Annals of surgical oncology
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As many as 40 % of breast cancer patients undergoing axillary lymph node dissection (ALND) and radiotherapy develop lymphedema. We report our experience performing lymphatic-venous anastomosis using the lymphatic microsurgical preventive healing approach (LYMPHA) at the time of ALND. This technique was described by Boccardo, Campisi in 2009. ⋯ Our transient lymphedema rate in this high-risk cohort of patients was 12.5%. Early data show that LYMPHA is feasible, safe, and effective for the primary prevention of breast cancer-related lymphedema.
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We examined the incidence and modern national trends in the management of Paget's disease (PD), including the use of breast-conserving surgery (BCS), mastectomy, axillary surgery, and receipt of radiotherapy. ⋯ The incidence of Paget's disease has decreased over time while modern trends in local therapy suggest that BCS, SLNB, and adjuvant radiotherapy remain underutilized.
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Increasing rates of contralateral prophylactic mastectomy (CPM) correlate with adoption of total skin-sparing mastectomy (TSSM). We aimed to characterize patients with unilateral breast cancer who underwent TSSM with CPM or without CPM (No CPM). ⋯ Patients who choose CPM fit the profile of patients with higher risk of contralateral breast cancer (CBC), which may be due to polygenic risk factors that are currently under investigation. Physicians should address patients' fears of CBC, screening concerns, and the risk of complications when considering CPM.
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Breast surgeons negotiating employment agreements have little national data available. To reduce this knowledge gap, the Education Committee of the American Society of Breast Surgeons conducted a survey of its membership. ⋯ Salary-specific data for breast surgeons are limited, and differences in salary were seen across geographic regions, type of practice, and gender. This type of breast-surgeon-specific data may be helpful in ensuring equitable compensation.
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Because of disadvantages, such as the need to perform the localization and operation the same day and difficulty maintaining orientation of the center of the localization in relation to the margins of excision, alternatives to wire localization for surgery of nonpalpable breast lesions have been widely pursued. Radioactive seed localization (RSL) is one technique that has gained acceptance in many practices throughout the world and has been shown to be a safe, effective alternative to wire localization. ⋯ Although RSL is an attractive technique that is intuitive to learn, beginning a new RSL program entails a multidisciplinary effort that includes several challenges. We describe recommendations for how to start a RSL program.