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Autologous fat grafting is quite common for breast augmentations as well as for reconstructive breast surgery. Coleman has described the surgical technique of fat grafting. Fat is harvested, and after centrifugation and refinement, blunt infiltration cannulas are used to place the fat through small incisions. The grafted tissue is placed in small aliquots with each withdrawal of the cannula. In order to achieve an aesthetically pleasing contour of the breast, the fat should be layered into different levels from the chest wall to the skin. However, autogenous lipotransfer if not performed lege artis might lead to complications such as fat necrosis, calcification, formation of encapsulated fatty masses (cystic lesions), lymphadenopathy, disfigurement of breast contouring, hypersensitive breasts, itchy nipples. A 36-year old female patient, presented with multiple palpable cystic lesions, disrupted breast contouring, asymmetry, hypersensation and pain during examination, 6 months after autologous fat grafting for breast augmentation elsewhere. The patient had ultrasound and MRI screening, which revealed the multiple bilateral cysts formation in the breast tissue. Surgical removal of the large lesions was performed, and specimens were sent for pathology and cytology consideration and screening. A few months after surgical removal of these lesions and after symptoms subsided, breast augmentation was performed with silicone implants. An aesthetically pleasing result together with relief of the patient’s initial symptomatology was achieved. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Mechanical imaging yields tissue elasticity map and provides quantitative characterization of a detected pathology. The changes in the surface stress patterns as a function of applied load provide information about the elastic composition and geometry of the underlying tissue structures. The objective of this study is the clinical evaluation of breast mechanical imager for breast lesion characterization and differentiation between benign and malignant lesions. The breast mechanical imager includes a probe with pressure sensor array, an electronic unit providing data acquisition from the pressure sensors and communication with a touch-screen laptop computer. We have developed an examination procedure and algorithms to provide assessment of breast lesion features such as hardness related parameters, mobility, and shape. A statistical Bayesian classifier was constructed to distinguish between benign and malignant lesions by utilizing all the listed features as the input. Clinical results for 179 cases, collected at four different clinical sites, have demonstrated that the breast mechanical imager provides a reliable image formation of breast tissue abnormalities and calculation of lesion features. Malignant breast lesions (histologically confirmed) demonstrated increased hardness and strain hardening as well as decreased mobility and longer boundary length in comparison with benign lesions. Statistical analysis of differentiation capability for 147 benign and 32 malignant lesions revealed an average sensitivity of 91.4% and specificity of 86.8% with a standard deviation of ±6.1%. The area under the receiver operating characteristic curve characterizing benign and malignant lesion discrimination is 86.1% with the confidence interval ranging from 80.3 to 90.9%, with a significance level of P = 0.0001 (area = 50%). The multisite clinical study demonstrated the capability of mechanical imaging for characterization and differentiation of benign and malignant breast lesions. We hypothesize that the breast mechanical imager has the potential to be used as a cost effective device for cancer diagnostics that could reduce the benign biopsy rate, serve as an adjunct to mammography and to be utilized as a screening device for breast cancer detection.

BackgroundBreast augmentation is one of the most frequently performed esthetic operations. Galactorrhea and galactocele formation are both very rare complications. The real cause still remains unknown, but various risk factors have been well reported in the literature. This report concerns a case of postoperativegalactocele following bilateral breast augmentation via the inframammary approach with dual-plane insertion of implants, which is usually considered a protective approach in terms of risk factors for induction of postoperative galactorrhea.MethodsThe patient had no significant surgical, gynecological or medical history, including galactorrhea or hyperprolactinemia, and did not present any chest wall abnormalities. There has been no use of oral contraceptives or any other drugs. After the surgical procedure, the patient presented with infection-like symptoms, for which galactorrhea or galactocele was initially not considered, mainly for the absence ofspecific risk factors.ResultsAfter antibiotic and bromocriptine therapy, her breast returned to normal, with no pain, inflammation, enlargement or esthetic alterations. After 6 months of follow-up, the patient did not present any abnormality and she was satisfied with the result.ConclusionWith our report, we want to underline that galactorrhea and galactocele cannot be ruled out, even in patients with no risk factors and with procedures considered as “protective.” With a fast diagnosis and a specific therapy, implants and final result can be rescued.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Ultrasound has become an increasingly popular modality in facilitating the performance of peripheral nerve blocks. There exists no literature that examines the learning curve of the ultrasound novice. In this prospective series, we evaluated the learning curve of inexperienced anesthesia residents in performing a simulated ultrasound-guided interventional procedure. In doing so, we hoped to identify reproducible patterns of human errors, which could potentially aid in the prevention of real-life iatrogenic injuries. Ten subjects were prospectively enrolled. After a brief introduction to the ultrasound system, the subjects were asked to perform 6 sequential trials of a simulated breast cyst aspiration. For the first 3 trials, each subject attempted to place a 22-gauge b-bevel needle into any aspect of an olive buried inside the turkey breast. After completion of these 3 trials, the subjects were asked to place the needle into the exact midpoint of the olive wall closest to the transducer. Trials were videotaped and analyzed for task performance in terms of speed and accuracy. All subjects successfully completed the 6 interventional trials. The mean time to perform the task was reduced by 38% and 48%, respectively, for the second and third trials. A composite score of accuracy showed an improvement of 36% and 59%, respectively, for the second and third trials. The most common committed error, which occurred in 7 of 10 subjects, was the failure to accurately image the needle while advancing. This resulted in excessive depth of penetration and inadvertent transfixation of the olive in 5 of these subjects. Anesthesiology residents, with little or no ultrasound experience, can rapidly learn and improve their speed and accuracy in performing a simulated interventional ultrasound procedure. A concerning novice pattern was identified where the subjects advanced the needle even though it was not appropriately visualized in the ultrasound beam. This resulted in needle placement error, which could cause iatrogenic injury in the clinical setting.

A 35-year-old lactating woman with pre-existing polyacrylamide gel (PAAG) implants for 10 years presented on numerous occasions following both her pregnancies with bilateral recurrent breast infection, pain and finally massive breast enlargement with a ruptured galactocoele necessitating surgical intervention. As the safety of PAAG for the breastfeeding baby is not known, breastfeeding with PAAG implants is not recommended.

Background The majority of studies have reported risks of breast cancer (BC) from benign breast disease (BBD) in essentially homogenous Caucasian populations. Information on breast cancer risk factors in larger, multi-ethnic populations should facilitate the development of appropriate and targeted risk reduction strategies. Design Cases and controls were drawn from a parent BBD cohort of 4,970 women, 1,341 African-Americans (AA) and 3,629 non-AA who were diagnosed with BBD after examination of an excisional breast biopsy. Risk factors (34 variables) included demographics, lesion types, and epidemiological variables. Results The final multivariable model retained significance (P < 0.05) for lesion risk-level, fibroadenoma, and the interaction of age-by-race. Women with proliferative lesions (no atypia, risk level 2) were 1.7 times more likely to develop BC when compared with women with non-proliferative lesions (OR = 1.7, 95% CI 1.13, 2.42, P = 0.009). Women with atypia (risk level 3) were 3.75 times more likely to develop BC compared to women with non-proliferative lesions (OR = 3.75, 95% CI 1.99, 7.06, P < 0.001). The odds of breast cancer was approximately 35% lower among women with fibroadenoma as compared to women without fibroadenoma (OR = 0.65, 95% CI 0.46, 0.94, P = 0.020). AA women with BBD who were 50 years or older were 2.28 times more likely to develop breast cancer as compared to non-AA women who were less than 50 years old (OR = 2.28, 95% CI 1.34, 3.88, P = 0.002). Conclusion Women with fibroadenoma (nonproliferative or proliferative) were less likely to progress to BC. Older AA women are at greater risk for progression to breast cancer from BBD.

The patient had a medical history of basal cell carcinoma of the cheek and his family history was significant for breast cancer in a sister, who was diagnosed at the age of 35 years. The pathology of the specimen revealed a tumor size of 3.2 cm, ductal carcinoma in situ present, cribriform type, focal comedo necrosis, nuclear Grade 2, and surgical margins were negative for carcinoma. A sentinel lymph node biopsy can be performed with the procedure for full staging with a mastectomy.4 Because most cases are estrogen receptor-positive, tamoxifen can be given as endocrine therapy.

Cystic breast lesions are caused by a wide spectrum of breast diseases and can range from simple cysts to malignant tumors. Ultrasonography is a good tool for evaluation of the morphology and vascularity of cystic breast lesions. We report three patients in whom contrast-enhanced ultrasonography (CEUS) was used to evaluate intracystic tumors. One of the three patients was diagnosed with intracystic papilloma. Compared with conventional ultrasonography alone, CEUS more clearly demonstrated that the solid component within the mass was lobulated with a narrow base. The other two patients were diagnosed with intracystic papillary carcinoma, and CEUS clearly revealed the presence of widely elevated solid components within both masses, suggesting malignancy. Therefore, CEUS simplified morphological evaluation by enhancing the solid components within the cystic masses.

The aetiology is unknown but it has been suggested that it may be associated with previous or present stimulation by prolactin, some form of ductal obstruction or the presence of secretary breast epithelium. 3 4 Previous case reports have included a male infant with persistent hyperprolactinaemia and another with panhypopituitarism. 3 5 In our case, the hyperprolactinanemia was transient.