No abstract

Augmented expression of connective tissue growth factor (CTGF/CCN2) is observed in healing wounds and in a variety of fibrotic disorders. It appears to enhance many of the effects of transforming growth factor-beta and has been shown to have independent fibrogenic functions. Despite these observations, its importance to dermal wound healing and the transition from wound to scar remains poorly defined. In this study, we use established rabbit models to evaluate the roles of CTGF in dermal wound healing and hypertrophic scarring. We show that CTGF mRNA demonstrates persistent up-regulation in hypertrophic scars. Treatment of wounds with antisense oligonucleotides to CTGF has no measurable effect on early wound closure. However, antisense therapy significantly limits subsequent hypertrophic scarring. Inhibition of CTGF is associated with a marked reduction in the number of myofibroblasts in scars and decreased transcription of TIMP-1 and types I and III collagen. These findings confirm CTGF to be a key mediator of hypertrophic scarring in this model. Its effect on myofibroblasts in this setting suggests a mechanism whereby it plays this role. Its limited participation in early healing implies that it may be a useful and specific target for modulating hypertrophic scarring following injury.

NSM in BRCA1/2 carriers is associated with a low rate of complications and locoregional recurrence but these patients require long-term follow-up in both the cancer and risk-reduction setting.

CPM is associated with significant increases in some, but not all, surgical site complications. CPM does not increase the likelihood of medical complications, which are generally infrequent.

Facility and socioeconomic factors are most strongly associated with longer wait times for breast operations, and delays to surgery are associated with delays to adjuvant chemotherapy initiation.

Older women who undergo PMBR have better breast-related QOL outcomes than those who do not. Moreover, the outcomes of PMBR in older women are similar to those seen in younger women. When appropriate, older women should be encouraged to consider PMBR.

No abstract

Background and Objectives The authors sought to study patient-reported outcomes following nipple-sparing mastectomy (NSM). Methods From 2008 to 2011, the BREAST-Q was administered to women undergoing NSM surgery for cancer treatment or risk-reduction prior to surgery and at two years after completion of reconstruction. The change in score over time and the impact of surgical indication, complication occurrence and laterality on scores were analyzed. Results The BREAST-Q was prospectively administered to 39 women undergoing NSM for cancer treatment (n=17) or risk-reduction (RR) (n =22). At two years after operation, median overall satisfaction with breasts was 75 (IQR=67,100). There were significant postoperative increases in scores for overall satisfaction with breasts (+8, p=0.021) and psychosocial well-being (+14, p=0.003). Postoperatively, RR patients had significantly higher scores for psychosocial wellness, physical impact (chest), and overall satisfaction with outcome compared to cancer treatment patients (p<0.05). Also, increase from preoperative to postoperative psychosocial wellness was higher in the RR compared to cancer treatment patients (+17 vs. +1, p=.043). Complication occurrence did not significantly impact postoperative scores. Conclusions Following NSM for cancer treatment or RR, patients demonstrated high levels of satisfaction and quality of life as measured by BREAST-Q. Satisfaction level increased two years following operation.