Summary: Capsular contracture is one of the most common complications after breast reconstruction. Surgical treatment is the main option for capsular contracture correction and includes capsulotomy, capsulectomy, and removal/replacement of the affected implant. However, the surgical trauma from reoperation, along with reduced quality of life, in patients with clinically significant capsular contracture has prompted a search for alternative treatment options. The use of the botulinum toxin type A in the treatment of neurological diseases and of keloid scars in aesthetic practice nudged the idea of using the same toxin for the correction of capsular contractures in breast cancer patients. Botulinum toxin type A injection is an easy procedure requiring no anesthesia or inpatient care. The treatment has few side effects. In addition, the injection does not cause sensory loss or dysesthesia. We described a clinical case of the capsular contracture correction using incobotulinumtoxin A. Capsular contracture IV developed 4 months post surgery after long-term lymphorrhea. Radiation therapy was not performed. According to the internal protocol, the patient was advised to undergo incobotulinumtoxin A treatment instead of surgery. Within 1 week after the second injection, all symptoms decreased—specifically, the general shape of the reconstructed breast. Also, the pain syndrome disappeared.
СОБСТВЕННЫЕ ИССЛЕДОВАНИЯ • OWN INVESTIGATIONSЖурнал «Злокачественные опухоли» • № 1 -2017 г. (22) • www.malignanttumours.org Резюме В работе нашли отражения предпосылки возникновения концепции, история развития лимфографии, а также современное представление о состоянии дел в свете изучения концепции сторожевого лимфатического узла при злокачественных новообразованиях. Статус регионарного лимфатического узла имеет диагностическое значение для определения интенсивности злокачественного роста, так как метастазирование опухоли к регионарным лимфатическим узлам представляет собой первый шаг распространения опухоли большинства злокачественных новообразований. Комбинация и усовершенствование двух методик визуализации позволяет идентифицировать сторожевой лимфатический узел практически во всех случаях, в том числе при локализации опухоли в участках с неясным направлением лимфооттока. При отрицательных данных гистологического исследования сторожевого лимфатического узла с большой степенью надежности можно говорить об отсутствии метастазов в других лимфатических узлах. Рутинное гистологическое исследование лимфатического узла необходимо дополнять проведением иммуногистохимического исследования. Лечебная лимфаденэктомия должны быть выполнена только при гистологическом и иммуно-гистохимическом обнаружении метастазов опухоли в удаленных лимфоузлах. При обнаружении микрометастазов в удаленном лимфатическом узле вопрос о преимуществе выполнения лимфаденэктомии требует дополнительного обсуждения. AbstractThe paper reflected the background of the concept, history of lymphography, as well as the current understanding the problem by studying of the concept of sentinel lymph nodes in malignant tumors. As metastasis to regional lymph nodes is the first step in the spread of most malignant tumors the status of the regional lymph node has diagnostic value for determining the degree of malignancy. The combination of two imaging techniques of sentinel lymph node allows to identify in almost cases, including in any tumor location even in uncertain direction of lymph flow. In case of the negative sentinel lymph node can be argued on the absence of metastases in other lymph nodes. Routine histological study of the lymph node should be completed by Immunohistochemistry analysis (Real-time PCR). Therapeutic lymph node dissection should be performed only by histological and Real-time PCR verification of tumor metastases in lymph nodes. In case of detection of micrometastases in lymph node remote question of the advantage of total lymph nodes dissection requires the further discussion.ЕРМАКОВ А. В., САРИБЕКЯН Э. К., АБЛИЦОВА Н. В., УСОВ Ф. Н. ERMAKOV A. V., SARIBEKYAN E. K., ABLITSOVA N. V., USOV F. N. Сторожевые лимфатические узлы при злокачественных новообразованиях Sentinel lymph nodes in malignant tumors ВВЕДЕНИЕЛимфатические узлы являются основными гомеостатиру-ющими органами внутренней среды организма [1]. В связи с тем, что их структурно-функциональный ответ на средо-вые влияния носит черты общей стереотипии, морфо-функ-циональный стат...
Breast cancer is one of the most frequently diagnosed malignancies in the Russian Federation (RF), accounting for 20.9% of the female population in Russia. The surgery remains the primary treatment for breast cancer. Development and improvement of various options for reconstructive plastic surgery provides medical, psychological and social rehabilitation in patients with breast cancer, allows to achieve the best aesthetic and functional results. The possibility of performing such operations contributes to improving the quality of life of patients. According to ASPS (American Society of Plastic Surgeons), 80% of breast cancer reconstructions in the world are performed using silicone implants. Currently, the return of prepectoral space for placement of endoprostheses during breast reconstruction is trending, which is associated not only with the improvement of mastectomy techniques, but also with the coating of implants and the appearance of silicone highly adhesive gel filling of implants. According to the world literature data, the use of polyurethane-coated endoprostheses for prepectoral/subcutaneous reconstruction reduces the risk of capsular contracture, provides a more reliable fixation to the surrounding tissues, and thus allows breast reconstruction without the need for additional cover of the endoprosthesis. The use of the prepectoral space is characterized by a simpler operation technique compared to the retromuscular placement of the implant, the absence of damage to the large pectoral muscle, minimization of pain, reduction of the bed-day in the hospital and a faster rehabilitation period. So, this type of breast reconstruction can be considered as an alternative to submuscular implant placement in primary operable forms of breast cancer with sufficient thickness of the integumentary tissues.
ВВЕДЕНИЕОперация лимфаденэктомия, как важный этап диагности-ки и противоопухолевого лечения, сопровождается значи-тельным риском развития осложнений, в частности лим-фэдемы, потери чувствительности определенных участков кожи и худшего заживления ран. Эта операция, также, приводит к возрастанию финансовых затрат на лечение больных вследствие большей продолжительности анесте-зии, более длительного пребывания в операционной и за-
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