Breast reconstructive surgery has evolved tremendously since its inception. Following tumour clearance surgery, physical restoration with breast reconstruction is an important aspect of physical and emotional rehabilitation. Various methods have been described to suit patients demand for the best aesthetic outcome. Surgeon’s preference, experience and practicality of differing procedures must be considered. We describe a simultaneous bilateral breast reconstruction with free deep inferior epigastric (DIEP) flap and pedicled transverse rectus abdominis musculocutaneous (TRAM) flap immediately post mastectomies for bilateral breast cancers. The surgery described has resulted in a reasonable technical ease, acceptable flap and abdominal morbidity and good aesthetic outcome.
Mastectomy

Intraoperative active warming in daycare surgery may be least popular compared to major elective surgeries due to the lesser risk of perioperative hypothermia. This prospective, single blind, randomized, controlled trial in daycare breast lumpectomy was done to evaluate the routine use of intraoperative forced-air warmer in the presence of other warming modalities in prevention of perioperative hypothermia. Fifty patients were randomized into two groups; Group 1 received forced-air warmer and Group 2 received a standard cotton thermal blanket. Both groups received circulating-water mattress. Intraoperatively, all patients received pre-warmed intravenous fluid with an in-line warmer. Ear and ambient temperature was recorded using infrared ear thermometer and digital thermo-hygrometer respectively. Measurement was done before induction, every 15 minutes intraoperatively, upon arrival in recovery room and 30 mins later, postoperatively. All patients were normothermic prior to induction of anaesthesia. During the initial half an hour post-induction, both groups mean core temperature decreased at approximately 0.5˚C. Both showed no statistical difference in mean core temperature (0.04 ˚C) within the initial half an hour. The next half an hour, both groups had approximately 0.2˚C decrement but this time, Group 2 had a slightly higher mean core temperature than Group 1 which maintained until the end of surgery. Overall, within the initial one hour postinduction of GA, there was a drop of 0.7˚C and 0.6°C in Group 1 and Group 2 respectively, however the difference in final mean core temperature between the two groups was 0.05°C and it was not statistically significant (p value < 0.05). None of the patients experienced intraoperative hypothermia (< 36˚C) and all remained in the normothermic range with no shivering or sense of feeling cold, postoperatively. The results of the present study found no significant difference in the changes of final core temperature with or without the usage of intraoperative forced-air warmer in the presence of other warming measures in daycare breast lumpectomy.
Mastectomy, Segmental

Objective: To determine if early discharge after mastectomy is a safe alternative to the standard duration of postoperative hospital confinement. Methods: This is a review of breast cancer patients who were discharged early after mastectomy consulting at the breast center at the Vicente Sotto Memorial Medical Center from May 2007-May 2010. The following variables were recorded: date of surgery, date of discharge, presence of surgical site morbidities such as infection, dehiscence, necrosis and significant pain, date of 1st drain removal, date of 2nd drain removal, presence of seroma, application of elastic bandage. Results: Of the 60 patients: 43 (71.7%) were from CVGH Breast Specialty Clinic and 17 (28.3%) from VSMMC Breast Clinic. There were 9 patients (15%) who developed surgical site morbidities, namely: infection -3 (5.0%), minimal partial wound dehiscence -4 (6.7%), superficial skin necrosis -2 (3.3%). No patient complained of significant pain on follow-up. The first drain was removed within a mean of 6 days. The second drain was removed a mean of 7 days. Fifteen patients (25%) developed seroma. There was no readmission due to morbidities. Conclusion: Early discharge after mastectomy is a safe alternative to the standard duration of postoperative hospital confinement. Key words: mastectomy, postoperative pain
Human ; MASTECTOMY ; PAIN, POSTOPERATIVE

No Abstract Available.
Breast* ; Mastectomy, Subcutaneous* ; Nipples*

No abstract available.
Contracture* ; Mastectomy* ; Seroma*

No abstract available.
Breast* ; Female ; Mammaplasty* ; Mastectomy*

Background: Mastectomy is a common surgical procedure done worldwide. Surgical site infection (SSI) is a common healthcare-associated infection. Mastectomy SSIs are frequently under-reported.

Objectives: The study aimed to determine the incidence of SSI among mastectomy cases of the Department of Surgery, University of the Philippines - Philippine General Hospital (UP-PGH) during one year of full implementation of the Surgical Site Infection Surveillance Program and evaluate the program's surveillance follow-up rate.

Methods: This study was an observational practice audit research that included all adult patients who underwent a mastectomy in UP-PGH from January 1, 2018, to January 31, 2019, when the SSI Surveillance Program was fully implemented. SSI was monitored and assessed during the patient's hospital stay, on the day of hospital discharge, and at 30 days (± 2 days) after surgery, either during an outpatient visit or via phone call by a nurse navigator. SSI frequency for mastectomy was computed both during the in-hospital stay and at 30 days after surgery. Surveillance follow-up rate, defined as the proportion of patients who could follow-up up to 30 days after surgery, was determined.

Results: The 30-day SSI rate for mastectomy was 6.8% (19/279). All 279 patients were followed up to 30 days after surgery. Of the 279 patients, 277 (99.3%) were through clinic visits, one was through phone calls, and one was still admitted to the hospital.

Conclusion: Full implementation of the SSI Surveillance Program for mastectomy in UP-PGH for one year showed a higher SSI rate than in published international literature. The program had a complete 30-day patient follow-up, contributing to more accurate SSI reporting. Implementing an SSI surveillance program with standardized protocols, dedicated personnel, patient education component, and the analysis of the information derived from such programs can improve an institution's quality of surgical care.

Nowadays breast reconstruction with autologous tissues after radical mastectomy is commonly performed, and a natural inframammary fold in the reconstructed breast is considered to be an essential aspect of symmetrical breast shape and location. Total of 104 patients underwent breast reconstruction with free TRAM flap and formation of inframammary fold with free TRAM breast reconstruction was done in 79 patients. No suture fixation for inframammary fold were done in 19 patients. 27 patients(24.0%) were made of inframammary fold with absorbable suture, 52 patients (50.0%) underwent inframammary fold creation with nonabsorbable suture. There were 4 cases(16.0%) of displacement of reconstructed breast and 2 cases(8.0%) of partial disruption of inframammary fold in the group of no suture. There were 2 cases(7.4%) of displacement of reconstructed breast and 3 cases(11.1%) of partial disruption of inframmamary fold in the fixed group with absorbable suture. There was only 1 case(1.9%) of partial disruption of inframammary fold fixed with nonabsorbable suture group. Therefore, we could speculate that the reinforcement of ligamentous structure for making the definite inframammary fold is necessary, and the area of the inframammary fold should not be undermined in immediate breast reconstruction as much as possible in order to preserve the zone of adherence. If the fold is disrupted during the mastectomy, it should be re-created with the non-absorbable sutures. Nonabsorbable suture fixation seemed to be more stable than absorbable suture. Preoperative marking and design are very important to make the symmetrical shape and location of inframammary fold in both of immediate and delayed reconstruction of breasts.
Breast* ; Female ; Humans ; Ligaments ; Mammaplasty* ; Mastectomy ; Mastectomy, Radical ; Sutures

Breast Neoplasms/surgery* ; China ; Humans ; Mastectomy ; Mastectomy, Modified Radical

The Breast Cancer Surgery Operative Standards Consensus Conference aimed to establish industry technical standards and improve breast cancer surgery practices by addressing controversial and operative breast cancer surgery-related issues in clinical practice.The conference was led by the Breast Oncoplastic and Reconstruction Branch of Guangdong Medical Industry Association (GMIA) and involved 85 breast surgeons with expertise in breast cancer conserving, oncoplastic, and reconstructive surgery.Consensus was reached through 3 meetings.The first meeting brought up the topics of interest, and evidence summaries were presented for debate during the second meeting; the third meeting was held to reach consensus recommendation for selected topics.Pre-defined consensus criteria required that the consensus was reached only when more than 70% of the panelists agreed on the topic.Out of the 57 questions set for voting, 11 operative standards were recommended as Preferred, and one was recommended as Considered.Preferred operative standards included surgical details in breast conserving surgery, mastectomy, reconstructive surgery, surgical treatment of phyllodes tumor.Selected topics that did not reach consensus among the panelists were also discussed.These Preferred operative standards could help guide clinical surgical practice in routine patient care.
Humans ; Female ; Mastectomy ; Breast Neoplasms ; Mastectomy, Segmental ; Mammaplasty ; Breast