RESUMEN
BACKGROUND: Single-stage reconstruction using permanent expander implants is an established technique following mastectomy. Short and long-term outcome data following breast reconstruction using Becker tissue expanders is limited. METHOD: A retrospective case note review of patients undergoing expander-based procedures between 1989 and 2007 was undertaken. Data recorded included postoperative symptoms and complications, the use of radiotherapy, revisional surgery, and device failure. RESULTS: Three hundred and thirteen expanders were used in 276 patients with a mean age of 48.3 (17-78) years, over the 18 year study period. The mean follow up period was 64.6 (1-199) months. 256 Becker expanders were used during 175 latissimus dorsi (LD) and 52 subpectoral (SP) reconstructions, 13 contralateral augmentations and 16 implant replacements. The postoperative infection rate was 5.8%, leading to an expander loss rate of 3.8%. The use of prophylactic antibiotics was associated with an increased postoperative infection rate (p = 0.046). Six haematomas (2.5%) and 12 cases of skin envelope necrosis (5.0%) required unscheduled intervention. Symptoms of pain, distortion and hardness were experienced by 21.3% of patients, and radiotherapy was associated with a significantly higher risk of adverse symptoms (p < 0.0001). No patient developed symptomatic implant rupture or silicone granuloma but 17.9% of reconstructions underwent revisional surgery, the rate being highest following SP reconstruction (p = 0.029). Nine patients developed injection port complications (3.8%), and the overall device failure rate was 1.3%. The original expander has been retained by 74.2% of women. CONCLUSION: The Becker permanent expander is a reliable implant associated with a low complication rate and a high retention rate when used during breast reconstruction.
Asunto(s)
Implantación de Mama/instrumentación , Implantes de Mama , Neoplasias de la Mama/cirugía , Mastectomía , Dispositivos de Expansión Tisular , Adolescente , Adulto , Anciano , Implantación de Mama/métodos , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Falla de Prótesis , Reoperación , Estudios Retrospectivos , Colgajos Quirúrgicos/trasplante , Resultado del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Fine needle aspiration cytology (FNAC) prior to serial sonographic (USS) examination of the breast is said to impede accurate diagnosis. This study aimed to test the effect of performing FNAC prior to USS in a one-stop symptomatic breast clinic. METHODS: All patients (n=368) attending a one-stop clinic over a 1-year period were stochastically allocated to imaging prior to (Group 1) or after (Group 2) clinical examination and FNAC. Additional procedures required for diagnosis (open or core biopsies), false negative USS grade and final outcome were recorded. Statistical analysis was performed using the Fisher's exact test. RESULTS: There was no statistical difference between the two groups. CONCLUSION: In the clinical setting of a one-stop visit, FNAC prior to breast USS does not alter ultrasound diagnostic accuracy or patient management.