Faculty Bibliography

BACKGROUND: Occult breast carcinoma is occasionally found in reduction mammaplasty specimens. Historically, these patients were treated with mastectomy because the exact location of the tumor was unknown. Currently, breast conservation is the treatment of choice in 50 to 85 percent of breast cancers. The authors present a technique of routine specimen marking that allows localization of the tumor and preservation of the choice of lumpectomy. METHODS: This is a retrospective review of 866 patients who underwent reduction mammaplasty performed by a single surgeon between 1990 and 2009. Data were collected for patients who had occult cancer found in their specimens, including age, cancer risk factors, abnormality, nodal status, selected treatment, and survival status. Specimens were marked and oriented and then sent in separate bags to the pathologist. RESULTS: There were 10 cases of occult carcinoma among the 866 women (1.15 percent) who underwent reduction mammaplasty. Six cancers were found in patients undergoing reduction for symptomatic macromastia [n = 629 (0.95 percent)]. Four new cancers were found in the group of patients with a personal history of cancer [n = 237 (1.69 percent)]. All 10 patients had normal preoperative mammograms. Location, size, and margin status were easily identified and patients were offered the choice of lumpectomy or mastectomy. CONCLUSIONS: This article demonstrates that careful marking of reduction specimens in high-risk patients or in women older than 40 years allows the pathologist to orient, localize, and further section tissue for margin status. Communication among plastic surgeon, pathologist, oncologist, and radiation therapist preserves the choice of breast conserving therapy for early cancers.

BACKGROUND: Body mass index (BMI) has been correlated with complications and outcome in surgical patients at the two extremes of the nutrition spectrum. OBJECTIVE: To study the relationship between BMI, outcome, hospital length of stay, and complications in patients admitted to the surgical intensive care unit (SICU). DESIGN: Review of prospectively acquired data in SICU patients. Data acquired included weight, height, age, gender, Acute Physiology and Chronic Health Evaluation (APACHE) II-III scores, Simplified Acute Physiology II (SAPS II) scores, and morbidity and mortality. Patients who stayed in the unit <24 hours were excluded. RESULTS: Of 793 patients, 706 had a normal BMI (NBMI; mean 22.12 kg/m(2)) and 87 were underweight (UBMI; mean 16.81 kg/m(2)). There was no statistically significant difference in APACHE II-III and SAPS scores. The NBMI group had more infections, and the UBMI group had more pulmonary complications (chi(2), P < .0087). There was no significant difference in acute respiratory distress syndrome, atrial fibrillation, myocardial infarction, septicemia, or ventilator- associated pneumonia (Fisher exact test, P = 0.38; chi(2), P = .41). The ICU length of stay between the 2 groups was not significantly different (6.7 vs 5.8 days; P = .64). Overall, there was 11.1% (88/793) SICU mortality; 74 of 706 (10.5%) patients expired in the NBMI group, and 14 of 87 (16.1%) patients expired in the UBMI group. CONCLUSIONS: Low BMI is associated with increased mortality in SICU patients. A BMI <18.5 kg/m(2) is an independent factor affecting outcome in surgical critical care patients.