Göran Jurell

Psychological Reactions, Quality of Life, and Body Image After Bilateral Prophylactic Mastectomy in Women At High Risk for Breast Cancer: A Prospective 1-Year Follow-Up Study

PURPOSE To prospectively evaluate body image, sexuality, emotional reactions (anxiety, depression), and quality of life in a sample of women having increased risk for breast cancer before and 6 months and 1 year after bilateral prophylactic mastectomy (BPM), and to compare preoperative expectations of the operation with postoperative reactions concerning the impact on six areas of the womens lives. PATIENTS AND METHODS A total of 90 of 98 consecutive women who underwent BPM during October 1997 to December 2005 were included. Data were collected by self-administered questionnaires (eg, Hospital Anxiety and Depression scale, Swedish Short Term-36 Health Survey, Body Image Scale, Sexual Activity Questionnaire) before the operation (n = 81), and 6 (n = 71) and 12 months (n = 65) after BPM. RESULTS Anxiety decreased over time (P = .0004). No corresponding difference was found for depression. No differences in health-related quality of life over time were found, with one exception. A substantial proportion of the women reported problems with body image 1 year after BPM (eg, self consciousness, 48%; feeling less sexually attractive, 48%; and dissatisfaction with the scars, 44%). Sexual pleasure was rated lower 1-year post-BPM as compared with before operation (P = .005), but no differences over time in habit, discomfort, or activity were found. CONCLUSION No negative effects on anxiety, depression, and quality of life were found. Anxiety and social activities improved. Negative impact on sexuality and body image was reported.

Capsular Contracture after Breast Reconstruction with Silicone-Gel and Saline-Filled Implants: A 6-Year Follow-Up

A major problem after breast reconstruction with augmentation mammaplasty is contracture of the fibrous capsule around the prosthesis. In a series of 72 breasts in 65 women, silicone-gel and saline-filled implants were randomly selected prior to breast reconstruction. The results were judged with respect to consistency, tenderness, wrinkles, and sounds by two independent plastic surgeons according to the breast augmentation classification (BAC) and by the patients themselves. Capsular contracture was found by the surgeons in 50 percent of the gel implant group and in 16 percent of the saline implant group, which is in conformity with the results of the follow-up 5 years earlier. The incidence of deflation was 16 percent in the saline group and occurred in different sizes of both overinflated and underinflated prostheses. The degree of slow leakage from saline implants will be discussed. Despite the high rate of contractures in the gel group, 85 percent of all patients were satisfied with the result of the reconstruction.

Measurement of Breast Volume with Thermoplastic Casts

A pilot study was carried through to assess the reproducibility of a new method of measuring breast volume. Twenty healthy female volunteers participated. A negative replica of the breast was made with thermoplastic cast material. The volume was measured by filling the cast with water until it reached two opposite points of the boundaries of the breast delineated on the cast. Three measurements were made of every cast and the mean was calculated. The range of the three measurements expressed as a percentage of the mean volume was 2.9 (SD 1.6)%. Each volunteers breasts were measured twice with a brief intervening pause. The coefficient of variation between the two corresponding measurements was 6%.

Textured or smooth implants for submuscular breast augmentation : A controlled study

&NA; Capsular contracture consistently has been the most frequently noted complication of submuscular and subglandular breast augmentation. The etiology of this complication is still unknown, although silicone bleed, hematoma, infection, foreign bodies, and surgical trauma have been implicated. In this prospective, double‐blind study, 61 women undergoing submuscular breast augmentation were randomized between Dow Corning textured and smooth‐walled silicone gel implants. Any consequent capsular contracture was assessed by an independent plastic surgeon and also by the patients themselves. Objective evaluation was made by applanation tonometry. It was found that depending on doctors, patients, and objective method used, 3 to 9 percent grade III and IV encapsulation followed submuscular augmentation with textured implants and 10 to 20 percent with smooth‐walled implants after 1 year. The differences were significant according to both patient assessment and applanation tonometry but not according to the physicians’ evaluations. There was no correlation of capsular contracture with the age of the patient, duration of the operation, or degree of blood loss. There was a small but inconclusive difference in capsular contracture rate that favored the placement of textured rather than smooth implants in the submuscular pocket. (Plast. Reconstr. Surg. 97: 1200, 1996.)

Increased survival of experimental skin flaps in rats following treatment with antiadrenergic drugs.

The effect upon the survival of skin flaps of several drugs which affect the adrenergic system was studied in rats. In control animals 41% of the skin flaps had survived seven days after the operation. Reserpine (1 mg/kg) injected intraperitoneally (i.p.) three days and one day before the flap operation increased the surviving flap area by 75% (p less than 0.001) as compared to control rats injected with saline. I.p. injection of guanethidine (5 mg/kg) or bretylium (10 mg/kg) every 12 hours, starting 24 hours before surgery and continued for 5 consecutive days, also increased the surviving flap area (19 and 33% respectively p less than 0.001). The surviving flap area was unchanged when desipramine (5 mg/kg) was injected in the same way and was decreased by 15% (p less than 0.05) following i.p. injection of the MAO inhibitor pheniprazine (5 mg/kg). Treatment with alpha-methyl-p-tyrosine (75 mg/kg), i.p. 30 min before surgery or 6-hydroxydopamine (50 mg/kg) i.v. 24 hours prior to surgery also increased the flap survival (56 and 49% increase in surviving flap area, respectively, p less than 0.001). The results demonstrated that the survival of skin flaps increased when the function of the adrenergic nervous system was inhibited. Enhanced sympathetic nervous activity slightly reduced or did not affect skin flap survival.

Preoperative Antibiotics and Capsular Contracture in Augmentation Mammaplasty

The main drawback with augmentation mammaplasty using implants is capsular contracture. The cause of this complication is still unknown. Silicone particles, hematoma, and bacterial contamination are some of the etiologic factors discussed. In this randomized, double-blind study on 76 breast-augmented women, 50 percent of the patients had preoperative prophylaxis with benzylpeni-cillin and dicloxacillin. Bacteria samples were taken intra-operatively. The number of negative cultures increased significantly with antibiotic prophylaxis. In four follow-ups during the first postoperative year, the rate of contractures was evaluated by subjective and objective methods. The results showed no statistically significant difference between the placebo and the antibiotic group with respect to the incidence of capsular contracture.

The Influence of Varying Pressure and Duration of Treatment with Hyperbaric Oxygen on the Survival of Skin Flaps

The effect of varying modes of hyperbaric oxygen treatment was studied on experimental skin flaps in rats. Immediate postoperative treatment increased the surviving flap area by up to twice that in non-treated control rats. Better results were gained with an oxygen pressure of 2 ata rather than 3 ata, apparently because the individual oxygen exposure periods could be made longer without toxic effects of oxygen. Periods of intermittent hyperbaric oxygen treatment longer than 24 hours, however, did not increase the surviving area. If the start of hyperbaric oxygen treatment was delayed until 24 hours after surgery, its effect was considerably less.

Results of Subglandular Breast Augmentation Using a new Classification Method—18-Year Follow-UP

The main problem after augmentation mammaplasty is the formation of capsular contractures. The frequency of this complication varies in different reports. In this study the results in 60 women 15-21 years after subglandular breast augmentation are presented. The patients completed a questionnaire and the breasts were judged according to a new Breast Augmentation Classification (BAC) scale. Of all breasts examined 79% had grade III or IV, but 77% of the patients were satisfied with the final result. However, 84% thought that their breasts were too hard. Breast cancer had not developed in any patient. Rheumatoid arthritis developed in one patient 4 years after the operation. Capsular contracture and unacceptable results after subglandular breast augmentation were found in the major portion of the patients in this study.

Breast Reconstruction Using Tissue Expansion

To assess the advantages of tissue expansion as a method of breast reconstruction, a prospective, consecutive study was carried out in 41 women who had undergone mastectomy. The expander was positioned in the submuscular plane and expanded weekly to double the volume of the calculated permanent implant. A permanent gel implant was inserted after 10 weeks. Two examiners judged the rate of capsular contracture after 15 and 32 months according to the Breast Augmentation Classification. The rate of capsular contracture was 28% at the second follow-up. Major complications were rare--7%. The patients were pleased with the overall result in 82% of cases. We conclude that tissue expansion is safe, produces a good result and causes few complications with only minor discomfort to the patient.

No differences in aesthetic outcome or patient satisfaction between anatomically shaped and round expandable implants in bilateral breast reconstructions: a randomized study.

Background: The demand for bilateral mastectomy and immediate breast reconstruction has increased in recent years, primarily due to the development of genetic testing. The aim of this study was to evaluate if there was a difference between anatomically shaped and round permanent expandable implants in one-stage bilateral breast reconstruction after bilateral prophylactic mastectomy. Methods: The anatomically shaped permanent expander implant McGhan Style 150 (Inamed, Santa Barbara, Calif.) was compared with the round permanent expander implant Siltex Becker 25 (Mentor, Santa Barbara, Calif.). Thirty-six women who opted for bilateral prophylactic mastectomy and immediate reconstruction with implants from 2004 to 2006 were included and randomly assigned to each group [18 women (36 breasts) per group]. Time to follow-up was a minimum of 2 years after the bilateral prophylactic mastectomy. Implant-related complications, breast symmetry, aesthetic outcome, and patient satisfaction were evaluated. Aesthetic outcome was evaluated by an expert panel that also tried to recognize if the breasts were reconstructed with anatomically shaped or round implants. Patient satisfaction was evaluated by a questionnaire. Results: Average time to follow-up was 30 months (range, 24 to 49 months). There was no statistical difference between the two implant groups in terms of complications, breast symmetry, or outcome scores from the expert panel and patient assessment. The expert panel guessed the right implant shape in 42 percent of the anatomically shaped implants and 66 percent of the round implants. Conclusion: In immediate one-stage breast reconstruction after bilateral prophylactic skin-sparing mastectomy, anatomically shaped and round permanent expander implants had comparable complication rates, aesthetic outcomes, and patient satisfaction after 2 years of follow-up.