Dissertations / Theses on the topic 'Breast reconstructions'

Women diagnosed with breast cancer and who have the disease surgically treated by mastectomy experience a health crisis. This thesis focused on the behaviours, feelings and attitudes of women during their breast cancer and mastectomy experiences. The overall purpose was to identify therapeutic factors that can be used by health professionals to improve the psychological and physiological well-being of women with this disease. The conceptual scaffolding for the thesis was drawn from the fields of perceptual psychology and decision-making. The thesis was supported by a study that examined specific areas concerning the breast cancer and mastectomy experience. These areas were self-perceptions, the psychological milieu resulting from a breast cancer diagnosis, and post-mastectomy breast restoration decision-making. The population included: a prosthesis group of 64 women who had mastectomies and wore external breast prostheses, a reconstruction group of 31 women who had mastectomies and underwent breast reconstructions, a control A group of 75 women who had not experienced mastectomy, and a control B group of 65 women who also had not experienced mastectomy. Self-perceptions: The perceptions of the prosthesis, reconstruction and control A groups regarding their body-image, self-concept, total self-image, and self-esteem were compared by using Polivy's (1977) Body-Image Scale and Rosenberg's (1965) Self-Esteem Scale. The body-image, total self-image, and self-esteem mean scores indicated that the prosthesis and reconstruction groups had more positive feelings regarding their bodies than did the control group. There were no significant differences in self-concept among the three groups. These findings challenge a common assumption that mastectomy automatically results in psychiatric morbidity caused by an altered body-image and suggest that health professionals should not make assumptions about how a woman will psychologically respond to mastectomy. Quality of life perceptions were compared among the prosthesis, reconstruction and control B groups using the Ferrans and Powers (1985) Quality of Life Index. The mean scores of the prosthesis and reconstruction groups were higher than the control group's scores, with higher scores indicating more positive quality of life perceptions. The findings suggest that the women in the mastectomy samples had found ways to cope with their health crises. Over time, they learned not to define all existence in terms of a cancer diagnosis and had gained or maintained a positive perspective on life. Post-mastectomy attitudes in the prosthesis and the reconstruction groups were compared. Using the Mastectomy Attitude Scale the results indicated that both groups were satisfied with their bodies, had a positive outlook towards their lives, implied that sexuality entailed more than having breasts, and felt that mastectomy treatment was necessary to save their lives. Neither group concealed that they had a mastectomy, nor were the women prone to discuss their mastectomy experiences. The findings from the study indicate that the women post-mastectomy already had or developed positive attitudes towards themselves and life in general and the method chosen for breast restoration had no apparent impact on these attitudes. The self-perception data indicated that women do adjust and cope with breast cancer surgically treated by mastectomy. These women should be encouraged by health professionals to develop a helping relationship with other women who are newly diagnosed with the disease. This alliance could engender hope in those women who are beginning their journey along a similar road to survival. More hope for these women and less fatalism would decrease their sense of crisis and facilitate their abilities to take an active part in the decision-making processes relating to their treatment. Psychological Milieu: The women in the prosthesis and the reconstruction groups were interviewed about their breast cancer and mastectomy experiences. The findings supported the premise that receiving a diagnosis of breast cancer plunged the women into a health crisis and caused an instant disruption to their lives. The women found that they had to suddenly deal with several complex issues all at the same time, such as what must be done in the immediate future to treat the cancer, as well as the more frightening issues of the meaning of the illness on their ultimate life expectancy. All of this turmoil played havoc with their ability to make informed decisions regarding their breast cancer treatment alternatives. This finding suggests the need for more individualised interventions and support for women when they are making decisions during this stressful period. Health professionals need to keep in mind that simply hearing the word "cancer" often prevents a person from assimilating the complete diagnosis, indicated treatments, and possible prognosis. Therefore, care-givers must be prepared to repeat and elaborate upon information previously given to the affected individual and the family. Breast Restoration Decision-Making: To evaluate the prosthesis and the reconstruction groups' abilities to undertake competent breast restoration decision-making, a 5 Stage process was devised, modelled after Janis and Mann's (1977) seven criteria for competent decision-making. Analysis of the data revealed that both groups displayed passive information seeking behaviour in relation to breast restoration alternatives. They had either no knowledge or limited knowledge regarding the alternatives. Their lack of knowledge was due either to (1) anxiety about their disease, or (2) deficiencies in the interpersonal skills of individuals presenting information to them, or (3) the perceptions that they had insufficient time to gather information, or (4) a combination of these factors. Because the prosthesis and the reconstruction groups were under stress they used coping styles to accomplish decision-making. To measure their coping styles five categories were defined, based on Janis and Mann's (1977) conflict model of emergency decisionmaking and Simon's (1957) notion of "bounded rationality". Two styles emerged. The prosthesis group used the "Sideliner" style that allowed the women to make a quick, conflict-free decision. They were not aware of alternative choices resulting in their decision-making experience being uncomplicated and effortless. The reconstruction group used the "Contented" style that also allowed them an uncomplicated and effortless decision-making experience. The women decided that breast reconstruction was their only viable option. Many of them did not even think that they had made a decision about an alternative because of the strong salience towards breast reconstruction. A breast restoration decision-making model has been developed and proposed for women to use when considering their alternatives. This model offers to health professionals and women a realistic and useable decision-making process that can be implemented when individuals are experiencing a health crisis. The model can be modified and used for numerous situations that require decisions regarding treatment alternatives. This inquiry has demonstrated that there is a need for a specific health professional to assist women newly diagnosed with breast cancer. This individual would assume several roles that include one of advocacy for the women, and the important role of ensuring that these individuals have the information and knowledge to make competent decisions regarding their breast cancer treatments.

Aim: To investigate women’s perspectives of radiotherapy combined with deep inferior epigastric perforator (DIEP) flap and transverse rectus abdominis musculocutaneous (TRAM) free flap breast reconstructions post mastectomy for breast cancer. Background: Breast cancer can be treated by a number of modalities. Two of these are surgery and radiotherapy. If a mastectomy is recommended an immediate breast reconstruction may also be offered. There are a number of different reconstructive techniques; one uses tissue from the abdomen, and another uses tissue and muscle. In some cases radiotherapy may be recommended and delivered post-operatively as an adjuvant. There is confusion in the literature whether radiotherapy has a detrimental effect on these autologous (tissue-only) reconstructions, and there is limited research in this arena from the patient’s perspective. Method: Three focus groups were held in London in 2013. The aim of these groups was to explore the experiences of women who had received this combination of treatment, and to identify their thoughts on whether post-operative radiotherapy impacted their tissue-only immediate breast reconstructions. Data from these focus groups were transcribed and analysed using framework analysis. Results: Six themes emerged from the data; Being changed, Control, Coping strategies, Information, Normalisation and Trust/faith in healthcare professionals. The women did not appear to be worried about the combination of treatment or any effects the radiotherapy had on their immediate autologous breast reconstructions; furthermore, they would recommend this option to others in the same situation. The women discussed their experience of breast cancer and how this had affected them. The data illustrated that breast cancer and treatment reverberated through every aspect of the women’s life; their self-identity, daily routines and experiences with friends and family. In context of the enormity of the breast cancer experience, the combination of treatment with immediate autologous reconstruction followed by radiotherapy appeared well tolerated and not a notable issue for the participants. Although longer-term issues are not known, these women reported that other aspects of their treatment had been challenging, for example chemotherapy, but when reflecting on their whole experience these did not seem too great in hindsight. Conclusions: This is the first study to report qualitative data on this specific combination of treatment. The findings of this research are that the participants did not voice concerns regarding the delivery of post-operative radiotherapy on their DIEP or TRAM flap immediate breast reconstructions. Understanding the thoughts and experiences of these women will furnish healthcare professionals with information, assist them when recommending treatment for women within this setting, and give confidence and encouragement when suggesting this combination of treatment. It is hoped that this will translate to a better patient experience and enable clinicians to target and assist with specific needs in a holistic manner.

Fluorescence-enhanced optical imaging using near-infrared (NIR) light developed for in-vivo molecular targeting and reporting of cancer provides promising opportunities for diagnostic imaging. However, prior to the administration of unproven contrast agents, the benefits of fluorescence-enhanced optical imaging must be assessed in feasibility phantom studies. A novel intensified charge-coupled device (ICCD) imaging system has been developed to perform 3-D fluorescence tomographic imaging in the frequency-domain using near-infrared contrast agents. This study is unique since it (i) employs a large tissue-mimicking phantom (~1087 cc), which is shaped and sized to resemble a female breast and part of the extended chest wall region, and (ii) enables rapid data acquisition in the frequency-domain by using a gain-modulated ICCD camera. Diagnostic 3-D fluorescence-enhanced optical tomography is demonstrated using 0.5-1 cc single and multiple targets contrasted from their surrounding by ??M concentrations of Indocyanine green (ICG) in the breast-shaped phantom (10 cm diameter), under varying conditions of target-to-background absorption contrast ratios (1:0 and 100:1) and target depths (up to 3 cm deep). Boundary surface fluorescence measurements of referenced amplitude and phase shift were used along with the coupled diffusion equation of light propagation in order to perform 3-D image reconstructions using the approximate extended Kalman filter (AEKF) algorithm, and hence differentiate the target from the background based on fluorescent optical contrast. Detection of single and multiple targets is demonstrated under various conditions of target depths (up to 2 cm deep), absorption optical contrast ratio (1:0 and 100:1), target volumes (0.5-1 cc), and multiple targets (up to three 0.5 cc targets). The feasibility of 3-D image reconstructions from simultaneous multiple point excitation sources are presented. Preliminary lifetime imaging studies with 1:2 and 2:1 optical contrast in fluorescence lifetime of the contrast agents is also demonstrated. The specificity of the optical imager is further assessed from homogeneous phantom studies containing no fluorescently contrasted targets. While nuclear imaging currently provides clinical diagnostic opportunities using radioactive tracers, molecular targeting of tumors using non-ionizing NIR contrast agents tomographically imaged using the frequency-domain ICCD imaging system could possibly become a new method of diagnostic imaging.

Le cancer du sein est aujourd’hui le cancer le plus fréquent chez la femme ainsi que la première cause de décès féminin par cancer. Actuellement, l’IRM mammaire n’est réalisée qu’en seconde intention lorsque les autres modalités d’imagerie ne suffisent pas à poser un diagnostic. Dans le cas des populations à risque, l’IRM mammaire est recommandée comme examen de dépistage annuel en raison de sa très haute sensibilité de détection. Par IRM, la détection d’un cancer du sein se fait à la suite de l’injection d’un produit de contraste qui permet de visualiser les lésions mammaires en hypersignal. La majeure partie du diagnostic repose sur l’analyse morphologique de ces lésions ; une acquisition hautement résolue spatialement est donc nécessaire. Malgré l’utilisation des techniques d’accélération courantes, le volume de données à acquérir reste important et la résolution temporelle de l’examen d’IRM mammaire est aujourd’hui aux alentours d’une minute. Cette faible résolution temporelle limite donc intrinsèquement la spécificité de l’examen d’IRM mammaire. Un examen avec une haute résolution temporelle permettrait l’utilisation de modèles pharmacocinétiques donnant accès à des paramètres physiologiques spécifiques des lésions. L’approche proposée dans ce travail de thèse est le développement d’une séquence IRM permettant à la fois la reconstruction classique d’images, telle que celle utilisée en routine clinique pour le diagnostic, ainsi qu’une reconstruction accélérée d’images avec une plus haute résolution temporelle permettant ainsi l’application de modèles pharmacocinétiques. Le développement de cette séquence a été réalisé en modifiant l’ordre d’acquisition du domaine de Fourier de la séquence utilisée en clinique, afin qu’il soit aléatoire et permette la reconstruction a posteriori de domaines sous-échantillonnés acquis plus rapidement. Des acquisitions sur des objets tests, sur des volontaires et sur des patientes ont montré que l’acquisition aléatoire ne modifiait pas les images obtenues par reconstruction classique permettant ainsi le diagnostic conventionnel. Une attention particulière a été portée pour permettre la suppression de graisse nécessaire à l’acquisition des images d’IRM mammaire. Les reconstructions des domaines sous-échantillonnés sont réalisées via des reconstructions Compressed Sensing permettant la suppression des artéfacts de sous-échantillonnage. Ces reconstructions Compressed Sensing ont été développées et testées sur des fantômes numériques reproduisant des IRMs mammaires. Le potentiel de cette nouvelle acquisition a enfin été testé sur une lésion artificielle mammaire, développée à cet effet, et reproduisant des prises de contraste mammaires
Breast cancer is nowadays the first cause of female cancer and the first cause of female death by cancer. Breast MRI is only performed in second intention when other imaging modalities cannot lead to a confident diagnosis. In high risk women population, breast MRI is recommended as an annual screening tool because of its higher sensitivity to detect breast cancer. Breast MRI needs contrast agent injection to visualize enhancing lesions and the diagnosis is mostly based on morphological analysis of these lesions. Therefore, an acquisition with high spatial resolution is needed. Despite the use of conventional MRI acceleration techniques, the volume of data to be acquired remains quite large and the temporal resolution of the exam is around one minute. This low temporal resolution may be the cause of the low specificity of breast MRI exam. Breast MRI with higher temporal resolution will allow the use of pharmacokinetic models to access physiological parameters and lesion specifications. The main aim of this work is to develop a MRI sequence allowing a flexible use of the acquired data at the reconstruction stage. On the one hand, the images can be reconstructed with a conventional reconstruction like the protocol used in clinical routine. On the other hand, the new MRI sequence will also allow the reconstruction of images with a higher temporal resolution allowing the use of pharmacokinetic models. The development of this sequence was done by modifying the acquisition order in the Fourier domain. A random acquisition of the Fourier domain will allow the reconstruction of sub-sampled domains acquired faster. We paid attention to fat suppression efficiency with this new Fourier domain acquisition order. Tests were performed on phantom, female volunteers and patients. These tests showed that the random acquisition did not impact the quality of images (MRI signal and lesion morphology) obtained by conventional reconstruction thus allowing the conventional diagnosis. The reconstructions of the sub-sampled Fourier domains were made using Compressed Sensing reconstructions to remove sub-sampling artifacts. These reconstructions were developed and tested on digital phantoms reproducing breast MRI. The potential of this new MRI acquisition was tested on an artificial enhancing breast lesion developed especially for this purpose

An examination of the relevant literature revealed a lack of theoretical conceptualisations of breast reconstruction’s role regarding women’s self-image. The present study aimed to explore this topic further and develop appropriate theory. A Grounded Theory methodology was employed to retrospectively explore the experiences of women who had undergone breast reconstruction, focusing upon the concept of self-image. Ten participants took part in the current study, recruited from breast cancer support groups. Data was collected by means of semi-structured interviews and analysed via the NVivo 8 computer package. The views of three breast cancer care staff were also canvassed via focus group in order to verify the findings and emerging theory. The current investigation generated a core category entitled ‘Feeling like me again’. This category emerged as a reflection of the participants’ belief that breast reconstruction surgery has helped them to restore a sense of normality in their lives and in how they see themselves. The core category comprised two principal categories, namely ‘Normal Appearance’ and ‘Normal Life’, and their subordinate themes. A further two main categories were generated, entitled ‘Moving On’ and ‘Image of Sick Person’. The categories were formulated into a Model of Breast Cancer, Breast Reconstruction and Self-Image. Implications of this model in relation to existing theory and clinical practice were considered. This study has highlighted that breast reconstruction’s role in relation to women’s self-image is subtle and wide-ranging.

In this thesis I analyzed the microwave tomography method to recognize breast can- cer. I study how identify the dielectric permittivity, the Helmoltz equation parameter used to model the real physic problem. Through a non linear least squares method I solve a problem of parameters identification; I show the theoric approach and the devel- opment to reach the results. I use the Levenberg-Marquardt algorithm, applied on COMSOL software to multiphysic models; so I do numerical proofs on semplified test problems compared to the specific real problem to solve.

Introduction: To save lives, mastectomy is an essential intervention, but it can also causephysical and psychological trauma. An important step in restoring breast cancer patient’squality of life is to offer reconstruction. Immediate breast reconstruction (IBR) is thealternative that provides highest patient-reported life quality post surgery. However, not allpatients are suitable for the procedure, besides surgical contraindications; both patient’s andsurgeon’s opinion on surgery may influence the frequency.Data from 2016 revealed low frequency of IBR in the County of Örebro, below nationaltargets. Since then, improvement work has been implemented to improve frequency.Aim: To investigate the current frequency of IBR in 2018 and compare with data from 2016.Method: Data on mastectomy and IBR frequency in breast cancer patients was extractedfrom casebooks. Patients with male gender, neoadjuvant radiotherapy and other purposes forsurgery than cancer were excluded. Using SPSS statistics, population characteristics wascompared between IBR and mastectomy alone patients, and with data from 2016.Results: It was evident that the frequency of IBR 2018 (12.66 %) was higher than in 2016(4.85 %), which match our hypothesis. Further, there was no significant difference incharacteristics between the mastectomy alone and IBR group except for “waiting time forsurgery”, “discussion at MDK on IBR” and “age”.Conclusion: IBR surgeries have increased since 2016. Future focus to improve frequencyshould be on shortening the waiting time and addressing patient’s opinion on surgery, asseveral patients declined.

Background Mastectomy is the mainstay of surgical treatment for women with breast cancer in South Africa. The increase in breast reconstruction after a mastectomy has prompted the need to evaluate patient reported outcome measures (PROMs) for this set of operative intervention. This study aimed to assess clinical and patient reported outcome measures in immediate breast reconstruction patients using the BREAST-Q and compare these with international cohorts. Methods A cross-sectional study was performed on all patients who underwent immediate breast reconstruction between January 2011 and December 2016. This consisted of a retrospective clinical record review of perioperative outcomes, and a quality of life analysis using the BREAST-Q Post-Reconstruction questionnaire. Outcome predictors were identified using Chi-square, Fisher exact, One-way ANOVA, Student t-tests and Kruskal Wallis analysis of variance. A random-effect single arm meta-analysis was performed to compare the BREASTQ scores with international cohorts. Results A total of 52 patients were included with a mean age of 43.2 (+/-9.5) years. Eighteen patients (34.6%) developed early complications; of these 8 (44.4%) were major. Thirty-one patients (59.6%) developed late complications; of these 18 (58.1%) were major. Fifteen patients (28.8%) had failed reconstruction. There was a significantly higher risk of failure following a total mastectomy (TM) (p=0.02), tissue expander reconstruction (TE) (p< 0.01) and stage 2 breast cancer (p=0.01). Patients who underwent nipple reconstruction and immediate-delayed reconstruction before 12 months, reported higher well-being and satisfaction scores. Compared to international cohorts our BREAST-Q scores were lower but fall within the 95% confidence interval for Sexual Well-Being and Satisfaction with Nipples and Care. Conclusion Immediate breast reconstruction poses a high risk of complications and reconstructive failure especially, with TM and TE. Our BREAST-Q scores are comparable to international studies and may be useful in guiding patient consent.

Background: As breast reconstruction evolves, plastic surgeons continue to find ways to improve their reconstruction' outcomes. The aim of our study is to demonstrate how plastic surgery research impacts and improves current surgical practices. For instance, we designed three clinical studies which illustrate how research can affect current popular surgical practices, not only during the pre-operative period, but also intra-operative and post-operative periods. Methods: In the first study, we performed a meta-analysis to evaluate first the safety and efficacy of Thoracic ParaVertebral Block (TPVB) for breast surgery, and then to compare TPVB to General Anesthesia (GA) with regards to postoperative pain, nausea and vomiting, opioid consumption and length of hospital stay. To do so, an electronic and manual search of English- and French- language articles on TPVB in breast surgery (published up to June 2010) was performed. Two levels of screening were used to identify relevant articles. The Mantel-Haenszel method (fixed effect) was used to perform the meta-analysis.In the second study, we performed a systematic review to evaluate the existing literature, comparing the use of drains or not in reduction mammaplasty. We assessed first, if there is enough evidence to reach a conclusion regarding the routine use of drains after reduction mammaplasty, and then, if there is a need for more randomized control trials. To do so, we searched PubMed, EMBASE, the Cochrane Central Database of Clinical Trials (CENTRAL) on the Cochrane Library and Science Citation Index Expanded for original articles and reviews from January 1980 to June 2009. Finally, in the third study, we are presenting our clinical experience of using subcutaneous breast tissue expansion prior to reconstruction with Deep Inferior Epigastric Perforator (DIEP) flaps, and we are showing how our new technique eliminates the patch-like appearance of the skin paddle. We developed this technique; surgical technique that was never described or presented before. Over the past 2 years (January 2008 – January 2010), five patients underwent breast reconstruction using this three-stage approach. Retrospective analysis of patients' characteristics, breast history, surgical stay, complications and outcomes were performed. Results: Our first study demonstrated that pre-operative TPVB provides effective anesthesia for ambulatory / same-day breast surgery and can result in significant benefits over GA. However further studies are required to determine if these advantages would still persist if an optimal technique for outpatient GA is employed. Adjunctive ultrasonography may contribute to improve the safety of TPVB in breast surgery and requires further investigation.Our second study, we demonstrated that although placement of intra-operative drains after reduction mammaplasty is common practice, it should not be used routinely in reduction mammaplasty. Further randomized controlled trials are not warranted. Finally, our third study demonstrated how innovation in plastic surgery research can improve the final, post-operative aesthetic outcome. Subcutaneous breast tissue expansion followed by DIEP flap reconstruction can be performed safely, offering patients a completely autologous breast reconstruction with low morbidity, as well as eliminating the classical patch-like appearance of flap reconstructions.Conclusion:These three different studies illustrate how plastic surgery research can have an impact on breast reconstruction outcomes. The first two studies demonstrate with a strong level of evidence (meta-analysis and systematic review, respectively) that established pre-operative and post-operative factors can be changed for the benefit of the patient. Finally, we demonstrated how surgical technique innovation can improve the post-operative outcome.
Contexte: Avec l'évolution de la chirurgie reconstructive du sein, les chirurgiens plasticiens continuent de trouver des moyens d'améliorer leurs reconstructions. Le but de notre étude est de démontrer, à travers trois études cliniques, comment la recherche en chirurgie plastique peut améliorer les pratiques chirurgicales courantes, durant les périodes pré-, intra- et postopératoires. Méthodes: Lors de notre première étude, nous avons effectué une méta-analyse afin d'évaluer la sécurité d'utilisation et l'efficacité des Blocs Thoraciques Para-Vertébraux (BTPV) pour la chirurgie du sein, en comparaison à l'Anesthésie Générale (AG). Pour cela, nous avons effectué une recherche électronique et manuelle d'articles écrits en anglais et français sur les BTPV en chirurgie du sein (publiés jusqu'en Juin 2010). Deux niveaux de sélection d'articles ont été utilisés. La méthode de Mantel-Haenszel (effets fixes) a été utilisée pour effectuer la méta-analyse. Lors de notre seconde étude, nous avons effectué une revue systématique afin d'évaluer la littérature existante qui compare l'utilisation de drains ou non lors des réductions mammaires. Pour cela, nous avons cherché Pub Med, EMBASE, le "Cochrane Central Database of Clinical Trials (CENTRAL) on the Cochrane Library" et le "Science Citation Index Expanded" pour les articles et revues de Janvier 1980 à Juin 2009. Finalement, lors de notre troisième étude, nous présentons notre expérience sur l'utilisation d'expanseurs sous cutanés de seins avant une reconstruction avec un lambeau basé sur la perforante de l'artère inferieure épigastrique profonde (lambeau DIEP). Nous démontrons comment notre nouvelle technique élimine l'apparence de patch du lambeau DIEP sur le sein. Nous avons développé cette technique; technique chirurgicale qui n'a jamais été décrite ou présentée auparavant. Au courant des deux dernières années (Janvier 2008 – Janvier 2010), cinq patients ont bénéficié de cette approche à trois étapes. Une analyse rétrospective des caractéristiques médicales des patients, de leur pathologie mammaire, de leurs hospitalisations, des complications et de leurs résultats, a été effectuée. Résultats: Notre première étude a démontré que les BTPV en préopératoire permettent une anesthésie effective pour les cas-de-jour de chirurgie du sein et démontrent des bénéfices supérieurs à l'AG. Cependant, plus d'études sont à faire afin de déterminer si ces avantages perdurent si une technique optimale pour une AG pour patients non-hospitalises est employée. L'échographie pourrait contribuer à améliorer la morbidité possible associée avec les BTPV en chirurgie du sein et devrait être étudiée en profondeur. Notre seconde étude a démontré que même si le placement routinier de drains en intra-opératoire après réduction mammaire est une pratique très populaire, cela ne devrait pas être utilisé de manière routinière après les réductions mammaires. Plus d'études randomisées contrôlées ne sont pas requises. Finalement, notre troisième étude a démontré comment l'innovation en recherche en chirurgie plastique peut améliorer le résultat final, postopératoire. L'expansion mammaire sous-cutanée suivie par reconstruction avec lambeau DIEP peut être effectuée en toute sécurité et offre aux patients une reconstruction mammaire totalement autologue, avec une faible morbidité, tout en éliminant l'apparence en forme de patch des reconstructions mammaires autologues classiques. Conclusion: Ces trois différentes études illustrent bien comment la recherche en chirurgie plastique peut affecter les résultats en reconstruction mammaire. Nos deux premières études démontrent avec un niveau d'évidence très élevé (méta-analyse puis revue systématique) que des pratiques préopératoires et intra-opératoires établies peuvent être modifiées au bénéfice des patients. Finalement, nous avons démontré comment une technique chirurgicale innovatrice peut améliorer les résultats postopératoires.

Aims: The main objective of this research was to compare psychological distress (anxiety and depression) and body image dissatisfaction (BID) between two groups of women: those who had undergone breast reconstruction following mastectomy for breast cancer (BR) and those who had undergone breast reconstruction and additional procedures (BR-AP). Furthermore, the study aimed to explore the possible reasons why women might undergo additional procedures following breast reconstruction. Method: A cross-sectional retrospective design was employed and data was collected at one time period only. Ninety seven patients were recruited (69.3% of the total patient cohort) who attended prearranged clinic appointments between August 2006 and February 2007 at a regional Breast Care Unit. Results: The prevalence of anxiety and depression was higher in the BR-AP group compared to the BR group. This difference was not significant for anxiety, however it was approaching statistical significance for depression (p = 0.09). The BR-AP group had a significantly higher BID than the BR group (p = 0.045). There was some evidence that undergoing additional procedures predicted depression (p = 0.060) and BID (p = 0.045). Conclusions: Undergoing additional procedures following breast reconstruction may not lead to a positive psychological outcome in terms of anxiety, depression and body image dissatisfaction. In view of the cost that undergoing these procedures presents to the NHS, coupled with the assumption that they offer psychological benefits, further research that prospectively examines psychological aspects of women seeking additional procedures is strongly recommended. Knowledge gained from such research is likely to assist in the pre-operative assessment of these women.

The purpose of the project is to create a Mixed Reality (MR) application for the 3D visualisation of the result of a breast reconstruction surgery. The application is to be used before surgery to facilitate communication between patient an surgeon about the expected result. To this purpose Microsoft HoloLens is used, which is a pair of Mixed Reality (MR) glasses developed and manufactured by Microsoft that has a self-contained, holographic rendering computer. For the development of the MR application on the Hololens, MixedRealityToolkit-Unity is used which is a Unity-based toolkit available. The goal of the application is that the user can scan a torso of a patient, render a hologram of the torso and attach to it a prefabricated breast which possibly follows the patient's specification. To prepare a prefabricated breast, a 3D model of the breast is first created in the 3D modelling software Blender. It then gets its texture from a picture taken with the HoloLens camera. The picture is cropped to better fit the model and uploaded as a 2D texture which is then attached to the prefabricated breast, which is imported into Unity. To scan objects, the HoloLens’s operating system feature Surface Observer is used. The resulting mesh from the observer is cropped using a virtual cube, scaled, moved and rotated by the user. The cropped mesh is then smoothed using the Humphrey's Classes smoothing algorithm. To fuse the smoothed mesh with the prefabricated breast model, the Unity components: Colliders and Transforms are used. On a collision the breast's transform parent is set to the mesh’s transform, making the objects transforms behave depending on each other. The MR application has been developed and evaluated. The evaluation results show that the goal has been achieved successfully. The project demonstrates that the Microsoft HoloLens is well suited for developing such medical applications as breast reconstructive surgery visualisations. It can possibly be extended to other surgeries such as showing on a patient’s body how the scar will look after a heart surgery, or a cesarean section.

La reconstruction en tomosynthèse numérique du sein est considérée comme un problème inverse, pour lequel les méthodes itératives régularisées permettent de fournir une bonne qualité d'image. Bien que la tâche clinique joue un rôle crucial lors de l’examen des images par le radiologue, elle n'a pas été jusqu'à présent directement prise en compte dans le processus de reconstruction des images de tomosynthèse. Dans cette thèse, nous introduisons une nouvelle formulation variationnelle de la reconstruction des images en tomosynthèse numérique du sein qui intègre la tâche clinique du radiologue, notamment la détection des microcalcifications. Le but de cette approche est de permettre à la fois le rehaussement de la détectabilité des microcalcifications et une restauration de bonne qualité des tissus mammaires.Tout d'abord, nous proposons une nouvelle approche qui vise à rehausser la détectabilité des microcalcifications. Nous formulons une nouvelle fonction de détectabilité inspirée d’observateurs mathématiques. Nous l’intégrons, par la suite, dans une fonction objectif minimisée par un algorithme de reconstruction dédié. Nous montrons finalement l'intérêt de notre approche à l'égard des méthodes standards de reconstruction. Dans une deuxième partie, nous introduisons une nouvelle régularisation, Spatially Adaptive Total Variation (SATV), en complément de la fonction de détectabilité dans le problème de reconstruction en tomosynthèse. Nous proposons une formulation originale où l’opérateur de gradient est remplacé par un opérateur adaptatif appliqué à l'image qui incorpore efficacement la connaissance a priori relative à la localisation de petits objets. Ensuite, nous dérivons notre régularisation SATV et l'intégrons dans une nouvelle approche de reconstruction. Les résultats expérimentaux montrent que SATV est une piste prometteuse pour améliorer les méthodes de régularisation de l’état de l'art. Dans une troisième partie, nous étudions l'application de l’algorithme de Majoration-Minimisation à Mémoire de Gradient (3MG) à notre problème de reconstruction. Dans le but d’accroître sa vitesse de convergence, nous proposons deux améliorations numériques. Dès lors, les performances numériques sont évaluées en comparant la vitesse de convergence de la méthode proposée avec celles d'algorithmes d'optimisation convexe concurrents. La dernière partie de la thèse porte sur l'évaluation quantitative des contributions de l'approche de reconstruction proposée en tomosynthèse numérique du sein. Nous menons une étude de lecture d'images impliquant quatorze lecteurs dont neuf radiologues avec différents niveaux d'expertise et cinq experts en mammographie de GE Healthcare. Les résultats démontrent l'intérêt de notre approche de reconstruction par rapport à l'approche standard non-régularisée selon des critères visuels spécifiques
The reconstruction of a volumetric image from Digital Breast Tomosynthesis (DBT)measurements is an ill-posed inverse problem, for which existing iterative regularizedapproaches can provide a good solution. However, the clinical task is somehow omittedin the derivation of those techniques, although it plays a primary role in the radiologistdiagnosis. In this work, we address this issue by introducing a novel variational formulationfor DBT reconstruction. Our approach is tailored for a specific clinical task, namely the detection of microcalcifications. Our method aims at simultaneously enhancing the detectionperformance and enabling a high-quality restoration of the background breast tissues.First, we propose an original approach aiming at enhancing the detectability of microcalcifications in DBT reconstruction. Thus, we formulate a detectability function inspired from mathematical model observers. Then, we integrate it in a cost function which is minimized for 3D reconstruction of DBT volumes. Experimental results demonstrate the interest of our approach in terms of microcalcification detectability.In a second part, we introduce the Spatially Adaptive Total Variation (SATV) as a new regularization strategy applied to DBT reconstruction, in addition to the detectability function. Hence, an original formulation for the weighted gradient field is introduced, that efficiently incorporates prior knowledge on the location of small objects. Then, we derive our SATV regularization, and incorporate it in our proposed 3D reconstruction approach for DBT. We carry out several experiments, in which SATV regularizer shows a promising improvement with respect to state-of-the-art regularization methods.Third, we investigate the application of Majorize Minimize Memory Gradient (3MG) algorithm to our proposed reconstruction approach. Thus, we suggest two numerical improvements to boost the speed of the reconstruction scheme. Then, we assess the numerical performance of 3MG by comparing the convergence speed of the proposed method with state-of-the-art convex optimization algorithms.The last part of this thesis is focused on the quantitative assessment of the contribution of our proposed DBT reconstruction. Thus, we conduct a visual experiment trial involving fourteen readers including nine radiologists with different levels of expertise and five GE Healthcare experts in mammography. According to specific visual criteria, the results show the outperformance of our proposed reconstruction approach over the standard non-regularized least squares solution

Introduction: Numerous methods exist for the assessment of the female breast. Traditionally, a subjective approach was taken for surgical planning and evaluation of the postoperative outcome. Several objective methods have been developed to support this procedure, among which are laser scanning, MRI, mammography, ultrasound and photography. Recently, 3D imaging technology has been developed. Material & Method: 3D breast assessment by multiple stereophotogrammetry was examined. A custom-made imaging system with eight digital cameras arranged in four camera pods was utilised. This system was used for breast capture, resulting in eight images obtained by the cameras. The merging of these images and 3D image construction was carried out by C3D software and the volume assessment of the 3D images was made using breast analysis tool (BAT) software, developed by Glasgow University. A validation study was conducted. Nine plaster models were investigated and their volume determined by 3D stereophotogrammetry and water displacement method. Water displacement was considered to be the gold standard for comparison. The plaster models were specially made in order to represent a variety of shapes and sizes of the female breast. Each plaster model was examined 10 times by each method. Further, the volumes of the breasts of six female volunteer live models were investigated by the same two methods and the results compared. A special focus was placed on the reproducibility of the assessment. Each live model was captured with the 3D capture system three times at two different time points after retaking a special pose in a custom-made positioning frame. Altogether, each live model was captured six times, resulting in six 3D images, each of which was measured three times with BAT software. A patient study was conducted in 44 patients after unilateral immediate breast reconstruction with Latissimus dorsi flap and no contra-lateral surgery. Each patient underwent 3D imaging with the multiple stereophotogrammetry system. During capture, the special pose in the custom-made positioning frame was taken by the patient’s leaning forward almost horizontally with the upper body for the breasts to rise off the chest wall to enable full breast coverage by the cameras. 3D images were constructed with C3D software and volumes measured with BAT. For each patient, one 3D image was constructed and measured four times with BAT software. In addition to the volume determination, a shape analysis was conducted. For this purpose, 10 landmarks were determined according to recommendations in the literature. Two landmarks, sternal notch and xiphoid, were marked, forming an imaginary midline between each other and four landmarks on each breast, i.e. the medial and lateral ends of the infra-mammary fold, and the most prominent and most inferior breast points were utilised for symmetry assessment between the right and left breasts. Each landmark was recorded four times by the operator on the 3D image and three-dimensional coordinates obtained. By assessment of the left and right breasts a breast asymmetry score was calculated. Firstly, breast asymmetry was assessed objectively on the 3D images through the centroid size, which was determined as the square root of the sum of squared Euclidian distances from each landmark to the centroid. The centroid was the geometric mean of the landmarks. Secondly, asymmetry was assessed through breast volume by application of BAT software. Thirdly, asymmetry was examined through the landmarks themselves by investigation of the mismatch of the landmark configuration of one breast and its relabelled and matched reflection. The non-operated and reconstructed sides were compared and landmarks were recorded by the operator in three dimensions in four repeated tests. A decomposition of the total landmark asymmetry into its factors was conducted by fixation of the surface of the non-operated side and translation, rotation and scaling of the surface of the reconstructed side. For comparison, a subjective breast assessment was conducted by six expert observers who rated the results after breast reconstruction by subjective qualitative assessment of the symmetry in 2D images of the same 44 patients in six poses. For this purpose the Harris scale was utilised, providing a score of 1 to 4 for poor to excellent symmetry. Results: The results revealed that differences in the obtained volumes in the plaster models were not significant. In contrast, differences in the breast volumes measured in the live models were significant. The examination of the reproducibility revealed that overall reproducibility obtained by stereophotogrammetry was better than that obtained by water displacement. No correlation between breast size and reproducibility of the measurements was found. The results of the patient study demonstrated that the reproducibility of the landmarks was within 5 mm. There was a non-significant difference of the centroid sizes between both breasts. There was a significant difference of the volumes between the two breasts, with the non-operated side being larger than the reconstructed side. Volume was considered to be a more accurate measure for comparison of both breasts than centroid size as it was based on thousands of data points for the calculation as opposed to only four points of the centroid size. The statistical analysis of the landmark data provided a mathematical formula for determination of the breast asymmetry score. The average asymmetry score, derived by landmark assessment as the degree of mismatch between both sides, was 0.052 with scores ranging from 0.019 (lowest score) to 0.136 (highest score). The decomposition of the landmark-based asymmetry revealed that location was the most important factor contributing to breast asymmetry, ahead of intrinsic breast asymmetry, orientation and scale. When investigating the subjective assessment, the inter-observer agreement was good or substantial. There was moderate agreement on the controls and fair to substantial intra-observer agreement. When comparing the objective and subjective assessments, it was found that the relationship between the two scores was highly significant. Conclusion: We concluded that 3D breast assessment by multiple stereophotogrammetry was reliable for a comparative analysis and provided objective data to breast volume, shape and symmetry. A breast asymmetry score was developed, enabling an objective measurement of breast asymmetry after breast reconstruction. 3D breast assessment served as an objective method for comparison to subjective breast assessment.

The problem of localizing a scatterer, which represents a tumor, in a homogeneous circular domain, which represents a breast, is addressed. A breast imaging method based on microwaves is considered. The microwave imaging involves to several techniques for detecting, localizing and characterizing tumors in breast tissues. In all such methods an electromagnetic inverse scattering problem exists. For the scattering detection method, an algorithm based on a linear procedure solution, inspired by MUltiple SIgnal Classification algorithm (MUSIC) and Time Reversal method (TR), is implemented. The algorithm returns a reconstructed image of the investigation domain in which it is detected the scatterer position. This image is called pseudospectrum. A preliminary performance analysis of the algorithm vying the working frequency is performed: the resolution and the signal-to-noise ratio of the pseudospectra are improved if a multi-frequency approach is considered. The Geometrical Mean-MUSIC algorithm (GM- MUSIC) is proposed as multi-frequency method. The performance of the GMMUSIC is tested in different real life computer simulations. The performed analysis shows that the algorithm detects the scatterer until the electrical parameters of the breast are known. This is an evident limit, since, in a real life situation, the anatomy of the breast is unknown. An improvement in GM-MUSIC is proposed: the Eye-GMMUSIC algorithm. Eye-GMMUSIC algorithm needs no a priori information on the electrical parameters of the breast. It is an optimizing algorithm based on the pattern search algorithm: it searches the breast parameters which minimize the Signal-to-Clutter Mean Ratio (SCMR) in the signal. Finally, the GM-MUSIC and the Eye-GMMUSIC algorithms are tested on a microwave breast cancer detection system consisting of an dipole antenna, a Vector Network Analyzer and a novel breast phantom built at University of Bologna. The reconstruction of the experimental data confirm the GM-MUSIC ability to localize a scatterer in a homogeneous medium.

Abstract Introduction Immediate breast reconstruction (IBR) can be offered to breast cancer patients after mastectomy. A satisfactory breast symmetry has positive effects on psychosocial morbidity, quality of life and body image. The frequency of IBR were in 2017 in Region Örebro County 4%, lower than the national target on 20%. Aim The aim is to provide an overview of the work with IBR at Örebro University Hospital in 2016, regarding frequency of IBR, work with IBR at multidisciplinary team conferences, documentation of the patient’s opinion about IBR, delayed reconstructions, patient characteristics and presence of contraindications. Material and methods This was a retrospective study of all women who underwent mastectomy at Örebro University Hospital in 2016. Results Five of the 103 women got IBR with expander implants in connection to mastectomy, additionally 28 had no contraindications for IBR. Five of the women have discussed about IBR at multidisciplinary team conferences and seven had notes about their attitude to IBR. Ten women underwent delayed reconstruction during the follow-up, additional seven patients were waiting for surgery. There were no significant differences in patient characteristics between the groups “mastectomy and IBR” and “mastectomy only”. Conclusions The low frequencies of performed IBR, discussions at multidisciplinary team conferences and documentation of the patient’s opinion about IBR indicate that there is space for a more active work about IBR. Besides the women who got IBR, there were additionally 28 women without any contraindications for IBR, indicating that there is a considerable group that can become candidates for IBR.

Women who undergo immediate mastectomy for breast cancer experience tremendous anxiety when faced with breast reconstruction and are often conflicted regarding which type of breast reconstruction to choose. This pilot study aimed to analyze the impact of a decision aid, adapted from Stanford University Breast Center, on decisional conflict in women with newly diagnosed breast cancer seeking breast reconstruction. Twenty newly-diagnosed breast cancer patients seeking breast reconstruction at a large academic healthcare center were randomized into two groups. Comparisons were made between women who reviewed the standard educational materials prior to initial consultation, and women who reviewed these materials and then reviewed a decision aid brochure at initial consultation and two weeks post consultation, utilizing the Decisional Conflict Scale. Technical issues halted data collection after only nine participants completed the study. Although no reliable findings could be interpreted from such a small sample size, the results suggest the decision aid as a valuable tool for patient education. Nurses may gain increased awareness of the emotional conflicts faced by newly diagnosed breast cancer patients when making decisions for breast reconstruction.

A cirurgia de reconstrução de mama é uma ferramenta cirúrgica de importância ímpar para reparar os defeitos e assimetrias causadas pelos vários tipos de tratamentos cirúrgicos do Câncer de mama. Várias técnicas e táticas têm sido demosntradas e aplicadas nos últimos anos. Muitos são os estágios em que se encontram os pacientes e vários são os esquemas de abordagem terapêutica para diferentes estágios e tipos histológicos que se apresentam. Tratamentos quimioterápicos pré ou pós-operatório, tratamento radioterápico no pós-operatório quase imediato, mastectomias preventivas, setores amplos em diferentes quadrantes, quadrantectomias, todos estes são vários aspectos de tratamento de uma mesma patologia, porém com estágios e características histológicas e moleculares diferenciadas. Como alternativa cirúrgica para reconstrução de mama em câncer de mama, nos casos em que está indicada a quadrantectomia e/ou setor de mama, independentemente da localização na mama, é que propusemos uma técnica de uso de enxerto autólogo da mama contralateral para manter a forma e a simetria mamária associada a técnicas cirúrgicas de mamoplastias. Objetivo: O objetivo do presente estudo foi avaliar o uso de enxerto de mama contralateral associada a outras técnicas de cirurgia mamária já descritas por outros autores e acompanhar o resultado quanto à estética e simetria mamária no pós-operatório imediato e após o tratamento radioterápico. Comparar os resultados com as mamas do pré-operatório e avaliar a simetria e a estética no pós-operatório. Métodos: Foram incluídos neste estudo 42 pacientes com diferentes tratamentos, porém todas com indicação cirúrgica semelhantes: setor de mama ou quadrantectomia, seguidos de radioterapia. Todos os casos foram fotografados no pré-operatório e mais de 3 meses pós-tratamento radioterápico. Foi utilizada uma escala contínua para avaliar o grau de simetria mamária no pós-operatório de mais de 3 meses de radioterapia. A escalala de medição se baseou numa régua milimétrica de 0 a 10 cm. Foi solicitado a quatro especialistas na área para colocar uma marca na escala com relação à simetria e ao aspecto estético das mamas. As notas de cada paciente foram avaliadas estatisticamente. Resultados: Os resultados foram estatisticamente significativos para a avaliação estética e para a simetria mamária pós-cirurgia e radioterapia. Conclusão: Cocluímos que o enxerto autólogo de mama contralateral em cirurgia de reconstrução de mama é um procedimento que, quando utilizado com outras técnicas, traz um resultado estético e simétrico adequado, desta forma mostrando mais uma alternativa para cirurgia de reconstrução mamária.
Background: The Breast Reconstruction surgery is a surgical tool of unparalleled importance to repair the defects and asymmetries caused by various types of surgical breast cancer treatment. Various techniques and tactics has been demonstrated and applied in recent years. Many patients are at different stages of the disease and several are the sorts of therapeutic approaches for different stages and histologic types that feature. Neo adjuvant chemotherapy treatments or postoperative chemotherapy, radiotherapy in almost immediately after surgery, preventive mastectomies, removing large breast tissue in different quadrants, quadrantectomies. All these are various aspects of treatment of the same disease however to different stages and histological and molecular characteristics. As a surgical alternative to breast reconstruction in breast cancer, where it is indicated quadrantectomy and or wide resection of breast tissue in the same quadrant, regardless of location in the breast that I proposed a technique contralateral breast grafiting replacement to keep shape and breast symmetry. Objetive: The aim of this study was to evaluate the contralateral breast graft associated with other breast surgery techniques already described by other authors, and follow the aesthetic result in the immediate postoperative period and after three months of radiotherapy. Compare the results with those of preoperative breast, and evaluate the symmetry postoperatively and proper aesthetic result. Methods: The study included 42 patients. Each case with different proposals for treatment, but all with similar surgical indication, wide resection of the breast or quadrantectomy, followed by radiotherapy. All cases were photographed in their preoperative, “pre radiotherapy” and three months post radiotherapy. A continuous scale was used to assess the degree of mammary symmetry in these patients in the post operative period of three months after radiotherapy. The measurement was based on a rule millimeter scale from 0 to 10 cm. We were asked to four experts in the field to put a mark on the scale with respect to symmetry and aesthetic appearance of the breasts. The scores of each patient were evaluated statistically. Results: The results were statistically significant for the aesthetic evaluation of the breasts and also for evaluation of the symmetry of the breasts after surgery and radiotherapy. Conclusion: We concluded that autologous graft contralateral breast in breast reconstruction surgery is a procedure that when used with other techniques, brings an aesthetic and suitable symmetrical result thus showing an alternative to breast reconstruction surgery.

Breast cancer affects one in eight women and approximately 40% will require a mastectomy. The loss of a breast may dramatically impact upon quality of life. Breast reconstruction (BR) is offered to improve outcomes. Making decisions regarding BR surgery, however, is challenging and women and healthcare professionals (HCPs) need to weigh-up the likely benefits of surgery against the risks of adverse outcomes. Decisions are informed by published outcomes and surgeon and patient preferences. Well-designed studies, such as multi-centre randomised controlled trials (RCTs) provide the optimal evidence, but few RCTs have been undertaken in BR. The aim of this thesis was therefore to explore the need for and the feasibility of RCTs in BR. Three systematic literature reviews (SRs) critically appraised and summarised the quality of outcome reporting in BR and semi-structured qualitative interviews were conducted with women and HCPs to explore decision-making and attitudes to randomisation in BR. The clinical outcomes SR included 123 observational studies and 11 RCTs. The majority were at high-risk of bias and outcome reporting was heterogeneous. The cosmetic outcome SR included 122 studies. Cosmesis was assessed by patients and HCPs, but the methodology was inconsistent. The patient-reported outcome SR included 62 studies, less than 60% of which were considered methodologically robust. Sixty-two interviews with women and HCPs demonstrated decision-making in BR to be complex. A third of women reported decisional regret and insufficient time and information were identified as barriers to decision-making. Inequalities in access to care, however, emerged as the most significant determinant of women's reconstructive experience. Both women and HCPs accepted RCTs in BR in particular circumstances. There is an urgent need for well-designed studies with standardised outcome assessment in BR. Selected randomised trials may be feasible, but they are unlikely to address the key questions in BR. Service re-organisation and interventions to improve decision-making are needed to improve outcome for women considering BR in the UK.

In the present thesis we address the problem of detecting and localizing a small spherical target with characteristic electrical properties inside a volume of cylindrical shape, representing female breast, with MWI. One of the main works of this project is to properly extend the existing linear inversion algorithm from planar slice to volume reconstruction; results obtained, under the same conditions and experimental setup are reported for the two different approaches. Preliminar comparison and performance analysis of the reconstruction algorithms is performed via numerical simulations in a software-created environment: a single dipole antenna is used for illuminating the virtual breast phantom from different positions and, for each position, the corresponding scattered field value is registered. Collected data are then exploited in order to reconstruct the investigation domain, along with the scatterer position, in the form of image called pseudospectrum. During this process the tumor is modeled as a dielectric sphere of small radius and, for electromagnetic scattering purposes, it's treated as a point-like source. To improve the performance of reconstruction technique, we repeat the acquisition for a number of frequencies in a given range: the different pseudospectra, reconstructed from single frequency data, are incoherently combined with MUltiple SIgnal Classification (MUSIC) method which returns an overall enhanced image. We exploit multi-frequency approach to test the performance of 3D linear inversion reconstruction algorithm while varying the source position inside the phantom and the height of antenna plane. Analysis results and reconstructed images are then reported. Finally, we perform 3D reconstruction from experimental data gathered with the acquisition system in the microwave laboratory at DIFA, University of Bologna for a recently developed breast-phantom prototype; obtained pseudospectrum and performance analysis for the real model are reported.

Conventional 2D mammography was the most effective approach to detecting early stage breast cancer in the past decades of years. Tomosynthetic breast imaging is a potentially more valuable 3D technique for breast cancer detection. The limitations of current tomosynthesis systems include a longer scanning time than a conventional digital X-ray modality and a low spatial resolution due to the movement of the single X-ray source. Dr.Otto Zhou's group proposed the concept of stationary digital breast tomosynthesis (s-DBT) using a Carbon Nano-Tube (CNT) based X-ray source array. Instead of mechanically moving a single X-ray tube, s-DBT applies a stationary X-ray source array, which generates X-ray beams from different view angles by electronically activating the individual source prepositioned at the corresponding view angle, therefore eliminating the focal spot motion blurring from sources. The scanning speed is determined only by the detector readout time and the number of sources regardless of the angular coverage spans, such that the blur from patient's motion can be reduced due to the quick scan. S-DBT is potentially a promising modality to improve the early breast cancer detection by providing decent image quality with fast scan and low radiation dose. DBT system acquires a limited number of noisy 2D projections over a limited angular range and then mathematically reconstructs a 3D breast. 3D reconstruction is faced with the challenges of cone-beam and flat-panel geometry, highly incomplete sampling and huge reconstructed volume. In this research, we investigated several representative reconstruction methods such as Filtered backprojection method (FBP), Simultaneous algebraic reconstruction technique (SART) and Maximum likelihood (ML). We also compared our proposed statistical iterative reconstruction (IR) with particular prior and computational technique to these representative methods. Of all available reconstruction methods in this research, our proposed statistical IR appears particularly promising since it provides the flexibility of accurate physical noise modeling and geometric system description. In the following chapters, we present multiple key techniques of statistical IR to tomosynthesis imaging data to demonstrate significant image quality improvement over conventional techniques. These techniques include the physical modeling with a local voxel-pair based prior with the flexibility in its parameters to fine-tune image quality, the pre-computed parameter κ incorporated with the prior to remove the data dependence and to achieve a predictable resolution property, an effective ray-driven technique to compute the forward and backprojection and an over-sampled ray-driven method to perform high resolution reconstruction with a practical region of interest (ROI) technique. In addition, to solve the estimation problem with a fast computation, we also present a semi-quantitative method to optimize the relaxation parameter in a relaxed order-subsets framework and an optimization transfer based algorithm framework which potentially allows less iterations to achieve an acceptable convergence. The phantom data is acquired with the s-DBT prototype system to assess the performance of these particular techniques and compare our proposed method to those representatives. The value of IR is demonstrated in improving the detectability of low contrast and tiny micro-calcification, in reducing cross plane artifacts, in improving resolution and lowering noise in reconstructed images. In particular, noise power spectrum analysis (NPS) indicates a superior noise spectral property of our proposed statistical IR, especially in the high frequency range. With the decent noise property, statistical IR also provides a remarkable reconstruction MTF in general and in different areas within a focus plane. Although computational load remains a significant challenge for practical development, combined with the advancing computational techniques such as graphic computing, the superior image quality provided by statistical IR will be realized to benefit the diagnostics in real clinical applications.

It's universally accepted that early detection, diagnosis, and suitable treatment are best hope to increase the survival chance for breast cancer (BC) patients. To date, the most cost effective method for breast screening and early detection is mammography. The mammography technique uses a low-dose X-ray system to acquire images of the breast. Limitations of mammography exist, including 20% false negative rate, many call backs for screening, low positive predictive value of about 15% to 34% from biopsy. Digital Breast tomosynthesis (DBT) is a new technique that acquires limited angle tomographic projection images to reconstruct three-dimensional information of the breast. The development of tomosynthesis is a substantial improvement over conventional tomography in that it allows retrospective reconstruction of an arbitrary number of planes with a acquisition dataset. In this project, we investigated three different tomosynthesis image reconstruction algorithms including shift-and-add (SAA), back projection (BP), filtered back projection (FBP) with parallel imaging geometry to improve breast cancer detection. In this project we also examined the effect of varying the number of projection images (N) and total view angle (VA) for each reconstruction algorithm characterized by impulse response (IR) analysis. IR data were generated by simulating the projection images of a very thin wire, using various combinations of VA and N. Based on this project, we hope to optimize the image configuration to contribute to the breast tomosynthesis field.

Advancements in medicine have allowed surgeons a menu of options in post-mastectomy breast reconstruction. A conundrum exists, however, in flap selection when faced with varying patient body types. In the case of the athletic patient who does not have the appropriate amount of donor site tissue to warrant a Transverse Rectus Abdominus Musculocutaneuos Flap (TRAM) the Transverse Musculocutaneous Gracilis Flap (TMG) is an appropriate alternative due to its functional and aesthetic benefits. An intricate and timely process, the TMG procedure can be difficult to understand for the layperson. Therefore, a need for a condensed and standardized description exists. By breaking the process down and illustrating the procedure one can effectively deliver the information for use across all realms of publication and education.

Introduction: Free tissue transfer using an abdominal tissue flap is a commonly used method of breast reconstruction. However, there are well recognised complications including venous congestion, fat necrosis and flap loss associated with the perfusion of these flaps. Post-operative aesthetic outcome assessment of such breast reconstructions have also proven to be difficult with current methods displaying poor inter-rater reliability and patient correlation. The aim of this research was to investigate potential improvements to the post-operative outcome of free abdominal tissue transfer breast reconstruction by assessing the effects of vascular augmentation interventions on flap perfusion and to assess the use of real-time digital video as a post-operative assessment tool. Methods: An in-vivo pilot study carried out on 12 patients undergoing DIEP flap breast reconstruction assessed the effect on Zone IV perfusion, using LDI and ICG angiography, of vascular augmentation of the flap using the contralateral SIEA and SIEV. A further animal experimental study was carried out on 12 Sprague Dawley rats to assess the effects on main pedicle arterial blood flow and on Zone I and Zone IV perfusion of vascular augmentation of the abdominal flap using the contralateral vascular system. A separate post-operative assessment study was undertaken on 35 breast reconstruction patients who evaluated their own reconstructions via patient questionnaire and underwent photograph and real-time digital video capture of their reconstructions with subsequent panel assessment. Results: Our results showed that combined vascular augmentation of DIEP flaps, using both the SIEA and SIEV together, led to an increase in Zone IV perfusion. Vascular augmentation of the rat abdominal flaps also led to a significant increase in Zone I/IV perfusion, but the augmentation procedure resulted in a decreased main pedicle arterial blood flow. Our post-operative assessment study revealed that real-time digital video footage led to greater inter-rater agreement with regards to cosmesis and shape than photography and also correlated more with patient self-assessment. Conclusion: Vascular augmentation of abdominal free tissue flaps using the contralateral vascular system results in an increase to Zone IV perfusion, however this may lead to decreased main pedicle arterial blood flow. Real-time digital video is a valid post-operative aesthetic assessment method of breast reconstruction outcome and is superior to static photography when coupled with panel assessment.

Breast cancer is the most common cancer in women in the UK and both diagnosis and treatment can cause significant levels of distress and impaired quality of life. There arc many factors that relate to psychological distress in women coping with breast cancer including changes in body image. Appearance-related side effects, such as hair loss, are often reported as more severe than side-effects such as nausea and fatigue. A review of the literature explores the links between mainstream body image models and breast cancer. The impact of mastectomy on body image and mental health outcomes is discussed as well as the role of breast reconstruction, as this may help to alleviate women's body image difficulties and emotional distress following surgery. The need to understand the role of body image investment within theoretical models as well as for breast cancer patients facing mastectomy and immediate reconstruction is highlighted, especially in light of the inconsistencies found within the literature. The empirical paper investigates the psychosocial and body image outcomes of two groups of women: those undergoing mastectomy alone and those undergoing mastectomy with immediate breast reconstruction. It also examines whether investment in body image acts as a moderating variable between surgery type and subsequent psychological distress. Both groups reported deteriorations in their body image following surgery, though this did not always correspond with increased emotional distress. Women who reported a higher body image investment who underwent mastectomy alone had the poorest outcomes.

Background There is evidence to suggest some degree of shoulder restriction and loss of strength in patients following Latissimus Dorsi (LD) breast reconstruction. However, due to there being no standardised assessment or follow-up period within the literature there are conflicting findings. Therefore, the overall aim of this research was to investigate the functional impact of LD breast reconstruction in women following mastectomy for breast cancer. Methods A focus group study explored the musculoskeletal (MSk) consequences of breast reconstruction using the LD muscle as perceived by the women (n=15) and their healthcare professionals (n=l1). A questionnaire survey was then administered to all women in Northern Ireland who had undergone LD breast reconstruction (n=159). Finally, dyad interviews were conducted in order to determine the impact of surgery on function and activities of daily living (ADL) from the woman's perspective and that of her significant other (n=8). Results Findings from the studies indicated low to moderate dysfunction among the group (n=159), however, node removal significantly impacted certain aspects of quality of life (p