A. Chakravorty - Academia.edu (original) (raw)

Papers by A. Chakravorty

Research paper thumbnail of Single-Stage Immediate Breast Reconstruction after Skin-Sparing Mastectomy

Plastic and Reconstructive Surgery, 2008

Background This study revisits the previously described technique of inverted-T skin-reducing mas... more Background This study revisits the previously described technique of inverted-T skin-reducing mastectomy and dermal-muscle pocket as a single-stage breast reconstruction using anatomical implants in large and ptotic breasts. Refinements have been added to enhance the quality of implant coverage, improve aesthetic outcome, and augment the implant volume than previously described in the literature. Subjects and methods The study was performed in three centers in the UK, Egypt, and Libya. It included patients with large ptotic breasts with a breast cup size of D or larger. The areola-to-inframammary fold distance is of 8 cm or more, and a nipple-sternal notch distance is 25 cm or more. Modification of the dermal-muscle flap was made through dividing the medial and lateral ends of the de-epithelialized flap at a distance of one inch to create wings that could be sutured to the free edge of pectoralis major muscle to act as a hammock. Results It included 42 patients, and the mean age of the patients was 44.4 years (range 28-62). The mean body mass index was 34.2 (range 24-42). The reconstruction was unilateral in 32 (76.2%) patients and bilateral in ten (23.8%) patients. The average implant volume was 498.5 CC (range 375-650). Seventeen (40.5%) patients had a symmetrizing breast reduction. The average follow-up time was 52 weeks. Major complications were noticed in four (7.7%) breasts: Three breasts had major skin necrosis and one breast had hematoma that necessitated surgical evacuation. There were no reported cases of implant extrusion. Minor complications were recorded in six (11.5%) breasts; two had wound infection, and three had minor skin necrosis. Conclusion The hammock technique of dermal-muscle flap is safe and versatile in large and ptotic breasts. It also creates a natural-looking breast with bigger implants.

Research paper thumbnail of 5010 ORAL Intraoperative Molecular Detection of Lymph Node Metastases and Micro-metastases – Results of the First UK Centre Using the One Step Nucleic Acid Amplification Assay

European Journal of Cancer, 2011

Research paper thumbnail of Women with breast implants in one stop clinic: our experience

European Journal of Surgical Oncology (EJSO), 2007

Research paper thumbnail of In vivo study of the surgical anatomy of the axilla

British Journal of Surgery, 2012

Classical anatomical descriptions fail to describe variants often observed in the axilla as they ... more Classical anatomical descriptions fail to describe variants often observed in the axilla as they are based on studies that looked at individual structures in isolation or textbooks of cadaveric dissections. The presence of variant anatomy heightens the risk of iatrogenic injury. The aim of this study was to document the nature and frequency of these anatomical variations based on in vivo peroperative surgical observations. Detailed anatomical relationships were documented prospectively during consecutive axillary dissections. Relationships between the thoracodorsal pedicle, course of the lateral thoracic vein, presence of latissimus dorsi muscle slips, variations in axillary and angular vein anatomy, and origins and branching of the intercostobrachial nerve were recorded. Among a total of 73 axillary dissections, 43 (59 per cent) revealed at least one anatomical variant. Most notable variants included aberrant courses of the thoracodorsal nerve in ten patients (14 per cent)--three variants; lateral thoracic vein in 12 patients (16 per cent)--four variants; bifid axillary veins in ten patients (14 per cent); latissimus dorsi muscle slips in four patients (5 per cent); and variants in intercostobrachial nerve origins and branching in 26 patients (36 per cent). The angular vein, a subscapular vein tributary, was found to be a constant axillary structure. Variations in axillary anatomical structures are common. Poor understanding of these variants can affect the adequacy of oncological clearance, lead to vascular injury, compromise planned microvascular procedures and result in chronic pain or numbness from nerve injury. Surgeons should be aware of the common anatomical variants to facilitate efficient and safe axillary surgery.

Research paper thumbnail of Axillary nodal yields: A comparison between primary clearance and completion clearance after sentinel lymph node biopsy in the management of breast cancer

Ejso, 2011

Aims : Axillary nodal status is the most important prognostic indicator which in turn influences ... more Aims : Axillary nodal status is the most important prognostic indicator which in turn influences adjuvant therapy and long term outcomes. The aim of this study was to compare total nodal yields from primary axillary lymph node dissection (pALND) with completion ALND after a cancer positive SLNB: either concurrently (cALND) following intra-operative assessment (IOA) of the SLN's or as a delayed procedure (dALND) when the SLN was found to be cancer positive on post operative histological examination. Methods: All axillary procedures performed between May 2006 and September 2009 were identified from a prospective database and categorised into four groups : SLNB with no further axillary surgery, pALND, cALND and dALND. Total nodal yield was the sum of SLN/s and ALND yields. Results: Of 1025 axillary procedures, ALND accounted for 332 (32.4%) of which 207 (62.3%) underwent pALND, 43 (12.9%) cALND , and 82 (24.6%) dALND. Median nodal yields were 15.0, 16.0 and 14.5 respectively (p = 0.3). Conclusion: Total nodal yields for primary, concurrent and delayed ALND were comparable suggesting completion dALND performed as a second operation does not compromise axillary staging.

Research paper thumbnail of A differential intra-operative molecular biological test for the detection of sentinel lymph node metastases in breast carcinoma. An extended experience from the first UK centre routinely offering the service in clinical practice

European Journal of Surgical Oncology (EJSO), 2014

Research paper thumbnail of 5010 ORAL Intraoperative Molecular Detection of Lymph Node Metastases and Micro-metastases – Results of the First UK Centre Using the One Step Nucleic Acid Amplification Assay

European Journal of Cancer, 2011

Aim: To investigate the efficacy of in-patient ERCP service for patients with CBD obstruction. Me... more Aim: To investigate the efficacy of in-patient ERCP service for patients with CBD obstruction. Methods: Retrospective study of patients admitted with CBD obstruction and had ERCP during January'2009 to June'2010. The time from admission to confirmation of diagnosis, to interventional ERCP, and the length of hospital admission were investigated. ERCP should be available within 5 days from admission in our institute. Results: 107 patients (45 male, 63 female), with mean age of 68 years (24-95) were included. 46 patients had ERCP within 5 days (<5days) of admission, 54 patients waited more than 5 days (>5days). 7 patients were discharged for outpatient ERCP. There was significant delay (p¼0.006) in >5days group (median: 4 days) to achieve correct diagnosis by MRCP, than <5days group (median: 2 days). The total length of admission for >5days group (median 11 days) was significantly longer (p<0.0001) than <5days group (median 6 days). However, there was no significant difference (p¼0.5865) in length of hospital stay post ERCP between >5days group (median 1 day) and <5days group (median: 2 days). Conclusion: Early diagnosis of CBD obstruction can avoid delay in treatment and unnecessary prolonged hospital admission. When appropriate, MRCP should be considered as the first line of investigation.

Research paper thumbnail of Single-Stage Immediate Breast Reconstruction after Skin-Sparing Mastectomy

Plastic and Reconstructive Surgery, 2008

Background This study revisits the previously described technique of inverted-T skin-reducing mas... more Background This study revisits the previously described technique of inverted-T skin-reducing mastectomy and dermal-muscle pocket as a single-stage breast reconstruction using anatomical implants in large and ptotic breasts. Refinements have been added to enhance the quality of implant coverage, improve aesthetic outcome, and augment the implant volume than previously described in the literature. Subjects and methods The study was performed in three centers in the UK, Egypt, and Libya. It included patients with large ptotic breasts with a breast cup size of D or larger. The areola-to-inframammary fold distance is of 8 cm or more, and a nipple-sternal notch distance is 25 cm or more. Modification of the dermal-muscle flap was made through dividing the medial and lateral ends of the de-epithelialized flap at a distance of one inch to create wings that could be sutured to the free edge of pectoralis major muscle to act as a hammock. Results It included 42 patients, and the mean age of the patients was 44.4 years (range 28-62). The mean body mass index was 34.2 (range 24-42). The reconstruction was unilateral in 32 (76.2%) patients and bilateral in ten (23.8%) patients. The average implant volume was 498.5 CC (range 375-650). Seventeen (40.5%) patients had a symmetrizing breast reduction. The average follow-up time was 52 weeks. Major complications were noticed in four (7.7%) breasts: Three breasts had major skin necrosis and one breast had hematoma that necessitated surgical evacuation. There were no reported cases of implant extrusion. Minor complications were recorded in six (11.5%) breasts; two had wound infection, and three had minor skin necrosis. Conclusion The hammock technique of dermal-muscle flap is safe and versatile in large and ptotic breasts. It also creates a natural-looking breast with bigger implants.

Research paper thumbnail of 5010 ORAL Intraoperative Molecular Detection of Lymph Node Metastases and Micro-metastases – Results of the First UK Centre Using the One Step Nucleic Acid Amplification Assay

European Journal of Cancer, 2011

Research paper thumbnail of Women with breast implants in one stop clinic: our experience

European Journal of Surgical Oncology (EJSO), 2007

Research paper thumbnail of In vivo study of the surgical anatomy of the axilla

British Journal of Surgery, 2012

Classical anatomical descriptions fail to describe variants often observed in the axilla as they ... more Classical anatomical descriptions fail to describe variants often observed in the axilla as they are based on studies that looked at individual structures in isolation or textbooks of cadaveric dissections. The presence of variant anatomy heightens the risk of iatrogenic injury. The aim of this study was to document the nature and frequency of these anatomical variations based on in vivo peroperative surgical observations. Detailed anatomical relationships were documented prospectively during consecutive axillary dissections. Relationships between the thoracodorsal pedicle, course of the lateral thoracic vein, presence of latissimus dorsi muscle slips, variations in axillary and angular vein anatomy, and origins and branching of the intercostobrachial nerve were recorded. Among a total of 73 axillary dissections, 43 (59 per cent) revealed at least one anatomical variant. Most notable variants included aberrant courses of the thoracodorsal nerve in ten patients (14 per cent)--three variants; lateral thoracic vein in 12 patients (16 per cent)--four variants; bifid axillary veins in ten patients (14 per cent); latissimus dorsi muscle slips in four patients (5 per cent); and variants in intercostobrachial nerve origins and branching in 26 patients (36 per cent). The angular vein, a subscapular vein tributary, was found to be a constant axillary structure. Variations in axillary anatomical structures are common. Poor understanding of these variants can affect the adequacy of oncological clearance, lead to vascular injury, compromise planned microvascular procedures and result in chronic pain or numbness from nerve injury. Surgeons should be aware of the common anatomical variants to facilitate efficient and safe axillary surgery.

Research paper thumbnail of Axillary nodal yields: A comparison between primary clearance and completion clearance after sentinel lymph node biopsy in the management of breast cancer

Ejso, 2011

Aims : Axillary nodal status is the most important prognostic indicator which in turn influences ... more Aims : Axillary nodal status is the most important prognostic indicator which in turn influences adjuvant therapy and long term outcomes. The aim of this study was to compare total nodal yields from primary axillary lymph node dissection (pALND) with completion ALND after a cancer positive SLNB: either concurrently (cALND) following intra-operative assessment (IOA) of the SLN's or as a delayed procedure (dALND) when the SLN was found to be cancer positive on post operative histological examination. Methods: All axillary procedures performed between May 2006 and September 2009 were identified from a prospective database and categorised into four groups : SLNB with no further axillary surgery, pALND, cALND and dALND. Total nodal yield was the sum of SLN/s and ALND yields. Results: Of 1025 axillary procedures, ALND accounted for 332 (32.4%) of which 207 (62.3%) underwent pALND, 43 (12.9%) cALND , and 82 (24.6%) dALND. Median nodal yields were 15.0, 16.0 and 14.5 respectively (p = 0.3). Conclusion: Total nodal yields for primary, concurrent and delayed ALND were comparable suggesting completion dALND performed as a second operation does not compromise axillary staging.

Research paper thumbnail of A differential intra-operative molecular biological test for the detection of sentinel lymph node metastases in breast carcinoma. An extended experience from the first UK centre routinely offering the service in clinical practice

European Journal of Surgical Oncology (EJSO), 2014

Research paper thumbnail of 5010 ORAL Intraoperative Molecular Detection of Lymph Node Metastases and Micro-metastases – Results of the First UK Centre Using the One Step Nucleic Acid Amplification Assay

European Journal of Cancer, 2011

Aim: To investigate the efficacy of in-patient ERCP service for patients with CBD obstruction. Me... more Aim: To investigate the efficacy of in-patient ERCP service for patients with CBD obstruction. Methods: Retrospective study of patients admitted with CBD obstruction and had ERCP during January'2009 to June'2010. The time from admission to confirmation of diagnosis, to interventional ERCP, and the length of hospital admission were investigated. ERCP should be available within 5 days from admission in our institute. Results: 107 patients (45 male, 63 female), with mean age of 68 years (24-95) were included. 46 patients had ERCP within 5 days (<5days) of admission, 54 patients waited more than 5 days (>5days). 7 patients were discharged for outpatient ERCP. There was significant delay (p¼0.006) in >5days group (median: 4 days) to achieve correct diagnosis by MRCP, than <5days group (median: 2 days). The total length of admission for >5days group (median 11 days) was significantly longer (p<0.0001) than <5days group (median 6 days). However, there was no significant difference (p¼0.5865) in length of hospital stay post ERCP between >5days group (median 1 day) and <5days group (median: 2 days). Conclusion: Early diagnosis of CBD obstruction can avoid delay in treatment and unnecessary prolonged hospital admission. When appropriate, MRCP should be considered as the first line of investigation.