We describe and discuss the technique and indications, advantages, disadvantages and future direction of fat transfer to the breast. SEARCH METHODOLOGY: A Medline database search was used to retrieve relevant literature. Key search words used were: breast fat transfer, fat auto-transplantation, adipose tissue injection and lipomodelling. As a number of original articles are in French these were translated and used in addition to the English publications.
Aims:To assess variations in consent practice for a single operative procedure, namely laparoscopic cholecystectomy, particularly with respect to the frequency with which potential complications are discussed with patients. Methods: Postal questionnaire sent to general surgeons in the West Midlands and to UK members of the Association of Endoscopic Surgeons of Great Britain and Ireland. Respondents were asked to estimate how often they discussed particular complications with their patients pre-operatively.
Results: Conversion to open cholecystectomy was the most frequently discussed complication.Other complications were much less likely to be mentioned overall and there was disturbing variation between individual surgeons in the frequency with which certain complications were discussed, particularly the risk of bile duct injury. Conclusions: In order for consent to be informed, patients need to be aware of significant risks. Our results indicate a lack of consensus from surgeons as to which risks are significant for this operation and this is likely to be true for other procedures.
As breast cancer is the most frequent cancer in the elderly with a peak incidence of 1 in 10 by the age of 80, it is important to establish optimum therapy in this group. We conducted a case note-based retrospective study of all elderly primary breast cancer patients aged 80 and above between 1992 and 2002. The type of treatment, complications, disease progression, recurrence, and overall survival were recorded. In all 110 patients aged 80 and above were treated for primary breast cancer, with 32 patients having advanced disease. Of these, 62 patients received primary endocrine treatment. 48 patients underwent surgery with 30 patients undergoing mastectomy. At follow-up, 34 patients suffered disease progression in the primary endocrine treatment group and three patients had local recurrence in the surgical group. The Kaplan-Meier analysis revealed significantly better survival in the surgical treatment group when compared with the primary endocrine treatment group, both in the early disease (n = 41; median survival: 71 months; compared to n = 37; median survival: 42 months; p = 0.0002) and the advanced disease (n = 7; median survival: 48 months; compared to n = 25; median survival: 36 months; p = 0.03). Prompt surgery and adjuvant treatment can decrease relapse and improve survival even in patients older than 80 years.
Xanthogranulomatous inflammation is a rare clinico-pathological condition involving many organ systems. Breast involvement with this rare condition reported from a few cases of mastitis has been limited to only microscopic involvement on histology. We would like to report an unusual presentation of this inflammatory process presenting as a solid lump mimicking malignancy in latissimus dorsi donor site scar and implant-based breast reconstruction as a result of a ruptured silicone gel implant. To our knowledge there have been no previous reports on similar presentation published in the literature. This case highlights a rare complication of a leaked silicone gel implant triggering a xanthomatous response in the absence of the usual infective or obstructing etiologies. This condition is of benign nature with complete clearance on surgical excision and excellent clinical prognosis reported from other organ involvement.
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