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Biomedical subjects

R M Rainsbury

Publications and source records attributed to R M Rainsbury.

At least 19 recordsLinked to original sources
PubMed2006

Skin-sparing mastectomy.

BACKGROUND: Skin-sparing mastectomy (SSM) is a new technique being used in a variety of clinical settings. This article reviews the published data on SSM to establish its current role in clinical practice. METHODS: A Medline search was carried out using the key words 'skin-sparing mastectomy' to identify English-language articles published between 1990 and 2004 and further material referenced in these publications. RESULTS: SSM is most commonly used for surgical prophylaxis and to treat in situ and early invasive disease in patients who request immediate breast reconstruction. SSM and non-SSM result in similar surgical and oncological outcomes, but skin flap ischaemia is more common after SSM and is associated with a range of risk factors, including smoking. CONCLUSION: SSM has become an established procedure in breast surgery, but there is a lack of prospective data on which to make evidence-based decisions about its use in individual patients.

Breast Neoplasms↗
PubMed2004

Skin-sparing mastectomy in the UK--a review of current practice.

BACKGROUND: Skin-sparing mastectomy (was first described in 1991 and has achieved popularity because it facilitates immediate breast reconstruction, preserving the infra-mammary fold and breast envelope. Little is known about the use of skin-sparing mastectomy in the UK. METHODS: All members of the BASO Breast Specialty Group were contacted in June 2001 with a questionnaire to determine the popularity of skin-sparing mastectomy, techniques used, indications, contra-indications and outcomes. RESULTS: Of 300 questionnaires sent, 130 were returned by September 2001. The number of respondents using skin-sparing mastectomy increased from 27 (21%) in 1997 to 95 (73%) in 2001. Of respondents, 35 (23%) avoided skin-sparing mastectomy because of their uncertainty about the benefits (22/35), indications (16/35) or oncological safety (13/35). Where skin-sparing mastectomy was performed, it was combined with immediate breast reconstruction in 90% of cases, using latissimus dorsi (84%), subpectoral (70%) or TRAM flap reconstruction (54%). Skin-sparing mastectomy was performed by breast surgeons alone (62%), or with a plastic surgeon (47%) and the preferred incisions were peri-areolar (68%) and elliptical (26%). Most respondents used skin-sparing mastectomy for prophylaxis, in situ cancer and early invasive disease and avoided skin-sparing mastectomy in patients with skin tethering (62%), where radiotherapy was planned (49%) and in smokers (28%). Complications seen by respondents included skin envelope necrosis (68%), haematoma formation (46%), cosmetic failure (41%) and local recurrence (12%). CONCLUSIONS: Skin-sparing mastectomy is becoming popular in the UK, but experience is limited. The variation in indications and techniques indicate the need to establish evidence-based guidelines for the wider practice of skin-sparing mastectomy in the UK.

Breast Neoplasms↗
PubMed2003

Impact of skin-sparing mastectomy with immediate reconstruction and breast-sparing reconstruction with miniflaps on the outcomes of oncoplastic breast surgery.

BACKGROUND: The aim of this study was to compare the outcomes of skin-sparing mastectomy (SSM) with immediate myocutaneous flap reconstruction and partial mastectomy with latissimus dorsi miniflap reconstruction (LDMF) for breast cancer. METHODS: Some 106 disease-free patients (57 SSM, 49 LDMF) who had breast reconstruction between 1991 and 1999 participated in this retrospective review. The mean duration of follow-up was 42 (range 6-102) months. Measured outcomes included surgical complications, functional disability, cosmetic result and psychological morbidity. RESULTS: SSM outcomes were less favourable than LDMF outcomes with regard to postoperative complications (14 versus 8 per cent), further surgical interventions (79 versus 12 per cent), nipple sensory loss (98 versus 2 per cent), restricted activities (73 versus 54 per cent) and cosmetic outcome by panel assessment. Anxiety about residual cancer and ease of breast self-examination were similar in both groups. CONCLUSION: LDMF was associated with fewer adverse surgical and physical sequelae than SSM, without compromising local control or cosmetic outcome. Both operations were associated with low psychological morbidity.

Adult↗
PubMed2003

The timing of surgery affects the detection of residual disease after wide local excision of breast carcinoma.

AIMS: To compare the frequency of residual tumour in the cavity wall in patients with positive resection margins undergoing either immediate re-excision (IR) at the time of surgery or delayed re-excision (DR) to investigate the effects of recent surgery on the detection of residual disease. METHODS: Records of 125 patients who had undergone wide local excision with positive margins were examined. In 64 patients re-excision was performed immediately and in 61 it was delayed by 13-69 days. The presence or absence of residual disease in the re-excision specimens was recorded. RESULTS: Residual tumour was detected in 40/64 (62%) and 20/61 (33%) DR specimens (P<0.001). DR specimens contained areas of fibrosis, fat necrosis and foreign body giant cell changes. CONCLUSIONS: The detection of residual disease is significantly lower in DR compared to IR specimens. Local repair mechanisms may account for this difference.

Adult↗
PubMed2002

Breast reconstruction in the United Kingdom and Ireland.

BACKGROUND: Although it is becoming more common, previous surveys have identified concerns regarding the safety of immediate reconstruction following mastectomy. The aims of this study were to define current practice of breast reconstruction in the UK and Ireland, and to identify the characteristics of surgeons who use immediate breast reconstruction. METHODS: : A postal questionnaire survey of 498 consultant breast surgeons in the UK and Ireland was performed in January 2000. RESULTS: There were 376 responses (response rate 76 per cent). Eighty-eight per cent of surgeons 'always' or 'usually' discuss reconstruction with patients due to undergo mastectomy; clinicians with a heavy caseload were significantly more likely to discuss it (odds ratio (OR) 18.45 (95 per cent confidence interval 1.99 to 171.07)). The majority of respondents (57 per cent) preferred delayed to immediate breast reconstruction; 70 per cent believed that immediate reconstruction has disadvantages, most commonly that it interferes with adjuvant therapy (56 per cent). Older surgeons were significantly less likely to perform immediate reconstruction (OR 5.18 (2.21 to 12.11)), and were significantly more likely to believe that immediate breast reconstruction has disadvantages (OR 2.02 (1.01 to 4.05)). Surgeons from Ireland were less likely to discuss and perform breast reconstruction (OR 0.20 (0.10 to 0.43) and 0.27 (0.12 to 0.60) respectively), or to have access to a plastic surgeon (OR 0.22 (0.11 to 0.44)). CONCLUSION: : Significant variation exists in the delivery of breast reconstruction after mastectomy in the UK and Ireland. The age, workload and personal characteristics of the surgeon are important in determining reconstructive practice.

Adult↗
PubMed2002

Breast-sparing reconstruction with latissimus dorsi miniflaps.

Volume loss following breast-conserving surgery (BCS) is the key reason for major local deformity and a bad cosmetic outcome. Latissimus dorsi miniflaps can be used to reconstruct central and upper quadrant resection defects, replacing the volume excised with autogenous tissue. Partial mastectomy, axillary dissection, flap harvest and reconstruction of the resection defect is performed as a one-stage procedure through a single lateral incision. This oncoplastic approach allows extensive local excision during BCS without cosmetic penalties in a group of patients normally treated by mastectomy.

Breast Neoplasms↗
PubMed2002

Fine needle aspiration cytology prior to breast ultrasonography does not alter ultrasound diagnostic accuracy or patient management.

INTRODUCTION: Fine needle aspiration cytology (FNAC) prior to serial sonographic (USS) examination of the breast is said to impede accurate diagnosis. This study aimed to test the effect of performing FNAC prior to USS in a one-stop symptomatic breast clinic. METHODS: All patients (n=368) attending a one-stop clinic over a 1-year period were stochastically allocated to imaging prior to (Group 1) or after (Group 2) clinical examination and FNAC. Additional procedures required for diagnosis (open or core biopsies), false negative USS grade and final outcome were recorded. Statistical analysis was performed using the Fisher's exact test. RESULTS: There was no statistical difference between the two groups. CONCLUSION: In the clinical setting of a one-stop visit, FNAC prior to breast USS does not alter ultrasound diagnostic accuracy or patient management.

Journal Article↗
PubMed2000

Ultra-conservative skin-sparing 'keyhole' mastectomy and immediate breast and areola reconstruction.

The popularity of skin-sparing mastectomy (SSM) which preserves the breast skin envelope is increasing, but the risks and benefits of this approach are only beginning to emerge. A technique involving ultra-conservative SSM and immediate breast reconstruction (IBR) has been evaluated to establish the surgical and oncological sequelae of skin conservation. Between 1994-1998, 67 consecutive patients underwent 71 SSM and expander-assisted immediate latissimus dorsi (LD) breast reconstructions (follow up, 24.1 months; range, 2-52 months). Breast resection, axillary dissection and reconstruction were performed through a 5-6 cm circular peri-areolar 'keyhole' incision. Patients were discharged 6.5 days (range, 5-15 days) after the 3.9 h (range, 3.0-5.5 h) procedure, and expansion was completed by 4.0 months (range, 0-10 months). Local recurrence occurred in 3% of breasts at risk, skin envelope necrosis occurred in 10%, and contralateral surgery was required to achieve symmetry in 14%. SSM and IBR is an oncologically safe, minimal-scar procedure which can be performed by surgeons trained in 'oncoplastic' techniques. It results in low rates of local recurrence and complication, and reduces the need for contralateral surgery.

Adult↗
PubMed1998

Detection of residual disease following breast-conserving surgery.

BACKGROUND: Assessment of completeness of tumour excision has become an integral part of breast-conserving surgery, but the accuracy of margin analysis has been questioned. This study compared the results of resection margin analysis with an examination of tumour bed biopsies and of the excised cavity wall. METHODS: One hundred and forty-four patients underwent breast-conserving surgery for T1-2 N0-1 breast cancer. Following wide local excision, four bed biopsies were taken from the cavity wall which was then completely excised. The presence of invasive and in situ disease at the inked resection margin (IRM) and in the adjacent bed biopsies and cavity wall was recorded. RESULTS: Positive margins and/or residual disease in either the bed biopsies or cavity wall was found in 62 (43 per cent) of 144 cases. Residual disease (invasive or in situ) was present at the IRM in 39 specimens (27 per cent) and was present in 25 bed biopsy (17 per cent) and 39 cavity wall (27 per cent) specimens. These comprised different but overlapping groups of patients. CONCLUSION: Margin analysis of wide local excision specimens is a poor predictor of completeness of excision. Routine resection and examination of the entire cavity wall increases the detection of residual disease compared with examination of bed biopsies alone and is a useful adjuvant to conventional margin evaluation.

Adult↗
PubMed1997

Extending the role of breast-conserving surgery by immediate volume replacement.

BACKGROUND: Cosmetic failure following breast-conserving surgery is commonly caused by volume loss, and the effect of immediate volume replacement on cosmetic outcome using a latissimus dorsi miniflap (LDMF) has been investigated. The technique avoids a frontal scar and allows a wide retromammary excision via a lateral approach. METHODS: Twenty patients who had LDMF reconstruction were compared with 38 who had wide local excision (WLE) without reconstruction between 1991 and 1994. Cosmetic outcome was judged using (1) breast retraction assessment and (2) panel assessment, recording the frequency of cosmetic failure. RESULTS: Patients who had LDMF reconstruction were younger (mean 45.1 versus 58.6 years; P < 0.0001) with larger tumours (mean 2.5 versus 1.3 cm; P < 0.0001) and underwent wider specimen excision (57 versus 13 per cent more than 150 g; P = 0.004) with reduced margin involvement (10 versus 37 per cent positive margins; P = 0.03) compared with those who had WLE. Cosmetic failure was uncommon after immediate volume replacement (LDMF 10 per cent versus WLE 34 per cent; P = 0.045). CONCLUSION: LDMF reconstruction extends the role of breast-conserving surgery without cosmetic penalties, and may reduce the need for mastectomy.

Adult↗
PubMed1994

Size isn't important; the Forrest Unit.

The early success of breast screening in the UK is encouraging, and has been achieved by cooperation between multidisciplinary teams working together in large screening units. Future market forces may serve to disintegrate this arrangement with the resulting emergence of smaller, self-sufficient units. Winchester's 'first round' screening results suggest that with appropriately trained team members, such units can provide a convenient, high quality local service without compromising cancer detection.

Breast Neoplasms↗
PubMed1994

'Tactile sensation': a new clinical sign during fine needle aspiration of breast lumps.

The tactile sensation (TS) felt during fine needle aspiration (FNA) of symptomatic breast abnormalities was recorded prospectively in 169 patients. TS was classified as malignant (if 'gritty'), or benign (if 'rubbery', 'soft' or 'fibrous'). This assessment was compared with fine needle aspiration cytology (FNAC) and the final diagnosis, to evaluate the clinical utility of TS. A 'gritty' TS was recorded in 55/59 cancers and 22/110 benign lesions (sensitivity 93.2%, specificity 80%). Comparison of TS and FNAC in 69 patients with definitive histopathology revealed complementary results (TS, sensitivity 88.9%, specificity 48.5%; FNAC, sensitivity 55.6%, specificity 100%). Combining the sensitivity of TS with that of FNAC increased the overall sensitivity to 97.2%. Recording TS during FNA of symptomatic breast lumps enhances diagnosis, and alerts the clinician to the possibility of an underlying carcinoma when FNAC fails to confirm malignancy.

Biopsy, Needle↗
PubMed1993

Cytodiagnosis of breast disease using a liquid suspension medium.

Fine-needle aspiration cytology specimens from 187 breast lesions were processed using conventional slide cytology. Results were compared with those from 201 lesions prepared using a liquid suspension medium (Cytospin) for specimen collection, to assess the clinical utility of each technique. The frequency of diagnostic groups was similar for each method. No significant difference was found in sensitivity (conventional slide cytology 86 per cent versus Cytospin 82 per cent), specificity (72 versus 82 per cent) or diagnostic accuracy (88 versus 91 per cent). The Cytospin technique compares favourably with conventional slide cytology and can be recommended for ease of use in breast cytodiagnosis.

Biopsy, Needle↗
PubMed1993

Breast reconstruction at a district general hospital.

Breast reconstruction is normally carried out by plastic surgeons, but the advent of permanent tissue expanders places post-mastectomy reconstruction within easy reach of the general surgeon. Nineteen patients underwent breast reconstruction between 1989 and 1991 using a subpectoral silicone-based, double lumen tissue expander. Assessment of results was by: (a) patient completed questionnaire; and (b) third party evaluation of standardized photographs. The mean operating time was 58 min (40-80 min) and mean hospital stay 3 days (2-7 days). Complications included one flap necrosis and one leaking injection port. Outpatient tissue expansion required an average of seven visits (4-11) and was completed in an average of 12 months (7-19). The injection port was subsequently removed under local anaesthetic as a day case. The fully dressed appearance following reconstruction was graded good or excellent by 100% of patients and in over 80% of third-party assessments. Equivalent figures for the appearance when wearing a bra were 93% and 60% and undressed 57% and 47%, respectively. All patients recommended the procedure but 25% found inflation uncomfortable. Subpectoral tissue expansion is a safe, cosmetically acceptable method of breast reconstruction which is associated with a high level of patient satisfaction.

Breast↗