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Epidemiology of Breast Cancer

Descriptive Epidemiology Breast cancer is the most common cancer in American women other than skin cancers. The average woman in the United States has a lifetime risk of developing breast cancer of about 13%. The American Cancer Society estimates about 281,550 new cases of invasive breast cancer will have been diagnosed in women during 2021, and there will have been approximately 49,290 new cases of ductal…

Discharges and Secretions of the Nipple

Introduction and Definitions Nipple discharge prompts the majority of women to seek immediate attention from their physician. Women view nipple discharge as a potential indicator of breast cancer. Thus it is critical for a physician caring for women with breast disease to have a comprehensive understanding of the physiology of breast secretions and the clinical significance of secretions and discharges. In this chapter, we review the…

Breast Physiology: Normal and Abnormal Development and Function

The mammary gland is composed of an epithelial system of ducts and lobuloalveolar secretory units embedded in a mesenchymally derived fat pad. The growth and morphogenesis of the epithelial structures of the breast occur in various stages and are associated with concurrent hormonal changes and affected by genetic mutations. Each stage reflects the effects of systemic hormones on the glandular epithelium and also the paracrine effects…

Anatomy of the Breast, Axilla, Chest Wall, and Related Metastatic Sites

Paired mammary glands, or breasts, are a distinguishing feature of mammals. These glands evolved as milk-producing organs to provide nourishment to the offspring, in a relatively immature and dependent state, with embryonic development in utero. The organ develops from the primordially derived breast tissue, which anatomically matures as a modified sweat gland. The act of nursing the young provides physiologic benefits to the mother by aiding…

Important Trials of the Last Decade

Breast cancer is the most common cancer in women worldwide, and is the second leading cause of cancer death in US women. Breast cancer mortality has declined by approximately 40% over the past several decades in the United States due to widespread mammographic screening and use of adjuvant systemic therapies for those with localized disease. Several studies performed in the 1980s and 1990s demonstrated that multidrug…

History of Surgical Clinical Trials and Cooperative Group Trials

Introduction Medicine and surgery have undergone drastic changes in the past century. This is due in part to the modernization of technology as well as new approaches and techniques for treatment. An ideal intervention or treatment will effectively treat the underlying condition while minimizing side effects and adverse events. Good clinical research rigorously tests hypotheses to determine if a new treatment method is effective or superior…

The History of the Therapy for Breast Cancer

As the most commonly occurring neoplastic disease of the female gender, breast cancer is recognized internationally as the leading cause of cancer-related mortality for women. Despite centuries of theoretical meanderings and scientific inquiry, breast cancer remains the most dreaded of all cancers for female patients. The historical accounts of efforts to cope with breast cancer are complex; aside from genetics, there is no definitive causation for…

Regenerative Engineering in the Field of Orthopedic Surgery

Disclosure Statement Dr. Laurencin is an owner of hot-bone, healing orthopedic technologies, natural polymer devices, and soft tissue regeneration. He receives royalties from Globus Inc. Dr Badon has no Disclosures. The field of regenerative engineering seeks to address the most complex and relevant questions in the realm of future of regeneration, namely, how to regenerate complex structures comprised of multiple types of tissues to improve the…

Biologics in Musculoskeletal Oncology

Targeted Therapies in Orthopedic Oncology As we continue to learn more about the pathophysiology of bone and soft tissue neoplasms, we are presented with new molecular targets for treatment. No chapter on the use of biologics in musculoskeletal oncology would be complete without a discussion of the use of biologics to treat these tumors. Targeted therapies, which use normal biology to manipulate pathologic genes and proteins,…

Biologics in Fracture Care

Introduction Fractures are a common cause of morbidity, lost productivity in the work force, and a significant driver of costs in the medical economy. Although exact numbers are difficult to identify, one Finnish registry study reported 53.4 fractures per 1000 person-years in women and 24.9 per 1000 person-years in men. Delayed healing and nonunion remain as significant complications in the treatment of fractures. Reported rates of…

Biologics in Foot and Ankle Surgery

Role of Biologics in Achilles Tendinopathy Despite the Achilles tendon being one of the strongest tendons in the human body, it is one of the most frequently ruptured lower limb tendons and comprises roughly 20% of all large tendon injuries. Unfortunately, healing of Achilles tendon has had unpredictable outcomes due to its limited bloody supply that diminishes usually after the third decade. Tendon healing often results…

Biologics in Spinal Fusion

Introduction As the medical community has developed a greater understanding of the critical steps necessary for tissue healing, biologics, both natural and synthesized, have become an important adjunct to many orthopedic procedures. Much research is underway to devise biologic strategies to repair or prevent many pathologies of the vertebral column. However, currently the most widely used application for biologics in spinal surgeries is to improve the…

Biologic Augmentation in Peripheral Nerve Repair

Introduction Peripheral nerve injuries remain a main source of morbidity and disability. Peripheral nerve injuries have life-altering impacts on the patients who suffer years of uncertainty while waiting for some level of recovery. Patients may be left with devastating sensory and motor deficits such as limb numbness, dysethesias, paralysis, and neuropathic pain which renders them disabled. The management of nerve injuries is multifactorial including the location…

Biologics in Hand Surgery

Bone Grafts and Substitutes Complex fractures, nonunions, or tumor resections can leave bone defects. Autologous bone grafts are effective fillers, carrying both osteoinductive and osteoconductive properties. However, autografts require harvesting, which lead to increased operative time as well as donor site morbidities. The amount of autograft available may not be sufficient. Therefore, there is a demand for bone graft substitutes that can be readily applied. Allografts…

Treating the Subchondral Environment and Avascular Necrosis

Introduction Although cartilage research has grown exponentially, basic science and clinical studies focusing on its foundation, namely the subchondral bone, have not received the same attention. The subchondral bone provides mechanical and biological support for the overlying articular cartilage, and it undergoes constant adaptation in response to changes in the biomechanical environment of the joint. It is noticeably involved in several chondral entities such as osteochondritis…

Biologics in Orthopedic Surgery: Ligament Reconstruction in the Knee

Knee Anatomy and Biomechanics The knee joint is the largest and most complex joint in the human body. The ligaments of the knee, which provide structural stability to the joint, are particularly vulnerable to injury. The knee consists of two bony articulations, one between the femur and the tibia creating the tibiofemoral joint, and one between the patella and femur creating the patellofemoral joint. The primary…

Orthobiologics in Osteoarthritis

Introduction The development of osteoarthritis (OA) precipitates an irreversible cascade of degenerative changes affecting the hyaline articular cartilage. It is projected to affect more than 20% of adults in North America and Europe by 2020. The burden of disease of OA on the affected patient population ranges from pain to severe functional limitation. With the increased prevalence of OA in the aging population, more than one-third…

Preserving the Articulating Surface of the Knee

Introduction Hyaline articular cartilage plays an integral role in the function of the knee joint. Isolated chondral lesions are incompletely understood, but once damaged, there is very little capacity for spontaneous healing due to intrinsically poor blood supply ( Fig. 9.1 ). Thus, the risk of patient pain, effusions, mechanical symptoms, decreased activity and quality of life, and the possibility of progression to diffuse osteoarthritis (OA)…

Bone Loss in the Upper Extremity

Introduction Bone loss is a serious problem that can affect any part of the body, both anatomically and functionally, and it must be considered and addressed appropriately. When examining the upper extremity specifically, an area that must be considered extensively is the glenoid and humerus that combine to create the glenohumeral joint. Hantes and Raoulis describe the shoulder as an inherently unstable ball and socket joint…

Rotator Cuff Augmentation

Introduction Massive rotator cuff tears are often chronic in presentation and complicated by poor tendon quality, muscular fatty atrophy, tissue retraction, and scarring. For these reasons, successful footprint repair and tendon healing may be difficult and can result in retear rate of large-to-massive rotator cuff tears as high as 70% in the elderly and an approximate 45% retear in massive rotator cuff repairs in younger cohorts…