Fashion And Beauty

Women with early-stage breast cancer who have undergone breast augmentation may be treated successfully with a partial-breast radiation treatment called brachytherapy, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA). Patients treated with brachytherapy have better cosmetic outcomes and avoid the risk of the implant hardening, compared to patients who undergo whole-breast radiation therapy.

“We are seeing an increasing number of breast cancer patients with augmentation,” said Robert R. Kuske Jr., M.D., clinical professor at the University of Arizona Health Sciences Center and radiation oncologist at Arizona Oncology Services in Scottsdale, Ariz. “By nature, these women are concerned about their appearance and we need to have options for them.”

According to the American Society of Plastic Surgeons, breast augmentation is the most popular cosmetic surgery in the U.S. with 347,500 procedures performed in 2007. This represents an increase of 64 percent since 2000.

Approximately one in eight women who undergo breast augmentation will develop breast cancer at some point in their lives.

The most common breast cancer treatment for patients with breast implants is skin-sparing mastectomy and implant exchange. Whole-breast radiation therapy after lumpectomy is an option, but carries a substantial risk during the healing process of scar tissue wrapping around the implant, causing it to become rock-hard and extremely painful. This condition, known as capsular contracture, also distorts the appearance of the breast.

Dr. Kuske set out to determine if partial-breast radiation with brachytherapy might offer a better outcome for women with implants wishing to avoid mastectomy.

Breast brachytherapy is a radiation treatment that can be given in higher doses to a small, targeted area of the breast after lumpectomy. Radioactive “seeds” are guided into place through small plastic tubes, or catheters, with the aid of imaging and a computer. The seeds emit high doses of radiation in short bursts.

Scar tissue is minimal, the implant remains unaffected and treatment time is shortened from 6 1/2 weeks with whole-breast radiation therapy to five days with brachytherapy.

For the study, 65 women who were diagnosed with small, early stage malignant tumors were treated with brachytherapy after a lumpectomy. The women received two doses per day, separated by six hours, over a five-day period. Follow-up was six months to five years. None of the patients experienced tumor recurrence during the follow-up period. Cosmetic outcome was determined to be good to excellent in 100 percent of patients with 95 percent judged excellent. Implant hardening was not observed in any of the patients.

“Compared to traditional treatments, brachytherapy offers an excellent alternative for these women,” Dr. Kuske said. “It offers very high rates of tumor control with fewer side effects and is easier on their lifestyle.”

Notes:

Disclosure: Dr. Kuske is a consultant for Nucletron and for Cianna Medical.

Copies of RSNA 2008 news releases and electronic images will be available online at http://www.RSNA.org/press08 beginning Monday, Dec. 1.

RSNA is an association of more than 42,000 radiologists, radiation oncologists, medical physicists and related scientists committed to excellence in patient care through education and research. The Society is based in Oak Brook, Ill. (http://www.RSNA.org)

For patient-friendly information on brachytherapy, visit http://www.RadiologyInfo.org

For breast cancer patients who underwent a mastectomy who undergo radiation therapy after immediate breast reconstruction, autologous tissue reconstruction provides fewer long-term complications and better cosmetic results than tissue expander and implant reconstruction, according to a study in the November issue of the International Journal of Radiation Oncology*Biology*Physics, the official journal of the American Society for Therapeutic Radiology and Oncology.

After undergoing a mastectomy (surgical removal of the breast), many women choose to have a breast reconstruction procedure performed immediately to better cope with the psychological and esthetic side effects of the surgery. However, the reconstruction can complicate radiation therapy treatments and sometimes radiation can negatively affect the outcome of reconstruction and increase the risk of long-term complications.

With radiation therapy increasingly becoming the standard of care for high-risk breast cancer patients after mastectomy, this can cause a problem for both patients and their radiation oncologists.

Researchers at the Department of Radiation Oncology at Long Island Radiation Therapy in Garden City, N.Y., the Department of Surgery at Long Island Jewish Hospital in New Hyde Park, N.Y., the Department of Surgery at North Shore University Hospital in Manhasset, N.Y., and the Department of Surgery at Winthrop University Hospital in Mineola, N.Y., sought to determine if the type of reconstruction performed on women who were receiving radiation after a mastectomy had an impact on their long-term outcomes.

Two types of reconstruction are available for patients undergoing mastectomy for breast cancer: ATR (autologous tissue reconstruction), which involves the placement of a tissue flap - most commonly from the transverse rectus abdominus muscle - as a breast mound, and TE/I (tissue expander and implant reconstruction), which involves placing an inflatable tissue expander over the chest wall and exchanging it for a permanent implant at a later date.

This study involved the largest reported series of patients who sequentially underwent mastectomy, immediate reconstruction and postmastectomy radiation therapy. Ninety-two patients were observed for 38 months following their reconstruction and radiation treatments, and researchers found that ATR is better tolerated by breast cancer patients because it is associated with fewer long-term complications and better cosmetic results than TE/I.

None of the 23 ATR patients required surgical intervention, while 33 percent of TE/I patients needed surgery to correct a problem with their reconstruction. Eighty-three percent of ATR patients reported acceptable cosmetic outcome, as opposed to only 54 percent of TE/I patients.

“This study is useful for patients who are candidates for either ATR or TE/I and are making a decision with regards to reconstruction technique,” Jigna Jhaveri, M.D., lead author of the study and a radiation oncologist at Advanced Radiation Centers of New York in Hauppauge, N.Y., said. “Our study provides evidence that patients who undergo autologous tissue reconstruction and radiation therapy have fewer long term complications and better cosmetic outcomes than those who undergo tissue expander/ implant reconstruction and radiation therapy.”

ASTRO is the largest radiation oncology society in the world, with 10,000 members who specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, biology and physics, the Society is dedicated to improving patient care through education, clinical practice, advancement of science and advocacy. For more information on ASTRO, visit http://www.astro.org. Visit http://www.rtanswers.org to learn more about radiation therapy.

Black women are 47% less likely than other women to undergo breast reconstruction after having a mastectomy, according to a study published in the November issue of Archives of Surgery, HealthDay/U.S. News & World Report reports. Undergoing breast reconstruction surgery immediately after having a mastectomy has several advantages, including aesthetic, psychosocial well-being and cost-effectiveness, according to the Johns Hopkins University researchers who conducted the study.

Researchers led by Gedge Rosson, an assistant professor of plastic surgery, analyzed data on 17,925 black and white women who had a mastectomy between 1995 and 2004; 27.9% of the women had breast reconstruction immediately after their mastectomy. The researchers also analyzed data on the communities where the women lived. Researchers found that being older, living in inner cities with high black populations and having a high school education or less all were factors indicating likeliness to not have reconstruction surgery. Wealthy women, those with more education and those who did not live in inner cities were more likely to have immediate reconstruction surgery, according to the study.

Researchers noted that even white women living in poor black neighborhoods were less likely to undergo the procedure. Rosson said, “The community a patient lives in actually does influence, in some way, the access they have to breast reconstruction. We need to learn more about why that is.” He added, “People have noticed that African-Americans have fewer referrals to plastic surgeons, and if they do have a referral, they have a lower rate of going to those referrals. Strangely, even once they see the plastic surgeon, reconstruction seems to be offered with less frequency.”

Researchers believe that more education programs are needed to inform women of the benefits of breast reconstruction and a particular emphasis is needed in racial and ethnic minority communities .

The study is available online.

Reprinted with kind permission from http://www.kaisernetwork.org.

How is breast reconstruction performed? How will the breasts look afterward? What are the risks and side effects? Will insurance pay for it?

These are important questions that may be going through the minds of millions of breast cancer survivors as they consider breast reconstruction. The Consumer Guide to Plastic Surgery’s new, comprehensive article on breast reconstruction surgery answers these and many other questions for women who will undergo mastectomy or have done so already.

The feature can be found here.

In 2007, 176,295 women were diagnosed with breast cancer, according to the American Cancer Society, Approximately 57,100 breast reconstruction procedures were performed in 2007, according to the American Society of Plastic Surgeons.

“There are lot of options for breast cancer survivors today, but that means there’s also a lot of new information for women to sift through and this can be especially challenging when they are also making life-saving treatment decisions,” says Walter L. Erhardt, Jr., MD, FACS, a leading cosmetic plastic surgeon in Albany, GA and a member of Consumer Guide to Plastic Surgery’s editorial advisory board. “This article can help women make sense of the new options as well as serve as a reference going forward.”

Dr. Erhardt adds that “breast cancer treatment has evolved so too has reconstruction. Our aesthetic results are better and women who were not considered good candidates 10 years ago do make candidates today.”

Some of the information you’ll find in the article includes:

- Is nipple reconstruction possible?
- Which type of implant should be used: saline or silicone?
- Will the reconstructed breast match the unaffected one?
- What happens if your breast cancer returns?
- Will the reconstruction interfere with mammography and other ongoing cancer checks?
- Is breast sensitivity an issue after surgery?
- Where does the new breast tissue come from?
- What other questions should you remember to ask the surgeon?

About Consumer Guide to Plastic Surgery

Consumer Guide to Plastic Surgery is a one-stop, independent resource with more than 150 pages of information on cosmetic plastic surgery and skincare procedures. In addition to breast reconstruction, popular topics include:

- Breast augmentation
- Facelift
- Liposuction
- Rhinoplasty
- Tummy tuck

Cosmetic surgery articles are reviewed by an editorial advisory board comprising some of the nation’s leading surgeons, assuring consumers of the highest-quality, most trustworthy information on the Web. To complement this robust content, a before-and-after photo gallery is available.

Consumer Guide to Plastic Surgery is published by Ceatus Media Group LLC, an online provider of health information and physician directories.

Consumer Guide to Plastic Surgery

Cytori Therapeutics (NASDAQ: CYTX) received U.S. Patent No. 7,429,488 (the ‘488 patent), which broadly protects the Company’s Celution® System-based methods of generating adipose tissue-derived stem and regenerative cell-enhanced fat grafts. Cell-enhanced fat grafts may be used in a variety of cosmetic and reconstructive surgery applications, including breast reconstruction following partial mastectomy, breast implant salvage, as well as facial and other cosmetic applications. The Celution 800/CRS System is currently available for sale in Europe and parts of Asia.

Receipt of the ‘488 patent, which runs until at least January 2024, is important to Cytori because it further strengthens the Celution System’s competitive position within the cosmetic and reconstructive surgery market. Part of Cytori’s strategy to create greater barriers-to-entry is to protect distinct applications of the Celution System. This allows Cytori to build additional layers of protection around U.S. Patent No. 7,390,484, which was recently issued to Cytori and covers the Celution System’s core technology. Additional patents have been filed around other Celution System applications, including cell banking, cardiovascular disease, spine and orthopedic repair, among others.

This patent broadly protects Cytori’s Celution 800/CRS System, which automates the method of creating a cell-enhanced fat graft. First, the Celution 800/CRS System processes stem and regenerative cells from a small amount of adipose tissue. Next, the Celution 800/CRS System mixes these cells with liposuctioned fat tissue. This forms the cell-enhanced fat graft, which may be used as a natural filler to reconstruct soft tissue defects.

Cytori’s intellectual property portfolio related to the devices, methods and uses of adipose-derived stem and regenerative cells includes eight U.S. and international patents and over 120 applications pending worldwide. Combined with Cytori’s proprietary know-how, exclusive supply agreements, and instrumentation, greater barriers-to-entry are being created to offer what the Company believes is the only safe, high-quality and effective adipose tissue processing device.

About Cytori

Cytori’s (NASDAQ: CYTX) goal is to be the global leader in regenerative medicine. The company is dedicated to providing patients with new options for reconstructive surgery, developing treatments for cardiovascular disease, and banking patients’ adult stem and regenerative cells. The Celution® 800 System is being introduced in Europe and Asia Pacific into the reconstructive surgery market while the Celution® 900 System is being commercialized globally for cryopreserving a patient’s own stem and regenerative cells. Clinical trials are ongoing in cardiovascular disease and planned for spinal disc degeneration, gastrointestinal disorders, and other unmet medical needs. http://www.cytoritx.com

A novel endoscopic-assisted technique for skin-sparing mastectomy with immediate breast reconstruction can successfully treat early breast cancer patients while offering favorable aesthetic results.

Researchers of a study in ANZ Journal of Surgery published by Wiley-Blackwell successfully developed a method to remove the entire mammary gland including early-stage breast cancer without injuring the skin of the breast.

“Although breast-conserving surgeries (BCS) are the most desirable choice for patients with early breast cancer, many have to abandon BCS due to tumors accompanied by extended intraductual components or multiple tumors. With this new technique, selected patients can be treated for breast cancer without breast deformity”, says author Dr. Ken-ichi Ito, Division of Breast and Endocrine Surgery, Shinshu University School of Medicine, Japan.

Skin sparing mastectomy is used for patients with early breast cancer who are treated with total mastectomy and immediate breast reconstruction. With advances in minimally invasive endoscopic techniques, patients can undergo this procedure with minimal skin incision - thereby improving the reconstructive and rehabilitative outcome.

“Mastectomy often induces adverse psychological events such as anxiety and depression over the disfigurement of their bodies. The current approach to breast surgery aims to minimize further tissue loss while obtaining maximal oncological safety”, says Dr. Ito.

The study titled “Endoscopic-assisted skin sparing mastectomy combined with sentinel node biopsy” showed favorable prognoses of patients treated with this technique, indicating that this procedure could be considered as an alternative treatment option for patients who are not candidates for BCS due to presence of intraductual component or multiple tumors.

This study is published in the October 2008 issue of ANZ Journal of Surgery (Vol. 78, Issue 10, 2008).

About ANZ Journal of Surgery

ANZ Journal of Surgery, established more than 70 years, is the leading surgical journal published in Australia, New Zealand and the South-East Asian region. The Journal is dedicated to the promotion of outstanding surgical practice and research of contemporary and international interest. ANZ Journal of Surgery publishes high-quality papers related to clinical practice and/or research in all fields of surgery and its related disciplines. A program of continuing education for surgeons at all levels is also provided.

About Wiley

Founded in 1807, John Wiley & Sons, Inc. has been a valued source of information and understanding for 200 years, helping people around the world meet their needs and fulfill their aspirations. Since 1901, Wiley and its acquired companies have published the works of more than 350 Nobel laureates in all categories: Literature, Economics, Physiology/Medicine, Chemistry and Peace.

Our core businesses include scientific, technical, medical and scholarly journals, encyclopedias, books, and online products and services; professional/trade publishes books, subscription products, training materials, and online applications and websites; and educational materials for undergraduate and graduate students and lifelong learners. Wiley’s global headquarters are located in Hoboken, New Jersey, with operations in the U.S., Europe, Asia, Canada, and Australia. The Company’s Web site can be accessed at http://www.wiley.com. The Company is listed on the New York Stock Exchange under the symbols JWa and JWb.

John Wiley & Sons, Inc.

New surgical techniques have dramatically improved the aesthetic results of mastectomy without sacrificing outcomes. Properly placed incisions and skin-sparing, or breast skin conserving, surgical approaches provide women undergoing biopsy and surgical treatment for breast cancer with the best option for appropriate cancer eradication while still permitting reconstruction of a more natural looking breast. Yet, according to a recent study, one third of California board-certified breast surgeons surveyed still regularly use the archaic practice of cutting across the whole breast when performing a mastectomy, resulting in unnecessarily disfiguring scars.

A skin-sparing operation removes cancerous breast tissue by using the same minimal and judiciously placed incisions used by plastic surgeons for elective breast surgery. The most common approach is to use a simple, small, circular incision around the edge of the nipple area. The surgeon leaves all or most of the overlying breast skin, preserving the natural skin envelope that can be filled with an implant or with a patient’s own fat tissue from another part of the body. This skin-sparing technique is appropriate for women whose breast cancer does not invade the skin of the breast.

In the study, recently presented at the American College of Surgeons meeting and published in the October 2008 issue of “The American Surgeon”, the researchers surveyed California board-certified general surgeons who perform breast cancer surgery. The majority of the 414 surgeons who responded to the study agreed that a skin-sparing mastectomy does not result in a higher risk of cancer recurrence, and three-quarters recognized that the cosmetic results of a skin-sparing operation were better than a standard mastectomy. Despite this, fewer than two-thirds said they perform a skin-sparing mastectomy in most cases when immediate breast reconstruction is planned.

“This finding is important because it shows that women with breast cancer are treated appropriately for the cancer, but many woman are unnecessarily left with highly visible scars and poor breast shape after surgery,” said Joel Aronowitz, M.D., senior author of the study and the Clinical Chief of the Plastic Surgery Division at Cedars-Sinai Medical Center in Los Angeles. “We have a well developed body of literature demonstrating uncompromised, highly effective treatment of the malignancy over the long-term, and more aesthetically pleasing results with skin-sparing mastectomy, yet there remains significant variation in practice patterns among general surgeons treating breast cancer.”

“Part of the problem is that amidst the shock and anxiety of a breast cancer diagnosis, many women and some physicians consider the appearance of the breasts of secondary importance and not worthy of serious consideration compared to the treatment of cancer. Natural looking breasts help restore a woman’s sense of wholeness and aid in the healing process,” continued Aronowitz.

Aronowitz and his co-authors concluded that additional education regarding skin-sparing mastectomy is needed among the general surgery community to increase utilization of breast skin conserving approaches and use of plastic surgery principles for placement of incisions for biopsy and mastectomy procedures. Their hope is that increased use of these modern, reconstructive surgery concepts will result in a decreased use of standard, centuries old “cut across the chest” incisions.

To help better educate and inform women with breast cancer and their caregivers, Aronowitz has established The Breast Preservation Foundation, a nonprofit organization dedicated to increasing awareness of the skin-sparing mastectomy.

“Breast cancer patients should be assertive with their doctors to ensure that the most modern aesthetic techniques and principles are applied with the same rigor as is given to the treatment of their cancer,” Aronowitz said.

The study was conducted by Aronowitz and David Kulber, M.D., of Cedars-Sinai Medical Center; and Jeannie Shen, M.D., Joshua Ellenhorn, M.D., and Dajun Qian, Ph.D., of the City of Hope Medical Center. Complete copies of the paper, “Skin-Sparing Mastectomy: A Survey-Based Approach to Defining Standard of Care,” are available for downloading at http://www.breastpreservation.org/news.htm