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When a study could not be retrieved from the electronic media or the local library, the authors were contacted to request a copy. The following data were extracted from each article: authors, date of publication, number of subjects, indication for the procedure, type of study, technique used for adipocyte implantation, follow up time, efficacy of treatment, patient satisfaction, clinical complications, volume retention, radiographic changes and incidence of primary and recurrent breast cancer. The principal summary measures are means over follow-up periods and percentages with the actual number given between parentheses. Statistical analysis To analyze the oncological safety, a random-effects meta-analysis was per formed to account for the heterogeneity among the different studies. For the analyses of the complications and radiological findings, the data were pooled to calculate the overall proportion with a 95% confidence interval. Due to insuffi cient data, statistical analyses of the fat grafting technique, volume retention and patient and surgeon satisfaction could not be performed. Risk of bias across studies Observational studies and clinical trials without detailed randomization proto cols were deemed studies with a high risk of bias. Two studies 12,13 13 described the same group of patients; thus, one of the studies was ex cluded from the analyses, leaving 43 studies. This included almost equal numbers of retro spective and prospective cohort designs (20 vs. Figure 1: Flowchart of included studies 32 Autologous Fat Grafting after Onco-Plastic Breast Reconstruction Indication In 28 studies, the indication and the previous form of surgical breast cancer 8,9,14,17-32,37-39,41,44-47,49 treatment were reported. Two studies did not present this information, and one only speci fied the type of oncological surgery in relation to the number of operated breasts. In 14 studies, 1371 invasive carcinomas and 512 carcinomas in situ were 8,14,19,20,23-26,28-31,37,39 reported. These included 569 cases of ductal carcinoma, 35 cases of lobular carcinoma, two medullary carcinomas and two mixed forms (ductal and lobular). Complications In a total of 33 studies, 461 complications were identified in 5502 patients (Table 8-12,14,17-22,24,25,27,30-37,39,41-45,48-52 4/ Figure 3).
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Health psychology: Mapping biobe the affect quality and directional focus of mental imagery on pain havioral contributions to health and illness. Affective state, attraction, and affiliation: Misery loves depressed and nondepressed students: Sadder but wiserfi Journal of Personality and Social Psychology, 71, Placing positive feelings within a general model of affect. Attention and self-regulation: A strengths: Fundamental questions and future directions for a positive control-theory approach to human behavior. Coping strategies and psychiatric morbidity in women attending breast assessment clinics. New York: job-search behavior and interview success: Distinguishing between Elsevier/North-Holland. The influence of positive affect and of coherence over time in cancer patients: A preliminary report. Will money increase subjective to aging: Longitudinal prediction from neuroticism and extraversion. Psychology of Women Quarterly, 22, jective well-being: A nomothetic and idiographic approach. Similarity of the relationship of job satisfaction to personological and environmental relations between marital status and subjective well-being across cul antecedents and volitional workplace behavior. A 5-year study of change in the and frequency: Dimensions underlying positive and negative affect. The personality structure of correlates of happiness: A cross-national comparison. Psychological factors, immuno having to help: Separate motivations for positive mood and guilt competence, and health of breast-feeding mothers and their infants.
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Comparison age at first childbirth on risk of developing specific of loss heterozygosity in primary and recurrent histologic subtype of breast cancer. Flow Her-2/neu level predicts decreased response to cytometric and histological analysis of ductal hormone therapy in metastatic breast cancer. Cancer Res more likely than women from the United Kingdom 1982 Aug; 42(8 Suppl):3434s-6s. Breast improved prognosis for patients with T1N0M0 Cancer Res Treat 2008 Mar; 108(2):271-7. Cancer 2006 evaluation of residual disease in women receiving Nov 1; 107(9):2245-53. Role of reconstruction using the superior gluteus for free ultrasound and sonographically guided core biopsy tissue transfer: a case report. J La State Med Soc in the diagnostic evaluation of ductal carcinoma in 1988 Jun; 140(6):43-5. Tumori 2000 activation, normal T cell expressed and secreted Nov-Dec; 86(6):A13-8. Not eligible exemestane administered for 2 years versus placebo outcomes on bone mineral density, bone biomarkers, and 1614. Opportunistic patterns of allelic loss in estrogen receptor-positive breast cancer screening in Hong Kong; a revisit of infiltrating lobular and ductal breast cancer. Changes in incidence of reduction mammaplasty in reconstructing partial in situ and invasive breast cancer by histology type mastectomy defects. Megestrol Immediate endoscopic latissimus dorsi flap: risk or acetate versus aminoglutethimide for metastatic benefit in reconstructing partial mastectomy defects. N cytokeratin 7 expression is not restricted to Paget Engl J Med 1982 Oct 14; 307(16):1010-4. Not cells but is also seen in Toker cells and Merkel eligible target population cells. Experience with fine-wire localization breast Mammary gland anatomy and the role of biopsies for nonpalpable breast lesions detected mammography and ultrasonography in the early mammographically. The with breast cancer, cowden disease, and juvenile effectiveness of the Gail model in estimating risk polyposis. Am J Hum Genet 1997 Dec; 61(6):1254 for development of breast cancer in women under 60. Temperature Not eligible target population distribution in locally advanced breast carcinoma 1636. Fine during hyperthermic treatment: relationship to needle biopsy specimens of benign breast lesions perfusion, vascular density, and histology. Int J distinguished from invasive cancer ex vivo with Radiat Oncol Biol Phys 1991 Jul; 21(2):423-30.
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Immediate mastectomy is not performed in most patients if the imaging studies are negative because the chances of finding a primary are low. Observation with axillary dissection can result in recurrence in the breast (25% to 75%, depending on the study), requiring further therapy. Our results show that in patients who have undergone axillary lymph node dissection alone, the incidence of local recurrence is 65% at 10 years, whereas a combination of axillary lymph node dissection and radiation therapy reduces the local recurrence rate to 25%. With this treatment, the overall survival rate was no different from that of patients with the same nodal stage of disease who had undergone mastectomy. The addition of adjuvant chemotherapy to surgery and radiation therapy increased the survival rate from 60% to 85% at 10 years. Patients underwent either mastectomy or breast-conservation therapy; external beam radiation therapy was used in 71% of patients, and systemic chemotherapy was used in 73%. No significant difference was found between mastectomy and breast conservation in locoregional recurrence, distant metastases, or 5 999 year survival rate. Regardless of the surgical treatment used, the number of involved nodes was the only determinant of survival. Excluding melanoma, the two most common histologic types are unclassified carcinoma and squamous cell carcinoma. In evaluating patients with inguinal metastases, a thorough investigation for the primary tumor should include examination of the skin of the lower extremities, perineum, buttocks, anal canal, and pelvic region. If the inguinal node is the solitary area of presentation, excision followed by local radiation therapy is the next preferred step. For bulky bilateral adenopathy, neoadjuvant chemotherapy followed by surgery (inguinal lymph node dissection) and radiation therapy can also be considered if there are no other sites of metastatic disease. These patients are prone to lymphedema after multimodality therapy, so they should be educated regarding the risks and undergo treatment if lymphedema develops. Peritoneal Carcinomatosis of Unknown Primary Site Patients with peritoneal carcinomatosis of unknown primary site can present with ascites, bowel obstruction, or nonspecific gastrointestinal symptoms. The two subgroups in this category include (a) patients with mucin-producing adenocarcinoma with and without signet ring cells and (b) women with primary peritoneal carcinomatosis. Patients with mucin producing adenocarcinoma often have multiple peritoneal implants, with the primary site most likely being the gastrointestinal tract. Patients in this group have a poorer prognosis and respond poorly to currently available treatment regimens. These patients should undergo an upper endoscopy and colonoscopy to evaluate for a gastrointestinal primary tumor. A histopathologic analysis of these patients reveals cells 1000 with serous papillary features and, on occasion, psammoma bodies.
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