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Biomedical subjects

R V Dowden

Publications and source records attributed to R V Dowden.

At least 19 recordsLinked to original sources
PubMed1995

Partial mastectomy and breast reconstruction. A comparison of their effects on psychosocial adjustment, body image, and sexuality.

BACKGROUND: This retrospective study compared psychosocial adjustment, body image, and sexual function in women who had either breast conservation or reconstruction for early stage disease. METHODS: Questionnaires were completed at a mean of 4 years after surgery by 72 women who had partial mastectomy and 146 women who had immediate breast reconstruction after mastectomy. RESULTS: In general, fewer than 20% of women reported poor adjustment on the domains measured. The two groups did not differ in overall psychosocial adjustment to illness, body image, or satisfaction with relationships or sexual life. There was a specific advantage of partial mastectomy over breast reconstruction in terms of maintaining pleasure and frequency of breast caressing during sexual activity. Women who had undergone chemotherapy had more sexual dysfunction, poorer body image, and more psychological distress. Hormonal therapy and radiation therapy, however, did not measurably affect quality of life. Factors predictive of greater psychosocial distress included a troubled marriage, a poor body image, sexual dissatisfaction, less education, and treatment with chemotherapy. CONCLUSIONS: The choice of local treatment had little psychosexual impact, whereas chemotherapy was associated with long term impairments.

Antineoplastic Agents↗
PubMed1995

Mammography after implant breast reconstruction.

This report deals with the question of performing mammography routinely after implant breast reconstruction. Mammography cannot be performed on the mastectomy flaps unless reconstruction is done. Successful mammography in this situation does require special techniques. The most probable location for a local recurrence is anterior to, rather than behind, an implant. Since only 6 to 10 percent of mastectomy patients would be expected to develop a local recurrence and only a small proportion of these would be nonpalpable, the yield of routine mammography could not be expected to be high. Three patients are presented whose occult local recurrences were detected by routine surveillance mammography. The author's opinion is that mammography should be a part of the standard follow-up care of breast reconstruction patients, particularly those whose original tumor contained microcalcifications.

Breast Implants↗
PubMed1994

Breast implant endoscopy. Detecting leaks in silicone-gel breast implants.

Until the development of implant endoscopy, the only method available to evaluate silicone-gel breast implants accurately for silicone leaks involved making a wide incision and visually inspecting the implant. Endoscopic magnification, however, allows an accurate diagnosis to be achieved rapidly and safely by using a tiny incision that does not endanger the implant. As breast implant endoscopy becomes more common, perioperative nurses should be able to discuss the procedure with patients. The information provided in this article is intended to educate nurses on the procedure and prepare them to counsel patients undergoing the procedure.

Endoscopy↗
PubMed1994

Radiation therapy as a cause of capsular contracture.

The effect of radiation therapy on the final result of breast reconstruction has been debated in the literature. We have had 4 patients with bilateral breast reconstruction who then received unilateral radiation therapy. We noted in all 4 that the irradiated side became contracted, whereas the nonradiated breast reconstruction remained soft. These 4 patients were compared with the bilateral breast reconstruction not receiving radiation therapy. The contracture rate in this control group was 10% (19 of 190 breasts). The difference in contracture rate between these two groups was significant (p = 0.05). A second group of patients was reviewed, unilateral reconstruction patients receiving radiation therapy to the reconstructed breast. This group was compared with bilateral reconstructions not receiving radiation therapy as a control group. The contracture rate in the unilateral reconstruction group receiving radiation therapy was 67% (7 of 11), versus the control of 10%. This difference is also significant (p = 0.001). We conclude that radiation therapy of prosthetic breast reconstruction does increase the rate of capsular contracture. Therefore, we counsel our implant reconstruction patients that the risk of capsular contracture is increased if subsequent radiation therapy is required.

Breast Neoplasms↗
PubMed1994

Periprosthetic bacteria and the breast implant patient with systemic symptoms.

This report presents seven women with breast implants who experienced systemic symptoms which resolved rapidly after implant removal. A hypothesis is that these symptoms (which have been labeled "silicone poisoning" or "silicone adjuvant disease") may actually be caused by periprosthetic bacteria which have generally been considered innocuous, e.g., Staphylococcus epidermidis. In these cases, systemic symptoms such as malaise, fatigue, diarrhea, muscle aches, and arthralgia rapidly resolved after an antibacterial regimen plus implant removal without capsulectomy. Of cultures taken by swab in four patients, all were positive; of those taken by irrigation in three patients, one was positive. I believe that these patients' symptoms were real and offer the hypothesis that treatment of periprosthetic bacteria might explain rapid clinical improvement following explantation.

Adult↗
PubMed1993

Endoscopic implant evaluation and capsulotomy.

Clinical use of breast endoscopy was begun 5 years ago for the purpose of internal endoscopic capsulotomy. This limited role for the endoscope has been entirely displaced by its use for inspection of implants for leaks or rupture. The materials and equipment are readily available, the proper techniques are safe for patient and implant, the method is easily learned, and the evaluation has been reliable. This report describes our first 50 breast endoscopies and details the technique and the means of learning it. The accuracy is far superior to that of mammogram or ultrasound, and to date, there have been no infections or damaged implants from the technique as described.

Endoscopy↗
PubMed1993

Detection of gel implant rupture: a clinical test.

This report outlines a simple clinical test for detection of a ruptured smooth, predominantly gel breast implant in a noncontracted capsule. The test is rapid and extremely simple to perform and has been used by me since 1979. Approximately 630 patients meeting these criteria have been examined with this method, many annually. Five ruptured implants were detected, and there were no false-positive results. There also were no false-negative results, although only 72 patients had surgical confirmation of implant integrity. The radiographic measures helpful for detecting a ruptured gel implant are also discussed. In this series, the clinical test was more accurate than mammography for detecting implant rupture in the absence of capsular contracture.

Equipment Failure↗
PubMed1993

Partial mastectomy without radiation is adequate treatment for patients with stages 0 and I carcinoma of the breast.

The treatment of potentially curable carcinoma of the breast has changed from one operation, radical mastectomy, to a flexible approach. At the Cleveland Clinic, we use four types of treatment for primary potentially curable carcinoma of the breast (Stages 0, I and II)--modified radical mastectomy, simple mastectomy, partial mastectomy with postoperative adjuvant radiation therapy and partial mastectomy without radiation therapy. The latter treatment (partial mastectomy without adjuvant radiation) is controversial. We recommend this procedure for patients with T(is) and T1 carcinomas that appear to be localized, without lymph node metastases, Stages 0 and I disease. The overall and disease-free survival rates are similar to those of patients having modified radical or partial mastectomy with radiation. Local recurrence is slightly higher at five years (11.0 percent) as compared with the other procedures, but at ten years, is only 16.1 percent, a figure comparable with patients having partial mastectomy with radiation (14.4 percent). For patients with Stages 0 and I carcinoma of the breast, the addition of postoperative radiation therapy after partial mastectomy seems to be unnecessary.

Breast Neoplasms↗
PubMed1992

Complete spontaneous regression of cutaneous primary malignant melanoma.

Melanomas may first present as nodal metastasis. Most of these cases have a discernible primary source. A proportion of these, however, have no apparent primary. A very few patients in this latter group actually have an identifiable primary source that regressed and disappeared. There is a set of stringent clinical and histologic criteria that must be met before a melanoma can be classified as complete spontaneous regression, and only 24 cases in the literature meet all these criteria. This report reviews those cases and presents the first report to provide sequential photographic documentation of a complete spontaneous regression of a cutaneous malignant melanoma. It also gives a 10-year follow-up, the longest in the literature.

Adult↗
PubMed1991

Selection criteria for successful immediate breast reconstruction.

To evaluate the factors leading to success in immediate breast reconstruction after mastectomy, 176 consecutive immediate reconstructions done with implants or expanders over a 5-year period were analyzed. None of these 176 had "complete muscle coverage." There were only five failures: four with implant loss (one involving radiation) and one removed electively. The failures were 1 in 40 regular implants, 4 in 77 temporary expanders, and 0 in 59 long-term expanders. There is no other report in the literature comparing these different types of implants. Various hypotheses for failure are reviewed. It is concluded that failure in immediate reconstruction is not related to use of drains, bilaterality, or lack of "complete muscle coverage." It is concluded that failure is related to implant type, prior radiation, and most of all to suboptimal patient selection. Specific selection criteria and operative techniques are discussed.

Adult↗
PubMed1990

Expandable breast implant reconstruction of Tikhoff-Linberg shoulder deformity.

Expanding breast implants were used in two patients to reconstruct shoulder contour following a Tikhoff-Linberg resection for cancer. In the first patient, one implant alone was used, and in the second patient, two implants in separate but adjacent pockets. The resulting double contour is more pleasing than that after a single implant, and there also appears to be more flexibility with shoulder motion. This method is suggested as an excellent means of reconstructing the contour of the shoulder area following resection for cancer.

Breast↗
PubMed1988

Mondor's disease in plastic surgery patients.

Thrombophlebitis of the chest wall is a benign, self-limiting condition. When it is recognized, the patient can be confidently reassured that spontaneous resolution is expected. The characteristic cutaneous cords are palpable five to seven weeks postoperatively, and they generally resolve within several months without specific therapy. Mondor's disease appears to be related to injury of the subcutaneous chest veins at the initial surgery rather than at reoperation. There is no apparent relationship between Mondor's disease and silicon implants nor between Mondor's disease and capsule contracture. Mondor's disease may be more common then generally believed.

Adult↗
PubMed1987

The tubular/tuberous breast syndrome.

There are various degrees of expression of the fully developed tubular/tuberous deformity. To develop an adequate treatment plan for this condition, the individual deformities constituting the fully expressed syndrome must be diagnosed. The treatment plan must include maneuvers to correct each deficiency within the syndrome itself. We present the spectrum of abnormalities constituting the tubular/tuberous syndrome and the treatment plan thereof.

Adult↗
PubMed1987

Achieving a natural inframammary fold and ptotic effect in the reconstructed breast.

Achieving a natural inframammary fold in the reconstructed breast is a challenging but essential aspect of the excellent result for which we strive. Just as there are many methods of reconstruction, so too are there many ways to enhance the effect of a distinct fold in the reconstructed breast. Several of these techniques are discussed here, including methods for use with flaps, advancements, and expanders, with particular emphasis on implant reconstructions, both immediate and delayed. Also covered are the contributions of external massage and open capsulotomy toward this objective.

Breast↗