast reconstruction with implant. Scores for 76 participants were compared with those in 920 age-matched women from the general population. Preoperative scores for emotional well-being and physical role functioning were lower than in the reference population, while after 12 months the scores in all domains had improved and were comparable with those in the reference population. The most common reason for immediate reconstruction was the desire to avoid an external prosthesis. Most women were satisfied with immediate reconstruction, and the major determinant of aesthetic satisfaction was completion of the procedure. Although many factors may influence quality of life, 1 year after breast cancer surgery with immediate reconstruction scores are equivalent to those of the normal population.

Background: Converting the latissimus dorsi musculocutaneous flap to a thoracodorsal artery perforator flap has been reported for breast reconstruction. The goal of this article is to evaluate the donor site after harvesting a thoracodorsal artery perforator flap in patients who underwent breast surgery and to show the advantages of sparing the latissimus dorsi muscle on the function of the shoulder. Methods: Between 2002 and 2004, 22 patients who had a partial breast reconstruction using a pedicled thoracodorsal artery perforator flap were enrolled in a functional study to evaluate shoulder function postoperatively. Latissimus dorsi muscle strength, shoulder mobility, and latissimus dorsi thickness were measured by using the MicroFet2, a goniometer, and ultrasound examination, respectively. The measurements of the operated and contralateral (unoperated) sides were analyzed statistically. Results: When comparing the operated sides to the unoperated sides, latissimus dorsi strength seemed to be maintained after surgery. Shoulder mobility was also similar in all movements, but both active and passive forward elevation and passive abduction were reduced significantly after surgery, and latissimus dorsi thickness was not affected by harvesting the thoracodorsal artery perforator flaps. No seroma formation was found in any of the donor sites. Conclusions: Donor-site morbidity after harvesting a thoracodorsal artery perforator flap was reduced to a minimum. Therefore, perforator flaps should be considered in reconstruction whenever adequate perforators can be identified and safely dissected. (Plast.

The aim of this study is to explain the advantages of immediate post mastectomy reconstruction of breast to the patients and convince them for the same as they are not aware of such procedures in government setup. Also to evaluate the reliability of various flaps in post mastectomy breast reconstruction. To setup a surgical protocol depending on the disease status, patient physical condition and reliability of the flaps.

Background: As survival rates increase, many people have to adjust to life after cancer. This includes adjusting to life after surgery. While previous research suggests that patients commonly strive to be ‘normal’ after mastectomy and reconstructive surgery, research surrounding individual perceptions of normality is lacking.Aim: The aim of this study was to explore concepts of normality within a sample of breast cancer patients eligible for reconstructive surgery following mastectomy.Methods: A total of 35 semi structured interviews, with women who had undergone or were about to undergo breast reconstructive surgery following breast cancer, were analysed using thematic analysis.Results: Four main themes emerged from the data. Women referred to looking normal (appearance); being able to fulfil everyday activities (behaviour); adapting to a new normal (reconstructing normality); and not being ill (health). The importance placed on each area of normality differed between patients. Additionally, patients used different standards to anchor concepts of normality. These included individual standards, social standards and clinical standards.Discussion: The results indicate that although there are commonalities between patients' concepts of normality, it is important for health care professionals to recognise potential individual differences. This may usefully aid communication and help to manage expectations among patients considering surgical options. Copyright © 2010 John Wiley & Sons, Ltd.

Aims and objectives. To evaluate the incidence of winged scapula following surgical breast cancer treatment, determine its evolution over time and correlate factors that might influence this incidence. Background. Winged scapula is a complication that may occur as a result of exposing the long thoracic nerve during axillary lymphadenectomy for the treatment for breast cancer. There is no consensus in the literature about the incidence of this complication after surgical treatment for breast cancer, and complication rates range from 1Á5-74%.

To compare the effect of acupuncture to a standard-of-care (control) group on pain, nausea, anxiety, and ability to cope. 
. Pilot randomized, controlled trial. 
. Abbott Northwestern Hospital, a large, urban, tertiary care hospital in Minneapolis, Minnesota.
. 30 adult women undergoing surgery for breast cancer.
. Women were randomly assigned to two hospital-based acupuncture treatments versus usual care after breast cancer surgery. Pain, nausea, anxiety, and the patient&#39;s ability to cope pre- and post-treatment were compared within and between groups at two different time points postoperatively. 
. Mean change in pain, nausea, anxiety, and ability to cope by treatment group.
. Compared to women assigned to the control group, women who received acupuncture reported a statistically significant greater reduction in pain, nausea, anxiety, and increase in ability to cope on the first postoperative day and in pain on the second postoperative day following mastectomy surgery.
. Acupu...

Most studies of quality of life following riskreducing bilateral salpingo-oophorectomy (RRSO) and mastectomy (RRM) for inherited breast and ovarian cancer susceptibility were conducted before counseling protocols were established and included women at varying times since surgery. This study aimed to overcome these deficiencies and to provide current data on outcomes for this growing group of women. Semi-structured interviews were used to explore the experiences of an Australian cohort of 40 high-risk women 3 years after they underwent RRM and/or RRSO. Data were analyzed using the method of constant comparison. 19/40 women underwent RRSO, 8/40 RRM and 13/40 both procedures. Two themes-looking different and feeling different-captured the psychosocial impact of surgery upon interviewees. All regarded RR surgery as a positive experience and were relieved at having their risks of cancer substantially reduced; however, reducing risk by removing these body parts is not without costs. In addition to relief interviewees also reported experiencing a range of negative emotions and a range of unexpected bodily sensations following surgery and reflected upon both positive and negative changes in their appearance. Women said they had been unprepared for the lack of sensation in reconstructed breasts and/or the severity of menopausal symptoms, which often had a negative impact upon sexuality. At-risk women regard RR surgery as a positive way to manage cancer risk. However, although women who currently undergo RR surgery are informed about its sequelae, few are entirely prepared for the reality of undergoing this procedure. We recommend that women who undergo these procedures should be provided with information supported by psychosocial input before and after RR surgery.

Over the last decade, the axillary SLNB has replaced routine ALND for clinical staging in early breast cancer. Studies describe a potential pitfall in the identification of a true sentinel node during surgery due to lymph node pigmentation secondary to migration of tattoo dye. These pigmented “pseudo-sentinel” nodes, if located superficially in the axilla, may mimic the blue sentinel node on visual inspection, therefore missing the true sentinel node and potentially understaging the patient. Here, we present a case report of a breast cancer patient with a tattoo and discuss the importance of tattoo pigment in the LN (Fig. 1, Ref. 8).

For Breast Cancer Awareness Month the UAL Lingerie Society, in collaboration with independent researcher Lorraine H Smith, hosted a mini-symposium on Thursday 24th October 2019 at London College of Fashion. The event featured four research presentations followed by a panel discussion.

* LORRAINE H SMITH (Independent Researcher) - "Technology and the Bra: A Very Brief History."
* ATEFEH OMRANI (PhD Candidate, St Mary's University) - "Support for sport: Short and long-term impact of a breast education intervention on adolescent girls’ breast knowledge and attitudes to breasts."
* SILKE HOFMANN (PhD Candidate, Royal College of Art) - "The wearer’s voice in contemporary post-mastectomy lingerie design."
* KADIAN A GOSLER (PhD Candidate, University of the Arts London) - "Is the future Bra Wearables? A Designer and Researcher’s Perspective."

There are several procedures available for nipple and areola reconstruction after radical mastectomy, many of them providing good results. This study presents a 1 year evaluation of nipple and areola reconstruction, using the C-V flap technique and areola tattooing. Twenty-nine patients who underwent breast reconstruction with implants in our department, between January 2006 and January 2007, were evaluated and asked to return to conduct a follow-up control. They all completed a questionnaire focusing on patient satisfaction using a 1e10 point visual scale. Nipple measurements were taken with a calliper: the average nipple projection of the reconstructed nipple after 1 year was 3.52 mm, compared to 4.96 mm for the native nipple. The fading of colour of the tattooed areola and the match with the native areola were estimated with computer software (Adobe â Photoshop â ). The technique results were simple, reliable and safe; overall patient satisfaction with the procedure was good.

Prosthetic breast reconstruction using acellular dermal matrix is currently used by many plastic surgeons. As our understanding of these matrices expands, our results and outcomes are becoming more reproducible and predictable. As with most new technologies, there is a learning curve associated with using acellular dermal matrix. There are principles and concepts that should be heeded when considering their use. The purpose of this article is to review some of the important principles and concepts to improve our understanding of how these matrices perform and what can be expected of them. (Plast. Reconstr. Surg. 130 (Suppl. 2): 44S, 2012.)

Aim: Technical advice is offered on how to mark up patients that are candidates for skin sparing mastectomy through keyhole circumareolar incision. To perform adequate mastectomy to extirpate the breast tissue along with formal axillary dissection without the need to extend or add another axillary incision and to suggest different methods to fill in the skin envelope to achieve optimum esthetic results. Methods: 18 patients with breast cancer underwent skin sparing mastectomy with formal axillary clearance. Immediate breast reconstruction was performed using different techniques to fill in the skin envelope. Two reconstruction groups were assigned--group 1 autologous tissue transfer only (n = 13) and group 2 implant augmentation (n = 5). After patient counseling and consent, care was taken to select the most suitable procedure to fit each patient individually taking into consideration post operative adjuvant treatment and medical co-morbidities. Autologous tissue transfer: Techniques used included filling in the skin envelope using Extended Latissimus Dorsi flap (10 patients) and Pedicled TRAM flap (3 patients). Augmentation with implants: subpectoral implants (3 patients) and LD pocket (2 patients). Results: All cases underwent adequate excision of the breast tissue along with complete axillary clearance en block with lymph nodes ranging from 18 to 32 lymph node per specimen, without the need for extension or an additional axillary incision. Conclusions: Skin sparing mastectomy through a circumareolar incision has proven to be a safe and feasible option for the management of breast cancer in Egyptian women, offering them adequate oncologic control and optimum cosmetic outcome. ª 2014 Production and hosting by Elsevier B.V. on behalf

Background Breast cancer is the most common cancer in women. With increasing numbers of women surviving breast cancer, there is a need to move beyond the traditional ways of evaluating clinical outcomes and include patient-based outcomes such as the quality of life.

Breast cancer is the most common in women worldwide, with some 5-10% of all cases due to inherited mutations of BRCA1 and BRCA2 genes. Obesity, hormone therapy and use of alcohol are possible causes and over-expression of leptin in adipose tissue may also play a role. Normally surgery, radiation therapy and chemotherapy allow a good prognosis where screening measures are in place. New hope in treatment measures include adjuvant therapy, neoadjuvant therapy, and introduction of mono-clonal antibodies and enzyme inhibitors.

In occidental countries, breast cancer is the most frequent cancer in women. In the last 30 years, the therapeutical progresses have improved the prognosis and the survival rate. However, despite this hope of recovering, women continue to face the fear of death and vulnerability. Moreover, treatments can induce cognitive, emotional and behavioral reactions in patients but also in their relatives. Therefore, the treatments are associated with physical and psychosocial dysfunctioning influencing quality of life.

We read with interest the article by Blanco et al regarding serratus plane block [1] and agree that this is a novel technique. This technique was first described by Fajardo et al at the ESRA Spain Congress 2012 and published in September 2012 [2].

This is a clinical study, a collaboration between
U.S. and Spanish providers, notable for a newer technique's
potential use during breast surgery, a common
type of ambulatory surgery. Although reprinting
an entire study in the newsletter is a bit unusual,
the technique described is novel and worth a look.

The purpose of this study was to determine the reliability and validity of the Body Image After Breast Cancer Questionnaire (BIBCQ) in a series of outpatients with breast cancer. One hundred sixty-four breast cancer patients attending outpatient clinics completed questionnaires at baseline. The patients' BIBCQ scores were compared with their scores on related psychological measures including depression, self-esteem, quality of life, and sexual functioning. Scores on the BIBCQ for women after mastectomy and breast conservation were compared. Select items of the BIBCQ were compared between women with and without breast cancer. Patients received a second questionnaire after a 2 week interval to assess test-retest reliability. Good reliability was found for the six scales (ranging from 0.77 to 0.87). The BIBCQ correlated with similar measures as predicted, but not with a measure of social desirability. The BIBCQ distinguished between women treated with lumpectomy and mastectomy, and between women with breast cancer and a control group, supporting the validity of the BIBCQ. The BIBCQ provides a reliable and valid assessment of the long-term impact of breast cancer on body image. It is suitable for use in research focusing on this issue.

This is Part II of four parts describing the three-step principle being applied in reconstructive and aesthetic breast surgery. Part I explains how to analyze a problematic breast by understanding the main anatomical features of a breast and how they interact: the footprint, the conus of the breast, and the skin envelope. This part describes how one can optimize results with breast reconstructions after complete mastectomy. For both primary and secondary reconstructions, the authors explain how to analyze the mastectomized breast and the deformed chest wall, before giving step-by-step guidelines for rebuilding the entire breast with either autologous tissue or implants. The differences in shaping unilateral or bilateral breast reconstructions with autologous tissue are clarified. Regardless of timing or method of reconstruction, it is shown that by breaking down the surgical strategy into three easy (anatomical) steps, the reconstructive surgeon will be able to provide more aesthetically pleasing and reproducible results. Throughout these four parts, the three-step principle will be the red line on which to fall back to define the problem and to propose a solution. (Plast. Reconstr. Surg. 123