Mimi Leong, MD, MS, FACS C. Bob Basu, MD, MPH, FACS M. John Hicks, MD, DDS, PhD
Aesthetic Surgery Journal, Volume 35, Issue 1, 1 January 2015, Pages 40–47
Published: 07 January 2015
Abstract
Background
Human acellular dermal matrix (HADM; previously termed “acellular cadaveric dermis”) may limit inflammatory changes believed to play a role in capsular contracture, a common complication of implant-based breast reconstruction.
Objectives
Differences between HADM and native breast capsule specimens were evaluated by immunohistochemical analysis of key inflammatory markers involved in capsule formation.
Methods
Twenty consecutive patients underwent immediate, 2-stage, implant-based breast reconstruction with dual-plane HADM. During tissue expander–implant exchange, full-thickness biopsies of biointegrated HADM and native breast capsule (internal control) from the tissue-expander envelope were obtained. Immunohistochemical analysis was performed for endothelial cells (CD31), B cells (CD20), T cells (CD3), macrophages (CD68), collagen I and III, and myofibroblasts (α-smooth muscle actin). Observed Levels of marker labeling were semiquantitatively scored from 0 (none) to 3 (severe) by a blinded histopathologist and were statistically analyzed with the Wilcoxon rank sum test.
Results
A bilateral sample was obtained from 1 patient; all other samples were unilateral. Compared with capsule samples from native breast tissue, HADM samples had significantly lower Levels of all inflammatory markers (P < .001).
Conclusions
These lower Levels of inflammatory markers support previous evidence that HADM may inhibit inflammatory and profibrotic signaling characteristics of breast capsule development and decrease the risk of capsular contracture. Further investigation is needed to determine the mechanism by which HADM inhibits these inflammatory cells, whether HADM reduces the incidence of breast capsular contracture, and if so, the longevity of this effect.
Level of Evidence: 3
Patient-Reported Quality-of-Life Outcomes of Breast Reduction Evaluated with Generic Questionnaires and the Breast Reduction Assessed Severity Scale.
Yavuz Kececi, MD Emin Sir, MD Melike Gungor, MD
Aesthetic Surgery Journal, Volume 35, Issue 1, 1 January 2015, Pages 48–54
Published: 07 January 2015
Abstract
Background
The effects of breast reduction on quality of life (QOL) have been evaluated in patients with macromastia, but few investigators have performed condition-specific assessments.
Objectives
The authors employed generic and condition-specific questionnaires to examine the QOL of patients with macromastia and determined the responsiveness of the Turkish version of Breast Reduction Assessed Severity Scale (BRASS).
Methods
This prospective cohort study included patients with breast hypertrophy who underwent breast reduction (n = 94). Patients completed the Turkish versions of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), the BRASS, and the Rosenberg Self-Esteem Scale preoperatively and 4 months postoperatively. Differences in responses were evaluated by paired t-test and by comparing change effect sizes. Multiple regression analyses were performed to evaluate improvements in QOL in response to adjustments in baseline differences across patients.
Results
Preoperative and postoperative questionnaires were completed by 78 patients (83%). Significant postoperative improvements in self-esteem (Rosenberg Self-Esteem Scale; P < .001) and in all domains of the BRASS (P < .001) were noted. Mean preoperative scores for 5 of 8 domains in the SF-36 were lower than those of a normative population. Postoperatively, all 5 mean scores improved significantly, but the score for bodily pain remained less than that of a normative population.
Conclusions
The results of this study indicate significant improvements in health-related QOL at 4 months after breast reduction in a population of patients with macromastia. The authors also demonstrate excellent responsiveness of the BRASS.
Level of Evidence: 3
Breast Implants and the Risk of Breast Cancer: A Meta-Analysis of Cohort Studies.
Eline C. Noels, MD Oren Lapid, MD, PhD Jan H.N. Lindeman, MD, PhDEsther Bastiaannet, PhD
Aesthetic Surgery Journal, Volume 35, Issue 1, 1 January 2015, Pages 55–62
Published: 07 January 2015
Abstract
Background
The popularity of cosmetic breast augmentation and the incidence of breast cancer have been increasing worldwide. It has been hypothesized that the risk of breast cancer may be greater among patients who have undergone cosmetic breast implantation.
Objectives
The authors performed a meta-analysis of the available literature on the risk of breast cancer among women with cosmetic breast implants.
Methods
The study was designed as a meta-analysis of observational studies. A systematic search of the English literature (published by August 28, 2013) was conducted in PubMed and EMBASE. Eligible reports were those that included relative risk (RR; the increased or decreased risk of breast cancer associated with breast implants) or the standardized incidence ratio (SIR) of the observed number of cases of breast cancer to the expected number of cases among patients that previously underwent cosmetic breast augmentation.
Results
Seventeen studies representing 7 cohorts were selected. Some of these were follow-up reports of previously published studies; in such cases, only the most recent reports were included in the meta-analysis. Summary SIR and RR rates and the corresponding 95% confidence intervals (CIs) were calculated with a random-effects (SIR) or fixed-effects (RR) model. The overall SIR estimate was 0.69 (95% CI, 0.56-0.85), and the overall RR, based on 4 studies, was 0.63 (95% CI, 0.56-0.71).
Conclusions
Finding of this meta-analysis suggest that women who have undergone cosmetic breast implantation do not have an increased risk of breast cancer.