Torrenting values, feelings and thoughts : cyber nursing and virtual self care in a breast augmentation forum

Earlier research shows that breast augmentation is positively correlated with positive psychological states. The aim of this study was to explore the shared values, feelings, and thoughts within the culture of breast enlargement among women visiting Internet-based forums when considering and/or undergoing esthetic plastic surgery. The study used a netnographic method for gathering and analyzing data. The findings show that the women used the Internet forum to provide emotional support to other women. Through electronic postings, they cared for and nursed each others’ anxiety and feelings throughout the whole process. Apart from the process, another central issue was that the women's relationships were frequently discussed; specifically their relationship to themselves, their environment, and with the surgeons. The findings suggest that Internet forums represent a channel through which posters can share values, feelings, and thoughts from the position of an agent of action as well as from a position as the object of action. These dual positions and the medium endow the women with a virtual nursing competence that would otherwise be unavailable. By introducing the concept of torrenting as a means of sharing important self-care information, the authors provide a concept that can be further explored in relation to post modern self-care strategies within contemporary nursing theories and practice.

Development and implementation of a web-enabled 3D consultation tool for breast augmentation surgery based on 3D-image reconstruction of 2D pictures

Producing a rich, personalized Web-based consultation tool for plastic surgeons and patients is challenging.

Augmentation mammoplasty: effect on diagnosis of breast cancer

Breast augmentation for cosmetic purposes is an increasingly common procedure in the USA and UK. In the USA in 2003, a total of 254 140 breast augmentation procedures were carried out [American Society of Plastic Surgeons, http://www.plasticsurgery.org/newsroom/ Procedural-Statistics-Press-Kit-Index.cfm9-1-2005; 2006.(1)]. It has been previously estimated that between 1 and 1.5 million women in the USA have prosthetic breast implants [Cook RR, Delongchamp RR, Woodbury M, et at. The prevalence of women with breast implants in the United States, 1989. J Clin Epidemiol 1995;48:519-25.(2)]. The UK National Breast Implant Registry has recorded a rise in the numbers of women receiving breast implants, with over 13 000 procedures registered in 2001; an estimated 77% of these were for cosmetic purposes. No association has been found between the presence of breast implants in a breast and an increased risk of breast cancer, and this subject has been comprehensively reviewed elsewhere [Hoshaw SJ, Klein PJ, Clark BD, et al. Breast implants and cancer: causation, delayed detection, and survival. Plast Reconstr Surg 2001; 107:1393-407.(3)]. However, as the population of women with breast implants ages, an increasing number of them will develop breast cancer; a reflection of the fact that the incidence of the disease increases with increasing age. Debate continues on the effect of breast implants on the efficacy of mammography in diagnosing breast cancer, and the role of other imaging techniques for this purpose, as well as the limitations that the presence of implants place on percutaneous biopsy techniques. We review the Literature on the radiological and tissue diagnosis of breast cancer in women with a history of previous augmentation mammaplasty. (c) 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Breast cancer following augmentation mammoplasty - a review of its impact on prognosis and management

The incidence of breast cancer in women with implants is increasing and will continue to do so for the foreseeable future due to the marked increase in breast implant insertion in recent years. Undoubtedly many of these women will wish to know whether the presence of implants worsens the prognosis of their breast cancer. Furthermore, the clinical management of such patients may be difficult, as aesthetic results are likely to be a major concern for women who have already undergone cosmetic surgery to the breast. There is no consensus on surgical approach to this scenario. This article reviews the literature on the prognosis of breast cancer patients with a history of augmentation mammoplasty and examines the available data regarding their surgical treatment. (c) 2007 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.

Unilateral hypoplastic breast in a male-to-female transsexual with Poland syndrome after gender reassignment--reconstructive considerations

Gender reassignment procedures are performed more frequently nowadays due to a multidisciplinary approach and improved techniques and selection process. Many male-to-female patients require bilateral breast augmentation as part of the transformation following the gender reassignment if they fail to develop female breast features after hormonal treatment. We report on a very rare incidence of male-to-female gender reassignment in a patient with Poland syndrome. A male-to-female transsexual on hormonal therapy for gender reassignment developed one normal female-shaped breast whereas the other breast remained hypoplastic. As a male, he was not aware of his chest wall deformity but it became a major issue after successful gender reassignment surgery. Our experience with the specific reconstructive considerations and recommendations regarding our surgical approach to this complex reconstructive problem are discussed.

As turbinadas e os pigmaleões: implantes mamários de silicone e a beleza construída

Esta dissertação trata da construção dos valores acerca do corpo que transforma aspectos estéticos em problemas de saúde física. Com base na pressuposição do compromisso de aliviar o sofrimento o cirurgião plástico busca, dentro do campo da saúde, justificativas para sua atuação. Por outro lado, na aspiração por modelos de beleza socialmente prestigiados há também a procura pela transformação pessoal com a construção e afirmação de papéis sociais, o que contribui para a maior aceitação das intervenções cirúrgicas com finalidade estética. Seguindo tendências estéticas sempre em mutação, observa-se, na atualidade, uma grande demanda por cirurgia plástica para colocação de implantes de silicone com objetivo de aumento mamário. Tomando como recorte a utilização de tais implantes, buscou-se analisar a construção médica e social da beleza e compreender como a procura e a prática da cirurgia plástica estão ligadas a valores controversamente aceitos ou criticados na sociedade contemporânea.

Avaliação volumétrica e funcional do músculo glúteo máximo submetido a gluteoplastia de aumento com implantes de silicone

A operação para aumento de glúteos com implantes teve início no fim da década de 1960, entretanto a técnica intramuscular, considerada padrão atualmente, foi descrita cerca de 30 anos depois. Cirurgiões e pacientes apresentam crescente interesse na realização do aumento de glúteos haja vista que sua frequência apresenta aumento nos últimos anos. A utilização de implantes intramusculares que superam o volume do músculo em mais de cinquenta por cento configura uma situação nova que deve ser estudada. O tecido muscular estriado esquelético apresenta grande suscetibilidade para atrofia secundariamente à compressão, e sendo o glúteo máximo um músculo importante na manutenção da postura ereta, deambulação, corrida e salto, é necessário pesquisar possíveis alterações musculares decorrentes da operação. O objetivo deste estudo é avaliar o volume e força do músculo glúteo máximo ao longo de 12 meses após a introdução de implantes intramusculares, o posicionamento destes implantes no interior da musculatura e mudanças antropométricas obtidas com a operação. Foram selecionadas 48 mulheres, 24 candidatas a gluteoplastia de aumento com implantes compuseram o grupo de estudo e 24 candidatas a mamoplastia de aumento compuseram o grupo controle de acordo com os critérios de inclusão e exclusão. As pacientes foram avaliadas em quatro momentos diferentes: pré-operatório e após três, seis e 12 meses da operação. Em todas as etapas foi realizada avaliação clínica nutricional, tomografia computadorizada com reconstrução 3D e teste isocinético. Todas as pacientes permaneceram afastadas de atividades físicas durante três meses após a operação. Foram utilizados implantes glúteos em gel coesivo de base oval e superfície lisa com volumes de 350 cm3 e 400 cm3. O nível de significância estatística foi mantido em 5%. As pacientes candidatas a gluteoplastia apresentaram valores da relação entre as medidas da cintura e do quadril maiores que aquelas do grupo controle. A operação de aumento glúteo com implantes demonstrou eficácia na melhora desta relação. Os implantes apresentaram posição obliqua com inclinação semelhante à das fibras musculares após três meses da operação, independente da posição em que foram inseridos. As pacientes do grupo de estudo apresentaram atrofia muscular após 12 meses em 6,14% à esquerda e 6,43% à direita, as pacientes do grupo controle não apresentaram atrofia. A força muscular apresentou redução do valor de torque máximo durante a flexão do quadril a 30 /s em ambos os grupos e aumento do torque máximo durante a adução a 60 /s apenas no grupo de estudo. Concluímos que a introdução de implante de silicone no interior do músculo glúteo máximo causa atrofia muscular após 12 meses. As variações na força deste músculo nesse período não podem ser atribuídas primariamente à operação ou à presença dos implantes em seu interior. Os implantes permaneceram em posição obliqua. O aumento de glúteos com implantes gera mudanças antropométricas nas mulheres submetidas a esta operação.

Avaliação dos efeitos do implante de silicone sobre o parênquima mamário e a musculatura peitoral maior

A mamoplastia de aumento está associada a alto grau de satisfação e significativa melhora da qualidade de vida das pacientes. Apesar disso, uma das principais causas de reoperação após esse procedimento se refere a deformidades de contorno e questões volumétricas. Ainda existem poucos dados objetivos para análise volumétrica pós-operatória da mamoplastia de aumento. O parênquima mamário sofre alterações microvasculares quando sob compressão mecânica, porém o tecido muscular é mais suscetível à lesão quando submetido a pressão do que outros tecidos, tendo pouca tolerância à compressão mecânica. O objetivo deste estudo é avaliar e comparar as alterações no parênquima mamário na mamoplastia de aumento subglandular e submuscular, além de avaliar as alterações volumétricas e funcionais da musculatura peitoral após a inserção de implantes no plano submuscular. Cinquenta e oito pacientes do sexo feminino foram randomizadas em dois grupos de estudo, com 24 pacientes cada, e um grupo controle com dez pacientes, de acordo com critérios de inclusão e não inclusão. Das pacientes do grupo de estudo, 24 foram submetidas à mamoplastia de aumento com inserção de implantes no plano suglandular e 24 foram submetidas ao procedimento no plano submuscular. As pacientes do grupo subglandular realizaram análise volumétrica da glândula mamária e as pacientes dos grupos submuscular e controle, além da volumetria mamária, também realizaram volumetria do músculo peitoral maior. A avaliação volumétrica foi realizada no pré-operatório e no pós-operatório, aos seis e 12 meses, por meio de ressonância magnética. Apenas as pacientes do grupo submuscular foram submetidas à avaliação da força muscular, com a utilização de teste isocinético, no pré-operatório e no pós-operatório, aos três, seis e 12 meses. Todas as pacientes estavam sob uso de anticoncepcional oral de baixa dosagem e as pacientes do grupo submuscular permaneceram afastadas de atividades físicas por um período de dois meses no pós-operatório. O grupo subglandular apresentou 22,8% de atrofia da glândula mamária ao final dos 12 meses, enquanto que o grupo submuscular não apresentou atrofia glandular ao final de um ano. O grupo submuscular apresentou atrofia muscular de 49,80% e redução da força muscular em adução após um ano de estudo. Não se observou correlação da forca muscular com a perda volumétrica, assim como não se observou alteração de forca em abdução. Concluímos que a mamoplastia de aumento suglandular causa atrofia do parênquima mamário, enquanto que o procedimento submuscular não causa esta alteração no parênquima mamário após o período de 12 meses pós-operatórios. Em contrapartida, a mamoplastia de aumento submuscular causa atrofia do músculo peitoral maior com diminuição da força muscular em adução após 12 meses de pós-operatório, sem correlação com a alteração de volume muscular.

Identification and characterization of new biomarkers in aggressive subtypes of breast cancer

En 2015, la récidive tumorale et les métastases du cancer du sein demeurent une cause importante de décès à travers le monde. Toutefois, ces cancers sont souvent hétérogènes car en dépit d’un phénotype similaire, l’évolution clinique et la réponse au traitement peuvent varier considérablement. Il y a donc un intérêt évident à identifier et à caractériser de nouveaux biomarqueurs pour permettre classer les tumeurs mammaires dans des sous-groupes plus homogènes. Notre hypothèse est que chaque cancer mammaire possède des caractéristiques distinctes au plan des altérations du génome et des profils d’expression géniques et que ces changements se traduisent cliniquement par une prédisposition à former des métastases ou à répondre ou non à la chimiothérapie et aux thérapies ciblées. Dans le cadre de nos travaux, nous nous sommes intéressés aux sous-types agressifs de tumeurs mammaires et notamment les cancers de type triple négatif. Nous avons aussi tenté d’identifier des marqueurs capables de distinguer l’une de l’autre les tumeurs de type luminal A et luminal B. Pour ce faire, nous avons d’abord utilisé une stratégie in silico à partir de données publiques (micro-puces d’ADN et séquençage de l’ARN). Nous avons ensuite construit sept micro-matrices tissulaires (TMA) provenant de tissus mammaires normaux et tumoraux fixés à la formaline et enrobés en paraffine. Ces outils nous ont permis d’évaluer par immunohistochimie les niveaux d’expression différentielle des marqueurs suivants : ANXA1, MMP-9, DP103 et MCM2. Ceux-ci ont été comparés aux marqueurs usuels du cancer du sein (ER, PR, HER2, CK5/6 et FOXA1) et corrélés aux données cliniques (survie globale et métastase). Nos résultats indiquent que ces nouveaux marqueurs jouent un rôle important dans l’évolution clinique défavorable des tumeurs de haut grade. Dans un premier article nous avons montré que l’expression d’ANXA1 est dérégulée dans les cancers de type triple-négatif et aussi, dans une certaine mesure, dans les tumeurs HER2+. Nous croyons qu’ANXA1 permet de mieux comprendre le processus d’hétérogénéité tumorale et facilite l’identification des tumeurs de haut grade. Nous proposons également qu’ d’ANXA1 stimule la transition épithélio-mésenchymateuse (EMT) et la formation des métastases. Dans un second temps, nous avons montré que les niveaux d’expression de MMP-9 reflètent la différenciation cellulaire et corrèlent avec les sous-types de cancers mammaires ayant un mauvais pronostic. Nous estimons que MMP-9 permet de mieux comprendre et d’identifier les tumeurs mammaires à haut risque. De fait, la surexpression de MMP-9 est associée à une augmentation des métastases, une récidive précoce et une diminution de la survie globale. Dans le cadre d’un troisième article, nous avons montré que la surexpression du marqueur de prolifération MCM2 s’observe dans les cancers triple-négatifs, HER2+ et Luminal B par comparaison aux cancers luminal A (p< 0.0001). Nos résultats suggèrent qu’en utilisant un seuil de 40% de noyaux marqués, nous pourrions distinguer l’une de l’autre les tumeurs de type luminal A et luminal B. Cela dit, avant de pouvoir envisager l’utilisation de ce marqueur en clinique, une étude de validation sur une nouvelle cohorte de patientes s’impose. En somme, les résultats de nos travaux suggèrent qu’ANXA1, MMP-9 et MCM2 sont des marqueurs intéressants pour mieux comprendre les mécanismes physiopathologiques impliqués dans la progression tumorale et le développement des métastases. À terme, ces nouveaux marqueurs pourraient être utilisés seuls ou en combinaison avec d’autres gènes candidats pour permettre le développement de trousses « multigènes » ou d’essais protéomiques multiplex pour prédire l’évolution clinique des cancers mammaires.

Systemic Inflammatory Reaction After Silicone Breast Implant

Systemic inflammation after augmentation mammaplasty with modern silicone implants is not currently recognized. In a prospective controlled study, C-reactive protein and other variables were monitored, aiming to test this hypothesis in a young cohort of patients. Females (18-30 years old, BMI = 18.5-30 kg/m(2), N = 52) were consecutively recruited for breast implant (n = 24, Group I) and for abdominal liposuction (n = 28, Group II/Controls). Patients were interviewed at baseline and followed until 6 months after operation. Variables included demographic and clinical information, surgical outcome, inflammatory markers and autoantibodies. Operations were well tolerated, without surgical or infectious complications. Mean prosthesis size was 258 +/- A 21 ml (range = 220-280) and mean aspirate of liposuction was 1972 +/- A 499 ml (range = 1200-3000). Preoperative, 2-month, and 6-month C-reactive protein concentrations for breast implant patients were 1.3 +/- A 1.2, 4.8 +/- A 3.0, and 4.3 +/- A 6.4 mg/l and for liposuction 3.5 +/- A 2.7, 3.5 +/- A 2.1, and 2.2 +/- A 2.2 mg/l, respectively. Change at 2 months was significant (p = 0.001). Autoantibody investigation failed to reveal remarkable aberrations, except for anticardiolipin elevation, which was nearly symmetrical in the two groups. C-reactive protein levels increased after operation and correlated with proinflammatory and procoagulatory indices. A mild increase in anticardiolipin IgM occurred but differences between populations were lacking. Despite excellent cosmetic outcomes and lack of complications, acute phase reaction could signal ongoing immunogenicity of silicone and long-term monitoring is recommended.

The extended diep flap: extending the possibilities for breast reconstruction with tissue from the lower abdomen

The classical DIEP-flap is considered state-of-the-art in microsurgical autologous breast reconstruction. Some patients may require additional volume to match the contralateral breast. This quality control study prospectively evaluates the feasibility and outcome of a surgical technique, which pursues the volumetric augmentation of the DIEP-flap by harvesting of additional subscarpal fat tissue cranial to the classical flap border.

Improving the assessment and outcome of free tissue transfer breast reconstruction

Introduction: Free tissue transfer using an abdominal tissue flap is a commonly used method of breast reconstruction. However, there are well recognised complications including venous congestion, fat necrosis and flap loss associated with the perfusion of these flaps. Post-operative aesthetic outcome assessment of such breast reconstructions have also proven to be difficult with current methods displaying poor inter-rater reliability and patient correlation. The aim of this research was to investigate potential improvements to the post-operative outcome of free abdominal tissue transfer breast reconstruction by assessing the effects of vascular augmentation interventions on flap perfusion and to assess the use of real-time digital video as a post-operative assessment tool. Methods: An in-vivo pilot study carried out on 12 patients undergoing DIEP flap breast reconstruction assessed the effect on Zone IV perfusion, using LDI and ICG angiography, of vascular augmentation of the flap using the contralateral SIEA and SIEV. A further animal experimental study was carried out on 12 Sprague Dawley rats to assess the effects on main pedicle arterial blood flow and on Zone I and Zone IV perfusion of vascular augmentation of the abdominal flap using the contralateral vascular system. A separate post-operative assessment study was undertaken on 35 breast reconstruction patients who evaluated their own reconstructions via patient questionnaire and underwent photograph and real-time digital video capture of their reconstructions with subsequent panel assessment. Results: Our results showed that combined vascular augmentation of DIEP flaps, using both the SIEA and SIEV together, led to an increase in Zone IV perfusion. Vascular augmentation of the rat abdominal flaps also led to a significant increase in Zone I/IV perfusion, but the augmentation procedure resulted in a decreased main pedicle arterial blood flow. Our post-operative assessment study revealed that real-time digital video footage led to greater inter-rater agreement with regards to cosmesis and shape than photography and also correlated more with patient self-assessment. Conclusion: Vascular augmentation of abdominal free tissue flaps using the contralateral vascular system results in an increase to Zone IV perfusion, however this may lead to decreased main pedicle arterial blood flow. Real-time digital video is a valid post-operative aesthetic assessment method of breast reconstruction outcome and is superior to static photography when coupled with panel assessment.

No evidence for association of ataxia-telangiectasia mutated gene T2119C and C3161G amino acid substitution variants with risk of breast cancer

Background There is evidence that certain mutations in the double-strand break repair pathway ataxia-telangiectasia mutated gene act in a dominant-negative manner to increase the risk of breast cancer. There are also some reports to suggest that the amino acid substitution variants T2119C Ser707Pro and C3161G Pro1054Arg may be associated with breast cancer risk. We investigate the breast cancer risk associated with these two nonconservative amino acid substitution variants using a large Australian population-based case–control study. Methods The polymorphisms were genotyped in more than 1300 cases and 600 controls using 5' exonuclease assays. Case–control analyses and genotype distributions were compared by logistic regression. Results The 2119C variant was rare, occurring at frequencies of 1.4 and 1.3% in cases and controls, respectively (P = 0.8). There was no difference in genotype distribution between cases and controls (P = 0.8), and the TC genotype was not associated with increased risk of breast cancer (adjusted odds ratio = 1.08, 95% confidence interval = 0.59–1.97, P = 0.8). Similarly, the 3161G variant was no more common in cases than in controls (2.9% versus 2.2%, P = 0.2), there was no difference in genotype distribution between cases and controls (P = 0.1), and the CG genotype was not associated with an increased risk of breast cancer (adjusted odds ratio = 1.30, 95% confidence interval = 0.85–1.98, P = 0.2). This lack of evidence for an association persisted within groups defined by the family history of breast cancer or by age. Conclusion The 2119C and 3161G amino acid substitution variants are not associated with moderate or high risks of breast cancer in Australian women.