| 1. |
- Fagerlund, Anders, et al.
(författare)
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Gynecomastia: A systematic review.
- 2015
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Ingår i: Journal of plastic surgery and hand surgery. - 2000-6764. ; 49:6, s. 311-318
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Forskningsöversikt (refereegranskat)abstract
- Gynecomastia is a common medical problem presenting in nearly a third of the male population. Treatment for gynecomastia can be either pharmacological or surgical. Patients with gynecomastia often experience affected quality-of-life. The aim of this systematic review was to analyze the quality of evidence of the current literature in relation to different treatment modalities and Quality-of-Life in patients with gynecomastia.
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| 2. |
- Fagerlund, Anders, et al.
(författare)
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Gynecomastia in Patients with Prostate Cancer: A Systematic Review.
- 2015
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Ingår i: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 10:8
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Tidskriftsartikel (refereegranskat)abstract
- Gynecomastia and/or mastodynia is a common medical problem in patients receiving antiandrogen (bicalutamide or flutamide) treatment for prostate cancer; up to 70% of these patients result to be affected; furthermore, this can jeopardise patients' quality of life.
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| 3. |
- Hallberg, Håkan, et al.
(författare)
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Benefits and risks with acellular dermal matrix (ADM) and mesh support in immediate breast reconstruction: a systematic review and meta-analysis
- 2018
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - 2000-656X .- 2000-6764. ; 52:3, s. 130-147
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Tidskriftsartikel (refereegranskat)abstract
- In modern implant-based immediate breast reconstruction, it has become common to use biological acellular dermal and synthetic matrices in combination with a tissue expander or an implant. The aim of this systematic review was to examine differences in recurrence of cancer, impact on oncological treatment, health related quality of life, complications and aesthetic outcome between matrix and no matrix in immediate breast reconstruction. Systematic searches, data extraction and assessment of methodological quality were performed according to predetermined criteria. Fifty-one studies were eligible and included in the review. The certainty of evidence for overall complication rate and implant loss is low (GRADE ⊕⊕□ □). The certainty of evidence for delay of adjuvant treatment, implant loss, infection, capsular contraction and aesthetic outcome is very low (GRADE ⊕□ □ □). No study reported data on recurrence of cancer or health related quality of life. In conclusion, there is a lack of high quality studies that compare the use of matrix with no matrix in immediate breast reconstruction. Specifically, there are no data on risk of recurrence of cancer, delay of adjuvant treatment and Health related quality of life (HRQoL). In addition, there is a risk of bias in many studies. It is often unclear what complications have been included and how they have been diagnosed, and how and when capsular contracture and aesthetic outcome have been evaluated. Controlled trials that further analyse the impact of radiotherapy, type of matrix and type of procedure (one or two stages) are necessary.
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| 4. |
- Hallberg, Håkan, et al.
(författare)
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Complications, long-term outcome and quality of life following Surgisis® and muscle-covered implants in immediate breast reconstruction: a case-control study with a 6-year follow-up
- 2019
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Ingår i: European Journal of Plastic Surgery. - : Springer Science and Business Media LLC. - 0930-343X .- 1435-0130. ; 42:1, s. 33-42
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Tidskriftsartikel (refereegranskat)abstract
- © 2018, The Author(s). Background: Matrices are now commonly used in breast reconstruction, but the scientific evidence is still scares. The main aim was to compare complications and the need for corrections in immediate breast reconstruction with the porcine-derived Surgisis®with the traditional muscle-covered technique. The secondary aim was to compare long-term quality of life and satisfaction. Methods: All consecutive patients who had their breast reconstructed with a Surgisis®or muscle-covered tissue expander/implant were included. Patients were followed clinically and with BREAST-Q. Results: During the study period, 116 reconstructions (71 patients) were operated in the Surgisis®group and 132 reconstructions (90 patients) in the control group. The median follow-up time was 74months (min 43–max 162). The total early complication rate was 37% in the Surgisis®group and 27% in the control group. There were no differences in implant loss (p = 0.68) or total number of complications (p = 0.24) between the two groups. Risk factors for complications were mainly patient characteristics and the use of a tissue expander. There was a slightly higher capsular contracture frequency in the Surgisis®patients (4.2% vs. 2.5%). The need for corrections and patient satisfaction and quality of life were similar in the two groups. Conclusions: The use of Surgisis®in implant-based reconstruction seems to result in an acceptable total early complication rate. The rate might be higher in tissue expander-based reconstruction. Risk factors are mainly patient characteristics. The capsular contracture rate and need for corrections, as well as patient satisfaction and quality of life, are similar in the Surgisis®patients and muscle-covered controls. Level of evidence: III.
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| 5. |
- Hallberg, Håkan, et al.
(författare)
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TIGR (R) matrix surgical mesh - a two-year follow-up study and complication analysis in 65 immediate breast reconstructions
- 2018
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - : Medical Journals Sweden AB. - 2000-656X .- 2000-6764. ; 52:4, s. 253-258
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Tidskriftsartikel (refereegranskat)abstract
- In recent years, it has become increasingly popular to use matrices, such as acellular dermal matrices, in implant-based breast reconstruction. To lower the cost and to avoid implanting biological material, the use of synthetic meshes has been proposed. This is the first study examining TIGR((R)) Mesh in a larger series of immediate breast reconstruction. The aims of the study were to examine complications and predictors for complications. All consecutive patients operated on with breast reconstruction with TIGR((R)) Matrix Surgical Mesh and tissue expanders (TEs) or permanent implant between March 2015 and September 2016 in our department were prospectively included. Exclusion criteria were ongoing smoking, BMI (kg/m(2))>30, planned postoperative radiation, and inability to leave informed consent. Fifteen breasts (23%) were affected by complications within 30d: four (6.2%) major complications and eleven (17%) minor complications. The major complications included two implant losses and one pulmonary embolism (PE). Predictors for a complication were age over 51 years, BMI over 24.5kg/m(2), large resection weight, and the need for a wise pattern excision of skin. Four minor surgical complications occurred after 30d (minimum follow-up 17months). There were no implant losses. In addition, minor aesthetic corrections, such as dog-ear resection, were performed in 10 breasts. In conclusion, breast reconstruction with a TE in combination with TIGR((R)) Matrix Surgical Mesh can be performed with a low complication rate.
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| 6. |
- Lewin, Richard, 1976, et al.
(författare)
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A Randomized Prospective Study of Prophylactic Cloxacillin in Breast Reduction Surgery.
- 2015
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Ingår i: Annals of plastic surgery. - 1536-3708. ; 74:1, s. 17-21
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Tidskriftsartikel (refereegranskat)abstract
- Postoperative infection after breast reduction surgery is a common complication, with the most commonly involved pathogen being Staphylococcus aureus. Previous studies of antibiotic prophylaxis in breast reduction surgery have been inconclusive. The aim of the present study was to clarify the role of prophylactic antibiotics in breast reduction surgery.
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| 7. |
- Lewin, Richard, 1976
(författare)
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Breast Hypertrophy and outcome of Breast Reduction Surgery
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to improve our knowledge of breast hypertrophy in women, its associated problems, and the outcome of breast reduction. Patients and methods: I. Five hundred and twelve woman were studied retrospectively for prevalence of and risk factors for complications. II. The study included 325 women, either randomized to prophylactic antibiotics or not. III. The Breast Evaluation Questionnaire (BEQ) for women with breast hypertrophy and breast reduction was validated. Two hundred and twentyfive women who had had breast reduction surgery and 216 controls were included. IV. Three hundred and forty-eight women were evaluated for gain in health-related quality of life (HRQL) after breast reduction surgery in this prospective, longitudinal paired study.Results: I. A long suprasternal notch to nipple distance increased the risk of infection and necrosis of the nipple. High BMI increased the risk of wound infection. A larger weight of resection increased the risk of delayed wound healing and fat necrosis. Smokers have twice the risk of getting a postoperative infection and diabetics are at higher risk of nipple necrosis. II. The incidence of postoperative infections was not significantly different between the groups. III. The modified BEQ is valid and shows good reliability. IV. Breast hypertrophy is associated with low HRQL, and breast reduction surgery increases HRQL. Conclusions: I. Sternal notch to nipple distance, BMI, resection weight, diabetes mellitus, and smoking are independent risk factors for complications after breast reduction surgery. II. One prophylactic dose of 2 g intravenous Cloxacillin or 600 mg Clindamycin did not reduce the incidence of postoperative infections. III. The BEQ has proven to be valid and to have good stability after being modified (mBEQ), when used before and after breast reduction surgery. IV. Women with breast hypertrophy have reduced quality of life and the HRQL is strongly increased or normalized after breast reduction surgery when SF- 36, mBEQ, BRSQ, and BREAST-Q are analyzed. Those with a higher body mass index, a longer sternal notch to nipple distance, a larger preoperative breast volume, or large volume of breast resection enjoy gains in healthrelated quality of life that are similar to, although probably not greater than, other women.
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| 8. |
- Lewin, Richard, 1976, et al.
(författare)
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Immediate breast reconstruction with a wise pattern mastectomy and NAC-sparing McKissock vertical bipedicle dermal flap.
- 2018
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Ingår i: Journal of plastic, reconstructive & aesthetic surgery : JPRAS. - : Elsevier BV. - 1878-0539 .- 1748-6815. ; 71:10, s. 1432-1439
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Tidskriftsartikel (refereegranskat)abstract
- Preservation of the nipple-areola complex (NAC) in immediate reconstruction of ptotic and large breasts is surgically challenging. This article presents a modification of the inferior dermal flap ("dermal sling") to a vertical bipedicle flap with NAC preservation. This flap is well described in breast reductions but has never been described in a mastectomy setting. The study reviews data for a case series of 17 breasts in 11 women who underwent breast reconstruction with the new technique. The complication rate was 12%, thus indicating that the vertical bipedicle NAC-sparing flap should be considered a feasible option for breast reconstruction in women with ptotic and/or large breasts.
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| 9. |
- Lewin, Richard, 1976, et al.
(författare)
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Objective evaluation of nipple position after 336 breast reductions.
- 2018
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Ingår i: Journal of Plastic Surgery and Hand Surgery. - 2000-656X .- 2000-6764. ; 52:4, s. 198-203
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Tidskriftsartikel (refereegranskat)abstract
- Throughout different eras and cultures what is considered the cosmetically ideal breast has varied greatly. There is no broadly accepted standardised method that objectively evaluates aesthetic outcome after breast reduction mammoplasty. The primary aim of this study was to evaluate the result of breast reduction regarding nipple position, comparing it to an objective previously described standard. Secondary aims were to determine symmetry and examine predictors for achieving an aesthetically pleasing breast. The position of the nipple was measured in postoperative pictures and compared to a previously described standard. Three-hundred and thirty-six breast were included in the study. Compared with the previously described standard, 26% (89/336) of the nipples were within the optimal position in mediolateral direction, and 44% (147/336) in craniocaudal direction. The majority of women had the nipple in the same position in the two breasts. Age at surgery seems to significantly influence the possibility of achieving an optimal nipple position. No other predictors were found. Improvements can be made in placement of the nipple during reduction mammoplasty. Further studies are needed on how knowledge of the ideal nipple position can be used to optimize surgical planning and technique, and reduce variability in outcomes, in breast reduction mammoplasties.
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| 10. |
- Lewin, Richard, 1976, et al.
(författare)
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Prospective Evaluation of Health After Breast Reduction Surgery Using the Breast-Q, Short-Form 36, Breast-Related Symptoms Questionnaire, and Modified Breast Evaluation Questionnaire.
- 2019
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Ingår i: Annals of plastic surgery. - 1536-3708. ; 83:2, s. 143-151
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Tidskriftsartikel (refereegranskat)abstract
- Breast hypertrophy is a condition associated with physical, psychological, and psychosocial problems. The primary aims of this study were to determine the impact of breast hypertrophy and the effects of breast reduction, performed on the basis of well-described inclusion criteria, on general and breast-related health, using both general and diagnosis-specific validated questionnaires. We used a prospective, longitudinal paired study design. A secondary aim was to analyze the relationship between preoperative breast volume, body mass index, sternal notch-to-nipple distance and the weight of resected tissue on the one hand and improvements in health on the other.Three hundred forty-eight consecutive patients undergoing breast reduction were included and the Short-Form 36 (SF-36), Breast-Related Symptoms Questionnaire (BRSQ), Modified Breast Evaluation Questionnaire (mBEQ) and BREAST-Q were distributed preoperatively and 1 year postoperatively.A total of 284 (83%) patients answered the questionnaires either preoperatively or postoperatively, or both, and 159 (46%) patients answered both. The breast hypertrophy patients had significantly lower scores preoperatively than the matched normal population when it came to all dimensions of the SF-36 and mBEQ. The preoperative scores for both the BRSQ and BREAST-Q were low.After breast reduction, there were significant improvements in all dimensions of the BRSQ, mBEQ, and Breast-Q and in several dimensions of the SF-36.Breast reduction reduces or removes disease-associated pain. It improves or normalizes perceived health and psychosocial self-esteem in slightly obese women or women of normal weight with preoperative breast volumes around 1000 mL. Women with higher preoperative breast volumes and longer sternal notch-to-nipple distances appear to be more satisfied with the cosmetic result postoperatively.
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