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Effect of Operative Treatment on Psychosocial Problems of Men With Gynaecomastia

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Kasielska A., Antoszewski B.
Polish Journal of Surgery
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2011
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vol. 83
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issue 11
614-621
EN
Gynaecomastia is defined as a hyperplasia of the breast tissue in men, bilateral or unilateral, usually not associated with the presence of malignant lesions.The aim of the study was to explore the psychosocial problems of men with gynecomastia and the effect of operative breast reduction on these problems.Material and methods. The survey was conducted in a group of 47 men who were treated surgically for gynaecomastia in the Department of Plastic, Reconstructive and Aesthetic Surgery. The mean age of the respondents was 25.6±3.5 years. For survey purposes, a questionnaire was developed with questions about the age of onset of gynaecomastia, coexisting disorders and medicines taken and also various aspects of the psychosocial life of the respondents. The questionnaire was completed by patients before surgery and at minimum 6 months after surgery.Results. The findings showed that in almost all patients gynaecomastia had caused emotional discomfort and limitation of everyday activity. In many patients, enlarged breasts caused difficulties in entering into social relationships. More than a half of the surveyed men admitted that their problems were ridiculed by others and they felt isolated. A comparison of the respondents' answers before and after the surgery showed statistically significant differences in all of the analysed questionnaire items.Conclusions. Gynaecomastia causes considerable emotional discomfort and limitation of everyday activity in young men, and that is why it constitutes a psychosocial problem. Surgical treatment of gynaecomastia significantly contributes to an increase in social activity and an improvement of social acceptance and emotional comfort, and thus significantly improves satisfaction from personal life in the men who underwent this intervention.
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Treatment of Patients with Giant Tumors in the Course of Recklinghausen Disease – Own Experience

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Fijałkowska M., Antoszewski B.
Polish Journal of Surgery
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2012
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vol. 84
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issue 12
632-637
EN
Neurofibromatosis type 1 (NF-1, von Recklinghausen disease) is included in the group of diseases known as phacomatosis. Clinical diagnosis of Recklinghausen disease is based on the presence of 2 from 7 criteria developed by a panel of expert. So far effective strategy of treatment of patients with NF-1 is not developed. One method of treatment are surgical excisions. The aim of the study was to present own experience of treatment of patients with giant tumors in the course of Recklinghausen disease. Material and methods. The Department of Plastic, Reconstructive and Aesthetic Surgery of Medical University in Łódź has under care 34 patients with NF-1. Fifteen patients (8 females and 7 males) with giant tumors were included in this analysis. The patients age was from 6 to 57 years. In analyzed group a retrospective review of surgical treatment was carried out on the basis of patients’ medical documentation. Results. Ten from 15 analyzed patients were operated on in our Department and performed surgeries were aimed to partially reduce the tumors mass. Only one patient had his tumor excised in one-stage procedure, in rest of the patients the lesions were too extensive. Most patients in histopathological examinations were diagnosed with neurofibroma (8 patients), 1 - neurofibromaplexiforme and 1 - neurofibrolipoma. Conclusions. Unpredictable course of Recklinghausen disease causes that follow-up examinations are necessary. Treatment of such patients is particularly indicated when the tumor mass causes difficulty in patients daily habits or is life-threatening. Also it is worth to remember that delayed decision of surgical treatment unable excision of the whole tumor in one-stage procedure. This in turn causes the risk of tumor re-growing and/or developing of malignancy
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The Prevalence of Cleft Lip and/or Palate in Children from Łódź in Years 2001-2010

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Antoszewski B., Fijałkowska M.
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vol. 85
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issue 6
329-332
EN
One of the most frequent congenital malformations is cleft lip and/or palate. The above-mentioned defect is a serious medical and social problem, and knowledge concerning its incidence pictures the scale of this phenomenon. The aim of the study was to determine the prevalence of cleft lip and/or palate in children in Łódź during the period between 2001 and 2010. Material and methods. We were able to obtain data from The Polish Registry of Congenital Malformations concerning the number of live born infants, and birth of children with cleft malformations in Łódź during the period between 2001 and 2010. Results. The mean incidence of cleft malformations amounted to 1.16/1000 live born infants in Łódź during the period between 2001 and 2010. Conclusions. During the period between 2001 and 2010, a significant decrease in the prevalence of cleft lip and/or palate was observed in Łódź. The most common type of defect was isolated cleft palate, while the most rare - cleft lip. Considering boys the most frequent defect was cleft lip and palate, while in girls - isolated cleft palate. Attention should be drawn to the fact of the decreased number of deliveries in Łódź, observed in the past decade
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Body Contouring after Massive Weight Loss – Case Report

100%
Zieliński T., Antoszewski B.
Polish Journal of Surgery
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2012
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vol. 84
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issue 11
585-589
EN
The paper presents a 25-year-old woman who is using a strict diet of 1000 kcal lost 83 kg in 18 months. Despite her young age, weight loss caused numerous cutaneous fatty folds, because her skin was not elastic or resilient enough. The patient undergo a multi-stage surgical treatment aiming to rectify the deformations. This example illustrates the problems of patients having undergone intensive slimming procedures and presents surgical treatment methods that rectify typical deformations in these patients.
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Surgical Treatment of Patients with Poland's Syndrome - Own Experience

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Fijałkowska M., Antoszewski B.
Polish Journal of Surgery
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2011
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vol. 83
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issue 12
662-667
EN
Poland's syndrome is characterized by variable clinical picture. Classic deformity consists of unilateral hypoplasia or aplasia of the sternocostal head of the pectoralis major muscle and ipsilateral hand malformations. Additionally on the affected side hypoplasia or aplasia of the breast in women is observed. Variable malformations in Poland's syndrome cause that there is no uniform treatment schedule.The aim of the study was to analyze surgical treatment conducted in patients with Poland's syndrome in Plastic, Reconstructive and Aesthetic Surgery Clinic.Material and methods. A retrospective analysis of surgical treatment was carried out in the group of 66 patients with Poland's syndrome on the basis of their medical documentation.Results. The most common operation performed in women was breast reconstruction with silicone implant. Two men had their chest symmetrized by fat grafting. Syndactyly observed in patients with complete Poland's syndrome was surgically removed in early childhood.Conclusions. Treatment of patients with Poland's syndrome, mainly due to variable clinical picture, is individual and depends on age, sex and degree of deformity. In children with complete Poland's syndrome operations include surgical removing of syndactyly. Breast reconstruction in women with Poland's syndrome with silicone implants is known and safe method. Such procedures are performed after 18 years of age.
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Face Skin Neoplasms - Reasons for Delayed Treatment

81%
Antoszewski B., Kasielska A., Fijałkowska M.
Polish Journal of Surgery
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2011
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vol. 83
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issue 7
361-366
EN
The most common skin neoplasms are carcinoma: basocellulare, spinocellulare, planoepitheliale and melanoma malignum. Early surgical treatment is crucial for recovery as well as for good aesthetic result, especially on exposed body parts. All those lesions are visible for observers and the time from their appearance to surgical treatment seems to be too long.The aim of the study was to answer the following questions: 1. After what time from the skin lesion appearance the patients report to a surgeon? 2. What is the underlying cause of delayed reporting for treatment of patients with skin lesions?Material and methods. Questionnaire studies and analysis of medical histories were performed in the group of patients referred to Plastic Surgery Out-Patient Clinic in Łódź because of facial skin tumor in the last 5 years. Finally we collected data for 123 patients.Results. The analyzed group consisted mostly of men (n=72). The age of respondents ranged from 45 to 92 years, mean 69.9 years ± 10.8 years. Mean time from observing lesion to the first medical consultation was 7.3 months and to visiting our Out-Patient Clinic was 2.7 years (ranged from 3 months to 16 years). All patients were qualified to surgical excision of tumor. Histopathological verification confirmed diagnosis of malignant neoplasms in 116 patients. In question concerning causes of delay in medical consultation or treatment, all respondents answered that fear of surgical procedure was one of the reasons.Conclusions. Fear of surgical treatment is the most common cause of delay in patients' visiting doctor. In our society conviction of neoplasm spreading after surgical excision is common, especially among elderly.
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Prace Oryginalne Original Papers Why Women Who Have Mastectomy Decide Not to Have Breast Reconstruction?

81%
Zieliński T., Lorenc-Podgórska K., Antoszewski B.
Polish Journal of Surgery
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2015
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vol. 86
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issue 10
451-455
EN
Breast cancer is the most common malignancy occurring in women. The treatment of breast cancer is a complex, multistep process involving surgical treatment, chemotherapy, radiotherapy, hormone therapy, targeted therapy, and very often rehabilitation. After the treatment of the underlying disease, or still in its course, there remains a problem of deformation of the chest. Although the number of women opting for breast reconstructive surgery increases every year, the number of such procedures in Poland is low. The aim of the study was to investigate the reasons why women after amputation of the breast due to cancer are not likely to undergo breast reconstructive surgery. Material and methods. The study comprised 73 women, residents of the province of Silesia, aged between 37 and 79 years, who had undergone mastectomy for malignancy in the years 1987-2013. Results. From all of the reasons given by women for refraining from breast reconstruction, the most frequently pointed was the fear of being subjected to further surgery (38.3%). 23 women (31.5%) admitted that they were also afraid of postoperative pain. Similarly, a common response (35.6%) was that it is not essential for their mental state, and 30% of respondents fully accepted their appearance after mastectomy. Concern about the effect of failed reconstruction was reported by 24.6% of the women, and the fear that the surgery could negatively affect the process of cancer treatment by 27.4% of respondents. Lack of information about the capabilities and knowledge of breast reconstruction methods was not an important factor in decision-making. Conclusions. Most of the surveyed women who abandon breast reconstruction surgery, make this decision on the basis of more than one reasons. Fear of undergoing a second surgical procedure and pain related to it were the most important reasons for the refusal of breast reconstruction. An important factor in the decision to desist from breast reconstruction is the age of the patients.
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Surgical Correction of a Webbed-Neck Deformity in Turner’S Syndrome

81%
Zieliński T., Lorenc-Podgórska K., Antoszewski B.
Polish Journal of Surgery
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2015
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vol. 87
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issue 3
134-138
EN
Turner’s syndrome occurs in approximately 1 out of every 2,000 to 2,500 live-born girls. This genetically determined pathology is characterised by multiple congenital anomalies. A typical form of this syndrome is associated with a lack of one of the sex chromosomes (karyotype 45, X). From the point of view of plastic surgery, one of the most important elements of the therapy is correction of the webbed neck deformity. The aim of the study was to present the possibilities of surgical treatment of a webbed neck of patients with Turner’s syndrome and the evaluation of treatment results. In the years 2000-2012, six children with Turner’s syndrome were treated because of the webbed neck deformity. The age of patients ranged from 9 to 17 years. In the case of all patients, the aim was to distribute the neck skin folds by using Z-plasty in conjunction with a shift to the back of glabrous skin flaps mobilised from the anterolateral surface of the neck. In the case of four operated patients, the folds were completely removed and a correct symmetrical outline of the neck was obtained. One patient was found to have unilateral moderate webbed neck recurrence after about 2 years of treatment. In one case, the correction was insufficient. The performed surgical procedures enabled correction of low hairline only in the lateral parts of the neck. The lower line of the scalp in the central part of the neck has remained unchanged. The lateral approach with a shift of glabrous skin flap to the back, which we performed, allows for effective reduction of the webbed neck, excision of bands of the connective tissue and correction of the low hairline on the side of the neck. Z-plasty enables an adequate extension of scars and improves the contour of the neck.
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Giant epidermal cyst of the occipital area

81%
Antoszewski B., Pisera P., Fijałkowska M., Kasielska-Trojan A.
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vol. 85
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issue 11
666-668
EN
Epidermal cyst is the most commonly observed cutaneous tumor. It usually involves the scalp, neck, face, back, and trunk. A commonly seen epidermal cyst is usually a slow-growing tumor of a diameter of 1-2 cm. Cysts with a diameter of more than 5 cm have rarely been reported in the literature. Herein we report a case of a giant epidermal cyst localized in the scalp of the occipital area, diagnostic problems and therapeutic proceedings.
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Dermatoscopy as a Helpful Tool in Plastic Surgeon’s Practice – A Preliminary Study

81%
Antoszewski B., Fijałkowska M., Stabryła P., Kasielska-Trojan A.
Polish Journal of Surgery
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2015
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vol. 87
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issue 12
609-613
EN
The aim of the study was to examine the utility of dermatoscopy in plastic surgeons’ practice in pigmented and non-pigmented skin lesions management. Material and methods. The examined group consisted of 68 patients with 132 lesions (50 women and 18 men) aged from 12 to 75 years (the mean: 47.2 years ± 16.9 years), who underwent dermatoscopy. Dermatoscopic photographs were analysed according to the ABCD and 7-point scales and then, a further treatment (surgical excision, electro resection or regular follow-up and observations) was planned. Results. The mean score of all lesions according to ABCD scale was 2.34 while in 7-point scale it was 0.62. In male and female groups the number of lesions and their ABCD and 7-point scale scores were similar (p>0.05). Histopathological examination revealed that all excised lesions were benign (compound melanocytic nevi) which corresponded with dermatoscopic evaluation. Conclusions. Dermatoscopy seems to be helpful in surgeons’ dealing with skin lesions practise and in many cases it enables to choose less invasive technique of lesions’ removal (electro resection), which gives better aesthetic results.
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Long-Term Results of Partial Nasal Reconstructions with Indian Flap

81%
Iljin A., Lewandowicz E., Starska K., Antoszewski B.
Polish Journal of Surgery
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2015
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vol. 87
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issue 12
626-633
EN
The aim of the study was clinical evaluation of the results following reconstruction with the Indian flap in patients with partial nasal defects, and estimation of their postoperative life quality in functional and aesthetic aspects. Material and methods. We analyzed results in 38 patients who underwent reconstructions with the Indian flap in the Department of Plastic, Reconstructive and Aesthetic Surgery between years 2000‑2013. The patients were followed-up for at least 2 years. We estimated their life quality in aesthetic and functional aspects after surgery. Results. Observed complications of nasal reconstruction were alar asymmetry in 6 patients (15.8%), nasal obstruction in 6 persons (15.8%), wide postoperative scar in 4 (10.5%), and non-aesthetic appearance of the donor site in two cases (5.3%). Estimation of life quality post surgery in the examined group of patients revealed significant postoperative improvement in both functional and aesthetic aspects. Conclusions. 1. Reconstructions of nasal defects with the Indian flap resulted in satisfactory longterm postoperative results, which confirms the efficiency of the applied technique. 2. Reconstructive surgery with Indian flap of individuals with partial nasal defects contributed to significant postoperative improvement in both functional and aesthetic aspects and their life quality.
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Long-term Results of Breast Reduction in Female-to-Male Transsexuals

81%
Antoszewski B., Bratoś R., Sitek A., Fijałkowska M.
Polish Journal of Surgery
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2012
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vol. 84
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issue 3
144-151
EN
Transsexualism is considered to be an extreme end in a large group of gender identity disorders. Two main types of transsexualism are identified: male-to-female (MtF) and female-to-male (FtM). Transsexual persons have a feeling of being incarcerated in a foreign body and therefore they wish to change their sex by hormone therapy and surgical treatment. Breast reduction usually is the first procedure in the process of surgical reassignment in FtM transsexual persons.The aim of this study was to evaluate the long-term results of breast reduction in FtM transsexual persons, taking into account breast size and surgical technique. The doctors' and patients' opinions about the results were also compared.Material and methods. The study was carried out in a group of 98 FtM transsexual persons treated at the Department of Plastic, Reconstructive and Aesthetic Surgery. Evaluation of the long-term results of breast reduction was performed based on clinical examination done by the doctors and a questionnaire filled in by the patients and the surgeons.Results. Good results of breast reduction were achieved in more than 60% of the examined patients operated on mainly by Webster technique.Conclusions. Clinical examination of the long-term results of breast reduction in FtM transsexual persons revealed good aesthetic effects. The doctors' and the patients' opinions were similar.
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Selected Methods of the Chest Wall Reconstruction for Sternal Dehiscence after Median Sternotomy

71%
Lewandowicz E., Iljin A., Kasielska-Trojan A., Fijałkowska M., Antoszewski B.
Polish Journal of Surgery
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2015
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vol. 86
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issue 5
230-234
EN
Dehiscence of a median sternotomy wound is a potentially devastating and life-threatening complication of cardiac procedures.Depending on the localization, extensiveness, and profoundness of the defect a variety of muscle flaps may be used to cover the frontal mediastinum, in particular: pectoralis major, rectus abdominisor latissimus dorsi. In spite of several options for restoration of sternal integrity we cannot avoid following serious local complications increasing patients morbidity. The aim of this paper is to report a method of sternal dehiscence management. Surgical technique and its results are presented on the example of two patients treated in Plastic, Reconstructive and Aesthetic Surgery Clinic, Medical University in Łódź because of sternal dehiscence after cardiovascular procedure with sternotomy. Our experience indicates that modified bilateral pectoralis major flap seems to be effective surgical method of sternal dehiscence treatment. Also it is worth to remember that surgical procedure in this complication should be performed as soon as possible to decrease patient’s disability and to avoid following complications
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Rekonstrukcja przewodu słuchowego zewnętrznego i/lub muszli małżowiny usznej wyspowym płatem zamałżowinowym u chorych z rakiem podstawnokomórkowym lub kolczystokomórkowym

71%
Iljin A., Antoszewski B., Durko M., Zieliński T., Pietruszewska W.
Polish Journal of Otolaryngology
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2018
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vol. 72
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issue 3
4-10
PL
Cel: Przedstawienie klinicznego doświadczenia z zastosowania wyspowego płata zamałżowinowego (Postauricular Island Flap; PIF) oraz ocena wyników rekonstrukcji przewodu słuchowego zewnętrznego (External Auditory Canal; EAC) i/lub muszli małżowiny usznej tą metodą u pacjentów po wycięciu złośliwej zmiany nowotworowej tej okolicy. Materiał i metody: Analizie poddano łącznie 19 chorych po wycięciu raka z zastosowaniem PIF (2000–2015) – 11 pacjentów po rekonstrukcji muszli małżowiny usznej, 8 pacjentów po rekonstrukcji muszli wraz z EAC. Oceniono wczesne i odległe wyniki leczenia operacyjnego. Porównano opinie chirurga i pacjenta. Wyniki: U wszystkich badanych zmiany wycięto w całości, nie stwierdzając wznowy w ciągu min. 2 lat obserwacji. Przekrwienie bierne wystąpiło u 5 chorych (26,3%), nadmierne przyleganie małżowiny usznej u 4 pacjentów (21%), u 3 chorych (15,8 %) zauważono odstawanie płatka, a u 3 osób (15,8%) zwężenie EAC. Wyniki pooperacyjne były bardzo dobre u wszystkich pacjentów (tak w ocenie chirurga, jak i chorych), za wyjątkiem pacjentów z nadmiernym przyleganiem małżowiny usznej i z odstawaniem płatka, u których oceny były satysfakcjonujące. Wnioski: 1) Operacje po wycięciu guza przewodu słuchowego zewnętrznego i/lub muszli małżowiny usznej połączone z rekonstrukcją wyspowym płatem zza małżowiny usznej pozwoliły na doszczętne wycięcie zmian (bez oznak wznów) oraz zachowanie właściwego konturu muszli operowanej małżowiny usznej. 2) Zastosowanie dostępu w okolicy zamałżowinowej u chorych z rakiem umiejscowionym w obrębie przewodu słuchowego zewnętrznego pozwoliło nie tylko na właściwą wizualizację i ocenę rozległości tych zmian, ale także stworzyło dobre dojście do pola operacyjnego.
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External auditory meatus and/or conchal bowl reconstruction with postauricular island flap in patients with Basal Cell Carcinoma or Squamous Cell Carcinoma

71%
Iljin A., Antoszewski B., Durko M., Zieliński T., Pietruszewska W.
Polish Journal of Otolaryngology
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2018
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vol. 72
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issue 3
4-10
EN
Aims. Presenting our clinical experience with the postauricular island flap (pif) and estimation of the results following partial external auditory canal (eac) and/or auricular conchal bowl reconstructions with pif in patients after carcinoma resections. Methods. We have analyzed postoperative results of 19 patients after auricular conchal bowl (11), or auricular conchal bowl and eac (8) reconstructions with pif, following malignant tumor resections, between 2000-2015. The patients were reexamined and evaluated in respect of early and long-term results after surgical treatment considering both the plastic surgeon’s and the patient’s opinion. Results. The cancers were completely excised in all patients, and there were no recurrences within at least 2 years of follow-up. The observed complications after reconstructions comprised venous congestion in five cases (26.3%), pinning of the operated ear in four patients (21%), prominent earlobe in three (15.8%), and eac constriction in three cases (15.8%). The postoperative result was very good in all cases (both in the opinion of the plastic surgeon and the patients), except for patients with pinning of the operated ear, with a prominent earlobe (moderately satisfied). Conclusions. 1. Combined operations involving postauricular island flap reconstructions after partial (external auditory meatus and/or auricular conchal bowl) resections allowed for complete removal of malignant tumors with no evidence of recurrence, and for the preservation of a proper conchal shape in the reconstructed ear. 2. A retroauricular approach in cases with cancer involvement of the external auditory meatus allowed for proper visualization and estimation of lesions extent, as well as adequate surgical access.
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