Augmentation mammoplasty using hydrogel fillers such as polyacrylamide gel (PAAG) or Aquafilling® has been performed commonly in some countries as an alternative to breast augmentation with saline or silicone implants. However, the safety of this procedure remains controversial, and many complications associated with the use of large-volume hydrogel injection have been reported in recent years. We present the case of a 33-year-old woman with a history of bilateral Aquafilling® injection augmentation mammoplasty who presented with an enlarged left breast while breastfeeding. Based on the clinical presentation and ultrasound findings, the patient underwent surgical incision as abscess formation caused by infection of the filler material could not be ruled out with certainty. Surgery revealed a galactocele with drainage of large amounts of milky fluid. Remaining filler material was removed as thoroughly as possible, and vacuum assisted wound dressing was performed. Galactocele formation in lactating women is a known complication after injection of hydrogel. Hence, it is important to be familiar with this uncommon but possibly severe complication in order to make an accurate diagnosis and initiate adequate treatment. To that end, it is recommended that patients who underwent Aquafilling® injection for breast augmentation should avoid lactation and that women intending to breastfeed should not undergo augmentation mammoplasty with injection of Aquafilling®.Level of Evidence: Level V, risk / prognostic study
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Luminal breast cancers are hormone receptor (estrogen and/or progesterone) positive that are further divided into HER2-negative luminal A and HER2-positive luminal B subtypes. According to currently accepted convention, they represent the most common subtypes of breast cancer, accounting for approximately 70% of cases. Biomarkers play a critical role in the functional characterization, prognostication, and therapeutic prediction, rendering them indispensable for the clinical management of invasive breast cancer. Traditional biomarkers include clinicopathological parameters, which are increasingly extended by genetic and other molecular markers, enabling the comprehensive characterization of patients with luminal breast cancer. Liquid biopsies capturing and analyzing circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) are emerging technologies that envision personalized management through precision oncology. This article reviews key biomarkers in luminal breast cancer and ongoing developments.
Aim: To evaluate the perioperative outcome and cosmetic outcome of prepectoral implant-based breast reconstruction using the TiLOOP® Bra Pocket.Background: Besides acellular dermal matrix (ADM), synthetic meshes have revealed good surgical and aesthetic outcomes. We present our data using TiLOOP® Bra Pocket, a ready-to-use mesh pocket which is made out of nonresorbable, titanized, lightweight polypropylene with a monofilament structure and designed to ensure optimal fixation of the breast implant following mastectomy. The idea behind the mesh pocket is to fix the implant to the muscle and provide coverage and stabilization for the implant by serving as an ´internal bra´, which will create an inferior and lateral sling to support the position and stability of the implant and prevent it from dislocating or twisting. Materials and Methods: A single-center retrospective study was performed to assess short-term complication rates and cosmetic outcomes in patients with immediate or delayed implant-based breast reconstruction using the TiLOOP® Bra Pocket after nipple- or skin-sparing mastectomy. The primary endpoint was complication rates, which were divided into major and minor complications during the first 6 months. Minor complications were defined as those treated conservatively, major complications were those requiring surgical therapy. The secondary endpoint was short-term cosmetic outcome after 6 to 12 months, which was judged by two professionals using the Harvard score (1 = poor, 2 = fair, 3 = good, 4 = excellent). Results: A total of 63 breasts (43 patients) were reconstructed by implant using the TiLOOP® Bra Pocket between 2018 and 2020, of which 57 were immediate reconstructions. Mean follow-up was 12 months. The overall complication rate was 30,2 % (n = 19/63). Major complications occured in 7 breasts (n = 7/63; 11,1 %) and minor complications occured in 12 breasts (12/63; 19,0 %). The cosmetic outcome was good (Harvard score: mean 3, range 1-4; SD 0,75). Seventeen cosmetic complications were observed (17/63; 27,0 %) and 6 cosmetic revision surgeries were performed (6/63; 9,5 %). Conclusion: Immediate prepectoral implant-based breast reconstruction with the TiLOOP® Bra Pocket seems to be a feasible method with moderate complication rates and good cosmetic outcomes. Careful patient selection and preparation techniques considering flap viability are vital in order to achieve acceptable complication rates and satisfying cosmetic results. Long-term follow-up is needed. The next follow-up will be performed after 24 months. Perioperative OutcomeComplications22Seroma with punction7/63 (11,1%)Seroma without punction1/63 (1,6 %)Hemorrhage2/63 (3,2 %)Nipple necrosis2/63 (3,2 %)Implant Infection3/63 (4,8 %)Skin Infection3/63 (4,8 %)Wound healing deficiency2/63 (3,2 %)Implant loss2/63 (3,2 %)Unplanned resurgery < 3 mo8 (12,7 %) Cosmetic Complication (N=17)Rippling2 (3,2 %)Asymmetry4 (6,3 %)Capsule contracture3 (4,8 %)Fat defects3 (4,8 %)Rotation2 (3,2 %)Cranialisation3 (4,8 %) Cosmetic Outcome (Harvard score; 1 = poor, 2 = fair, 3 = good, 4 = excellent)Observer 13,0 (1 - 4), SD 0,8Observer 23,4 (1-4), SD 0,7 Citation Format: Bich Doan Nguyen, Denise Vorburger, Heike Frauchiger-Heuer, Lilian Bringolf, Nadia Maggi, Julia Talimi-Schnabel, Konstantin Dedes. Prepectoral implant-based breast reconstruction with TiLOOP-bra pocket - a single-center retrospective study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-64.
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