Juvenile gigantomastia is a benign disorder of the breast in which one or both of the breasts undergo a massive increase in size during adolescence. The authors present a series of four cases of juvenile gigantomastia, advances in endocrine management, and the results of surgical therapy. Three patients were treated for initial management of juvenile gigantomastia and one patient was evaluated for a gestationally induced recurrence of juvenile gigantomastia. The three women who presented for initial management had a complete evaluation to rule out other etiologies of breast enlargement. Endocrine therapy was used in 2 patients, one successfully. A 17-year-old girl had unilateral hypertrophy treated with reduction surgery. She had no recurrence and did not require additional surgery. Two patients, ages 10 and 12 years, were treated at a young age with reduction mammaplasty, and both of these girls required secondary surgery for treatment. One patient underwent subtotal mastectomy with implant reconstruction but required two subsequent operations for removal of recurrent hypertrophic breast tissue. The second patient started a course of tamoxifen followed by reduction surgery. While on tamoxifen, the second postoperative result remained stable, and the contralateral breast, which had exhibited some minor hypertrophy, regressed in size. The fourth patient was a gravid 24-year-old who had been treated for juvenile gigantomastia at age 14, and presented with gestationally induced recurrent hypertrophy. The authors' experience has been that juvenile gigantomastia in young patients is prone to recurrence, and is in agreement with previous studies that subcutaneous mastectomy provides definitive treatment. However, tamoxifen may be a useful adjunct and may allow stable results when combined with reduction mammaplasty. If successful, the use of tamoxifen would eliminate the potential complications of breast prostheses. Lastly, the 17-year-old patient did not require secondary surgery, suggesting that older patients may be treated definitively with reduction surgery alone.
P. M.Glat, is a paid consultant and speaker for Mölnlycke Health Care, the manufacturer of EZ Derm.
Although several studies have analyzed risk factors for tissue expander removal prior to permanent implant placement in breast reconstruction, the outcome following explantation because of infection is unknown. From a prospectively maintained database covering a 10-year period, 39 such patients were identified. Twelve (30.8%) had prior radiotherapy. Nine patients (23%) underwent reexpansion, 3 (7.7%) had a latissimus dorsi flap and expander, and 1 (2.6%) received a free transverse rectus abdominis flap. Recurrent infection occurred in 1 reexpanded patient. Two patients developed late contractures. All other reconstructions were successful. Twenty-six patients (66.7%) did not undergo secondary reconstruction, most commonly due to a combination of patient preference, cancer progression, and radiotherapy. After removal of an infected expander, most patients who are interested and remain good candidates can still be reconstructed. Reexpansion was successful in patients without prior radiotherapy. Secondary reconstruction with autologous tissue is appropriate when there is a history of radiotherapy.
This prospective, randomized study assessed the clinical, microbiological, and patient comfort characteristics of two silver-based topical agents in the management of partial-thickness burn wounds. Pediatric patients were randomly assigned to treatment with either SilvaSorb Gel (Medline Industries, Munedelein, IL) or Silvadene silver sulfadiazine cream (King Pharmaceuticals, Bristol, TN) for up to 21 days or to the point of full reepithelialization of the wound. Inclusion criteria were patients ranging in age from 2 months to 18 years with TBSA ranging from 1 up to 40%. A total of 24 patients were enrolled and completed the study. Findings demonstrated that the use of SilvaSorb Gel was associated with less pain and greater patient satisfaction when compared with Silvadene. No statistically significant differences were found when assessing the rate of infection, time to reepithelialization, or the number of dressings changes required during treatment. The reduction of pain and improved overall patient satisfaction with the use of SilvaSorb Gel compared with Silvadene indicates an important role for SilvaSorb Gel in treatment of partial-thickness burns in a pediatric population.
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