Saul Hoffman

Breast cancer after breast augmentation with silicone implants

AbstractBackground: Although epidemiological studies have failed to demonstrate an increased incidence of breast cancer in women who had undergone prior prosthetic augmentation mammoplasty (PAM), it has been reported that when breast cancer arises in this group it presents mostly in a palpable form and at a more advanced stage. This is thought to be secondary to suboptimal mammographic evaluation caused by the masking effect of the implant. This study was undertaken to determine, in our experience, whether breast cancer arising in women who had undergone PAM could be detected in a prepalpable form by mammography and whether it presented at a more advanced stage as compared with nonaugmented women with breast cancer. Methods: The charts of 22 patients, treated by at least one of the authors, in whom 23 breast cancers developed after PAM (group A) were retrospectively reviewed. The comparison groups consisted of 611 nonaugmented patients who underwent 636 procedure for the treatment of primary breast cancer at our institution (group B) and the surveillance, epidemiology, and end results (SEER) data (group C). Parameters studied were mode of detection, tumor size, axillary lymph node involvement, and histopathology. Results: No significant differences between the groups were found in mean tumor size (group A vs. group B), the incidence of preinvasive cancer (group A vs. group B), or axillary lymph node involvement (group A vs. group B and group A vs. group C). Breast-preserving surgery was performed significantly less in augmented patients (group A vs. group B). Conclusion: We conclude that prepalpable and preinvasive breast cancer can be detected in the PAM patient by mammography and that the stage of presentation in this group is not significantly different than in nonaugmented patients. Total mastectomy is preferred over breast-preserving procedures for the treatment of breast cancer in the PAM patient.

Recurrent Deformities Following Reduction Mammaplasty and Correction of Breast Asymmetry

In order to properly evaluate results after reduction mammaplasty and correction of breast asymmetry, it is necessary to follow patients for several years. Cases are presented in which unusual deformities occurred after an initial satisfactory result. Pregnancy, aging, and fluctuations in weight contributed to these deformities. A case of recurrent hypertrophy 4 years following a reduction mammaplasty is presented. Several cases of asymmetry corrected by a combination of reduction and augmentation had early satisfactory results but several years later again showed asymmetry due to recurrent ptosis or atrophy. In one case, a 10-year follow-up showed considerable deformity after an initial good result following asymmetrical augmentation. It is important to point out to patients that changes do occur and that occasionally additional surgery is necessary.

A simple technique for locating the umbilicus in abdominoplasty.

A method for locating the umbilicus in abdominoplasty is described. The method utilizes a magnet sutured to the umbilical stalk and a locking device which determines the exact location of the umbilicus.

Experiences With The Pitanguy Method Of Correction Of Trochanteric Lipodystrophy

The operation for correction of trochanteric lipodystrophy has given good results in properly selected cases. It is a major procedure, however-one which has a significant postoperative morbidity.

Scrotal Reconstruction in Founier Syndrome

The extent of the scrotal defect following debridement of Fournier gangrene ranges from relatively small areas of scrotal loss to complete denudation of the testes and cords. In our experience, denudation of the testis alone is best treated by split-thickness mesh grafts and total denudation of the testis and cord by burial of the testicle in a subcutaneous medial thigh pocket.Three cases are presented illustrating the spectrum of methods that can be used either singly or in combination to repair scrotal defects in Fournier gangrene.

Revisional surgery after reduction mammaplasty.

The occasional unsatisfactory results after reduction mammaplasty are classified and analyzed. Methods of revision in 4 illustrative cases are presented and discussed.

Correction of established capsular contractures with polyurethane implants

Twelve patients with severe and recurrent capsular contractures following breast augmentation and reconstruction were improved with polyurethane-covered implants. It still has not been established whether these implants prevent or merely delay the onset of contractures, but some of these patients have been followed for over three years and all 12 were improved.

Alternatives to subcutaneous mastectomy.

It is our belief that subcutaneous mastectomy often leads to complications, with poor results. In addition, because a considerable amount of breast tissue may be left behind, its value as a prophylactic operation must be questioned. Two alternatives are presented. In our experience, these lead to fewer complications with a more thorough removal of the mammary gland, and achieve a better appearance. The alternatives are (1) simple mastectomy with secondary reconstruction; (2) the type of mastectomy described by Spira--with primary reconstruction using a subpectoral silicone prosthesis covered by muscle and an inferiorly-based dermal flap.

Unilateral Unitary Inflatable Penile Prosthesis to Correct Impaired Tumescence and Severe Penile Deformity Resulting from Traumatic Rupture of 1 Corpus Cavernosum

Nonsurgical management of a penile fracture can result in penile deformity due to plaque, and impaired tumescence due to corporeal fibrosis and altered erectile hemodynamics. We describe the correction of penile deformity and impaired tumescence by extensive resection of corporeal fibrosis and insertion of a unilateral unitary inflatable prosthesis. A possible role is proposed for correcting penile angulation secondary to unilateral disease using a unilateral unitary inflatable penile prosthesis.

A silicone template to facilitate cartilage grafting in the nose.

Silicone sheeting that has the thickness and consistency of septal cartilage for use as a template has been developed to facilitate cartilage grafting in the nose. This technique makes it easier to determine whether or not a graft will correct the deformity and how much autogenous material will be needed before the donor site is harvested. It also allows for more accuracy in the sizing and positioning of the grafts.