PubMed · 2134313
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R K Donis. 1990. Breast implants and contracture.. https://doi.org/10.1097/00006534-199010000-00068
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This study was carried out with the aim of elucidating the organ-specific effects of ethylene oxide in comparison with the sensitivity of cells from different tissues. An increased incidence of leukemia and lymphoma has been observed in workers exposed to ethylene oxide. However, contradictory findings exist regarding its ability to induce other tumor types, such as breast cancer. We characterized the genotoxicity of ethylene oxide by means of the alkaline version of comet assay in in vitro systems, in order to investigate the hypothesized role of this substance in the development of breast cancer. For this study, we used primary and secondary cultures of lymphoblasts (well-known target cells of the genotoxicity of ethylene oxide), breast epithelial cells (hypothesized target), peripheral blood lymphocytes (cells commonly used in biomonitoring), and of keratinocytes and cervical epithelial cells. DNA damage was measured and expressed as tail DNA, tail length, and tail moment. In the concentration range 0-100 microM, ethylene oxide induced a dose-dependent increase of DNA damage in the investigated cell types without notable cytotoxicity. A statistically significant increase of DNA damage could be observed after treatment with 20 microM ethylene oxide in lymphoblasts (51% increase of tail moment over the background), breast epithelial cells (26% increase) and peripheral lymphocytes (71% increase). In keratinocytes (5% increase) and cervical epithelial cells (5% increase) significant DNA damage could not be detected at this dose, but at higher concentrations (50-100 microM), such an increase was observed. These results are indicative of an increased sensitivity of breast epithelial cells towards genotoxic insults of ethylene oxide. Our observations provide additional data to evaluate the hypothesis that exposure to ethylene oxide may play a role in breast cancer, and the findings may contribute to the development of screening tests for monitoring an early response to genotoxic insults in occupational settings.
OBJECTIVE: This study aims at combined surgical therapy options concerning patients with a clinically relevant and long-established capsular contracture following subglandular breast augmentation in a glandular ptotic breast. METHODS: This is a review of 23 patients with capsular contracture. Three patients had a revision surgery for capsular contracture and implant dislocation before. The mean implant duration in the case of the twenty patients without any previous revision was 96 months. A revision implant has been re-located in a dual-plane position and further corrective surgery was carried out to adapt the glandular ptotic breast. Between 2001 and 2003, a chart review was performed on all patients for capsular contracture and ptotic breast by using the technique presented in this study. RESULTS: In each case, the operation was performed as a one-stage procedure. The procedure included the following steps: Removal of the implant and total capsulectomy, preparation of an inferior de-epithelialised skin pedicle above the inframammary crease, release of the inferior origins of the pectoralis major muscle, creation of a new implant pocket by continuous connection of the inferior muscle border with the cranial edge of the inferior skin pedicle (dual-plane), adaptation of the soft-tissue/skin envelope by closing the cranial V over the implant coverage, preservation of the areola by creating a cranial or cranial medial pedicle. There was a follow-up for a period of up to 48 months, and any complication that occurred was documented. At follow-up period, all patients who had been implanted with a new implant pocket were free of a clinically relevant capsular contracture. CONCLUSIONS: In the cases of a severe capsular contracture and glandular-ptotic breasts, we presented the surgical corrections of the parenchyma/skin envelop as a one-stage procedure following the establishment of a new implant pocket.
PURPOSE: To compare the Para Mixed technique for irradiation of the internal mammary nodes (IMN) with three commonly used strategies, by analyzing the dose to the heart and other organs at risk. METHODS AND MATERIALS: Four different three-dimensional conformal dose plans were created for 30 breast cancer patients. The IMN were enclosed with the Para Mixed technique by a widened mediolateral tangent photon beam and an anterior electron beam, with the Patched technique by an anterior electron beam, with the Standard technique by an anterior photon and electron beam, and with the PWT technique by partially wide tangents. All techniques were optimized for conformality and produced equally adequate target coverage. RESULTS: Heart dose was lowest with the Para Mixed and Patched technique for all patients and with the PWT technique for right-sided treatment only. Lung dose was highest with the PWT, lowest with the Patched, and intermediate with the Para Mixed and Standard techniques. Skin dose was highest with the Patched, lowest with the PWT, and intermediate with the Para Mixed and the Standard techniques. The Para Mixed technique resulted in a 13-Gy lower dose in an overlap area, and the PWT technique was the only technique that incorporated considerable volumes of the contralateral breast. CONCLUSION: The Para Mixed technique yielded the overall best results. No other technique resulted in a lower heart dose. Lung and skin were equally spared instead of one of them being compromised, and the contralateral breast was avoided.