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PubMedDate not supplied

Local recurrence of breast cancer after skin-sparing mastectomy following core needle biopsy: case reports and review of the literature.

The latest advances in diagnostic and therapeutic procedures for breast cancer have provided valuable technological breakthroughs. Yet the long-term consequences of these modern methods are still quite unclear. Such is the case for stereotactic or ultrasound-guided histologic needle biopsy and skin-sparing mastectomy. We report on three patients who presented with multicentric breast cancer diagnosed by stereotactic needle biopsy and treated by skin-sparing mastectomy. All three patients developed recurrence at the core needle entry site. Records of 58 patients with breast cancer who were treated by skin-sparing mastectomy followed by immediate reconstruction (with transverse rectus abdominis muscle [TRAM] flap or tissue expander) at the Breast Diseases Division of Buenos Aires British Hospital between December 1999 and December 2003 were reviewed retrospectively. Eleven of these patients were diagnosed by histologic needle biopsy. The mean follow-up was 28 months (range 5-60 months). Three (skin or subcutaneous) local recurrences at the needle entry site, diagnosed in a mean time of 23.6 months (16, 22, and 23 months), were reported. The three patients underwent complete resection with clear margins, radiation therapy to the "neobreast," and tamoxifen. All three patients are disease free with a mean postrecurrence follow-up of 24.3 months (30, 23, and 22 months). Based on the evidence of displacement of tumor cells and the potential nonresection of such tumor seeding at the time of skin-sparing mastectomy, as well as the poor probability of postoperative radiation therapy, we recommend surgical resection of the needle biopsy tract, including the dermal entry site, at the time of mastectomy.

Adult↗
PubMedDate not supplied

Seroma prevention using Mytilus edulis protein in a rat mastectomy model.

Seroma formation is common following mastectomy and autologous breast reconstruction and is a potential cause of significant morbidity in patients. For this reason, many methods have been investigated to prevent this complication. BD Cell-Tak is a tissue adhesive formulated from the proteins excreted by the marine mussel Mytilus edulis. The purpose of this study was to determine if Cell-Tak is able to prevent seroma formation in a rat mastectomy seroma model. Twenty Sprague-Dawley rats underwent unilateral radical mastectomy, partial axillary lymph node dissection, and disruption of the dermal lymphatics. The animals were randomly assigned to either control (n = 10) or experimental groups (n = 10). The experimental animals received 0.3 ml of the topical adhesive in the wound prior to closure, whereas control animals received no treatment. On postoperative day 7, seroma collections were aspirated and quantified and the tissue flaps were sent for histologic analysis. The control rats had a mean seroma volume of 5.3 +/- 2.6 ml, whereas the rats treated with Cell-Tak tissue adhesive had a mean seroma volume of 1.8 +/- 1.5 ml (p < 0.004). Histologic analysis revealed mild inflammation consistent with postoperative changes in both groups and no evidence of foreign body reaction to the adhesive. BD Cell-Tak tissue adhesive significantly reduces seroma formation in the rat mastectomy model. This tissue adhesive may prove beneficial in patients undergoing mastectomy with or without breast reconstruction.

Animals↗
PubMed1996

Influence of ovariectomy at the time of mastectomy on the prognosis for canine malignant mammary tumours.

The two-year prognosis for malignant mammary tumours seen in 175 bitches in the Tokyo metropolitan area was assessed based on the extent of mastectomy and on whether an ovariectomy was carried out at the time of mastectomy. The prognosis for the bitches was not influenced by the excision size of the affected mammary glands. Ovariectomy had no effect on the two-year survival rate of the dogs that underwent the tumour excision. There was no significant difference in the two-year survival rate between the dogs ovariectomised prior to mastectomy and those ovariectomised at the time of mastectomy. These results suggest that ovariectomy at the time of mastectomy has no effect on the prognosis in dogs with established neoplasms of the mammary gland.

Animals↗
PubMed1980

Consent for mastectomy.

The value of a system for reducing the number of women with breast lumps who consent unnecessarily to mastectomy was assessed. Sixty-one patients with breast lumps were divided preoperatively into three groups with benign, doubtful, and malignant lumps according to clinical, mammographic and ultrasound criteria. On the basis of these criteria written consent was requested from 29 patients for mastectomy and from 32 for only excision of the lump. Fourteen of the 29 patients who gave consent for mastectomy had carcinomas, and none of the 32 patients consenting to only lump excision. In an attempt to improve further on these results the same 61 patients were analysed retrospectively. Criteria based on age and the results of clinical examination and mammography were devised. By using these criteria only 19 women would have had to give consent for mastectomy. This new policy, which was devised to spare many women the stress of consenting unnecessarily to mastectomy, requires to be tested further in a much larger series of patients.

Adolescent↗
PubMed1987

Correlation between changes in prolactin and melatonin serum levels after radical mastectomy.

Both prolactin (PRL) and melatonin (MLT) (the most important pineal hormone) have been shown to play a role in regulating breast cancer growth. The present study was carried out to investigate the relationship between PRL and MLT secretions in human breast cancer. Twenty-four women with breast cancer, at clinical stage T1-2 N0-2 M0, were evaluated before and after radical mastectomy. As controls, 14 women who underwent surgery for reasons other than neoplastic disease were included in the study. PRL and MLT serum levels were measured by RIA before and 15 days after surgery. There were no significant differences in mean PRL serum levels between patients and controls; mean MLT serum values were significantly higher in patients than in controls. In no control subject was PRL affected by surgery. In contrast, 13/24 breast cancer women showed high PRL levels after mastectomy; the PRL rise induced by surgery was significantly higher in patients without axillary node involvement. MLT was not affected by mastectomy in 13 patients, whereas it was enhanced in 5 women and decreased in the last 6 cases. No significant correlation was seen between PRL and MLT changes induced by mastectomy. The present study shows that radical mastectomy influences PRL and MLT secretions, however, its clinical significance remains to be established.

Adult↗
PubMed1993

Prognosis following salvage mastectomy for recurrence in the breast after conservative surgery and radiation therapy for early-stage breast cancer.

PURPOSE: The prognosis and factors that influence prognosis following salvage mastectomy in patients with recurrence in the treated breast after conservative surgery (CS) and radiation therapy (RT) were investigated. MATERIALS AND METHODS: A total of 1,593 patients with stage I or II invasive breast cancer were treated following gross total excision of the tumor at the Joint Center for Radiation Therapy (JCRT) between 1968 and 1985. One hundred sixty-six of the 1,593 (10%) had subsequent recurrence in the breast. Of these, 123 had salvage mastectomy and constitute the study population. The recurrent tumor was predominantly invasive in 99 patients, noninvasive in 14, and focally invasive in 10. Following mastectomy, chemotherapy or hormonal therapy was administered to 29 patients. The median follow-up time was 39 months after salvage mastectomy. RESULTS: The 5-year actuarial rate of further local or distant relapse for the entire group was 41%. None of the 24 patients with focally invasive or noninvasive tumors had a subsequent relapse. In comparison, the 5-year actuarial rate of further relapse in the 99 patients with a predominantly invasive recurrence was 52% (P = .001). The method of detection of the recurrence, the age of the patient at initial diagnosis, the disease-free interval, and the location of the recurrence in the breast were not found to have a statistically significant association with the risk of further relapse. CONCLUSION: We conclude that the histology of the recurrent tumor is an important prognostic factor for the risk of further relapse. Patients with purely noninvasive or focally invasive tumors have an excellent prognosis following salvage mastectomy. In contrast, patients with predominantly invasive tumors are at substantial risk for further relapse.

Adult↗
PubMed2004

Determinants of patients' choice of reconstruction with mastectomy for primary breast cancer.

BACKGROUND: The aim of the study was to measure women's decisions about breast reconstruction (BR) after mastectomy and to assess the factors contributing to their decisions, in a context involving shared decision-making and maximum patient autonomy. METHODS: Women who were about to undergo mastectomy for primary breast cancer were systematically offered choices concerning BR and time of reconstruction (intervention always covered by the French National Insurance System). Self-administered questionnaires were used prior to the operation. RESULTS: Among the 181 respondents, 81% opted for BR and 19% for mastectomy alone. In comparison with those who chose mastectomy alone, those opting for BR more frequently recognized the importance of discussing these matters with the surgeon and their partner (adjusted odds ratio [OR(adj)] = 13.45 and 3.59, respectively; P <.05) and realized that their body image was important (OR(adj) = 10.55, P <.01); fears about surgery prevented some of the women from opting for BR (OR(adj) = 0.688, P <.05). Among the women opting for BR, 83% chose immediate breast reconstruction (IBR) and 17% chose delayed breast reconstruction (DBR). The preference for IBR was mainly attributable to the fact that these women had benefited more frequently from doctor-patient discussions (OR(adj) = 3.49, P <.05) but was also attributable to the patients' physical and functional characteristics: they were in a poorer state of health (P <.05). The surgeons predicted their patients' preferences fairly accurately. CONCLUSIONS: In a context of maximum autonomy, the great majority of the women chose IBR. The patients' choices were explained mainly by their psychosocial characteristics. The indication for BR should be properly discussed between patients and surgeons before mastectomy.

Adult↗
PubMed2006

Role of sentinel lymph node biopsy in ductal carcinoma-in-situ treated by mastectomy.

BACKGROUND: Sentinel lymph node biopsy (SLNB) is a widely accepted alternative to axillary lymph node dissection in invasive breast cancer. Its role in ductal carcinoma-in-situ (DCIS) is unclear. The purpose of this study was to determine factors associated with the subsequent diagnosis of invasive disease and to determine the role of SLNB when performing a mastectomy for DCIS. METHODS: A retrospective study was conducted of all mastectomies performed on patients with a preoperative diagnosis of DCIS between 2000 and 2005 at a single tertiary-care institution. RESULTS: Ninety mastectomies for DCIS were included, 54 (60%) of which were performed with concurrent SLNB. Of 44 patients diagnosed preoperatively with DCIS by core biopsy only, 34 patients (63%) had a concurrent SLNB, while 10 patients (28%) were treated with mastectomy alone (P < .01). Overall, 30 patients (33%) had invasive disease, 22 of whom received concurrent SLNB. Seven SLNB patients (13%) had positive SLNs. On univariate analysis, multifocality (P = .03), multicentricity (P = .01), comedonecrosis (P = .01), and diagnosis by core biopsy (P < .001) were associated with invasive disease on pathology. On multivariate analysis, comedonecrosis (P = .04) and diagnosis by core biopsy (P < .01) were independent predictors for invasion. There was no statistically significant predictor for sentinel lymph node metastasis. CONCLUSIONS: Approximately one-third of patients with DCIS treated with mastectomy at our institution later had invasive disease, and factors associated with invasion have been identified. On the basis of our results, routine SLNB is recommended in this patient population.

Breast Neoplasms↗
PubMed2005

Advances in breast reconstruction after mastectomy.

Over the past 40 years, surgical reconstruction of the breast following mastectomy has become an important aspect of the cancer patient's rehabilitation process. While the surgical emphasis remains on a cure for the cancer, experience with breast reconstruction has not demonstrated any increased rate of cancer recurrence, even when reconstruction is performed immediately following tumor resection. Advances in surgical technique and biotechnology have made post-mastectomy reconstruction possible. The development of silicone gel and saline-filled implants as well as tissue expanders has revolutionized breast reconstruction. The elucidation of musculocutaneous flaps now provides the surgeon with the ability to transfer adequate quantities of vascularized tissue to reconstruct the surgical defects. The advent of microsurgical techniques has provided an additional reconstructive option, with free tissue transfer allowing the plastic surgeon to move musculocutaneous flaps from remote or distant sites to reconstruct the defect. The option of having the reconstruction immediately following the mastectomy procedure is now available to the patient. When reviewing the anatomy of the breast region, the surgeon must consider the mammary gland, its vascular supply, and its lymphatic system. The surgical techniques involved in reconstruction after mastectomy include the use of breast implants and tissue expansion, as well as reconstruction with autogenous tissues. Reconstruction with autogenous tissues includes the use of latissimus dorsi musculocutaneous flap, transverse rectus abdominus musculocutaneous flap, free flap transfer, as well as nipple-areola reconstruction. Breast reconstruction after mastectomy should be undertaken by a plastic and reconstructive surgeon with considerable training and experience with these diversified procedures.

Breast↗
PubMed1993

Mammographic surveillance of breast cancer patients: should the mastectomy site be imaged?

OBJECTIVE: This study evaluated the usefulness of routine mammography of the mastectomy site in women who have been treated for breast carcinoma. MATERIALS AND METHODS: From a retrospective review of medical records and mammographic examinations of 827 patients who had mastectomies, the following information was obtained: demographic data, type of breast reconstruction (if any), length of follow-up after mastectomy, evidence of local recurrence, and results of physical examination of the breast and mammography immediately before diagnosis of local recurrence. RESULTS: Local recurrences of breast cancer were seen in 39 (4.5%) of the 859 breasts in the study group. All patients had a physical examination of the breast and mammography within 3 months of the diagnosis of recurrent breast carcinoma. Mammography of the mastectomy site did not show any recurrences that were not suspected on the basis of physical examination. For two of 20 patients, spot-compression views of palpable abnormalities showed thickening of the surgical scar. In four patients with pain in the chest wall, no abnormalities were found on physical examination or mammograms, but bone scintigrams showed metastasis to the ribs. CONCLUSION: Our results indicate that mammographic imaging of the mastectomy site does not increase the detection of locally recurrent breast cancer.

Adult↗
PubMed2002

Reducing dust using the electrocautery pencil with suction combined with the infusion catheter in mastectomy.

The dust from the vaporized tissue released during a mastectomy presents a hazard to the patients and the operating room personnel. More dust has been noted using the conventional electrocautery pencil in dissecting breast tissue than with the metal knife used in the past. It is very important to reduce the hazardous dust released during mastectomy. For this study 80 patients undergoing mastectomy for breast cancer from March to June 2001 were divided into two groups: 1) those whose dissections were performed with a combination of an electrocautery pencil and suction with an intravenous infusion catheter (40 cases) and 2) those whose dissections were performed with the conventional method in which the electrocautery pencil was handled by the surgeon and the metal suction tube was used separately by an assistant (40 cases). During mastectomy the personal air sampler was affixed to the operator's neck to collect the dust from the vaporized tissue. The concentrations of the total dust were significantly lower in the combined electrocautery-suction method (mean 5.56 +/- 3.26 microg/m3) than in the conventional method (mean 34.81 +/- 4.83 microg/m3) during mastectomy (P < 0.05). Although the operating time and blood loss were less in the combined method than in the conventional method this difference was not statistically significant (P > 0.05). The combined method of using the electrocautery pencil for dissecting breast tissue along with the intravenous infusion catheter reduced the concentrations of the total dust from the vaporized tissue plume. Furthermore this method reduces the hazards of dust to the surgeons and operating room personnel. Additionally the cost of this combined method is lower than that of the conventional method.

Adult↗
PubMed1992

[Change in arterial ketone body ratio during gastrectomy and mastectomy].

We evaluated the influence of operative procedure on arterial ketone body ratio (AKBR), which indicates the function of the liver cells, in patients undergoing gastrectomy or mastectomy. AKBR during the stomach resection was significantly lower than that during the breast resection. A significant reduction in AKBR due to induced hypotension was observed in mastectomy group. SGOT and SGPT increased significantly in gastrectomy group, but unchanged in mastectomy group on the first and the seventh postoperative days. On the first post-operative day, SGOT and SGPT in gastrectomy group were significantly higher than those in mastectomy group. These findings suggest that influence of operative procedure on the liver during gastrectomy is more serious than that during mastectomy.

Adult↗
PubMed1992

[Does the surgical technique modify the incidence of local recurrence after mastectomy?].

This article discusses operative technique in relation to the prevention of local recurrence following modified radical mastectomy (MM) for carcinoma of the breast. As with any other surgical procedure, a satisfactory outcome requires both a correct indication and attention to the details of operative technique. The indications for MM may be defined from the currently accepted contraindications to breast preservation, while most of the contraindications to MM relate to the presence of a stage IIIb or IV carcinoma. The ideal treatment needs to be defined for the individual case, avoiding both unnecessary overtreatment with its associated morbidity and dangerous undertreatment with consequent reduction of the chance for cure. In our view, confirmation of the diagnosis by an excisional biopsy with frozen section examination should be obtained irrespective of a positive finding in an aspirated specimen. The incision for biopsy must be chosen in such a way that it will be encompassed by a subsequent mastectomy incision. When mastectomy is performed the cavity of the excisional biopsy must not be entered. This includes preservation of the barrier of the pectoralis fascia. When breast preservation is an option, the excisional biopsy must fulfill the criteria of a lumpectomy or tumorectomy, which include a 0.5 to 1 cm macroscopically tumor-free margin, orientation of the specimen by sutures, and immersion of the specimen in india ink. As the extent of intraductal component cannot be reliably determined by frozen section examination, waiting for the definitive pathology report may be better than an immediate decision to perform a mastectomy or breast preservation. The skin incision for mastectomy is transverse or slightly oblique, ending laterally about five cm below the axillary pit. The skin flaps must not include the full thickness of the subcutaneous fatty tissue. The preserved layer of fatty tissue must not be irregular. Axillary dissection of levels I and II is sufficient for staging. Skip metastases to level III occur in less than five percent of cases. Therefore routine dissection of level III with its associated increased risk of lymphedema is not justified.

Biopsy↗
PubMed2005

Accuracy of intraoperative gross examination of surgical margin status in women undergoing partial mastectomy for breast malignancy.

Margin status is an important prognostic factor for local recurrence after partial mastectomy for breast malignancy. Options for intraoperative evaluation of margin status include gross examination of the specimen, frozen section, and "touch preparation" cytology. This study evaluates the accuracy of gross examination without other intraoperative pathological analysis as a method of determining margin status. Records of 254 consecutive patients undergoing partial mastectomy for 255 breast malignancies (199 invasive, 56 DCIS) over 6 years were analyzed retrospectively. All women underwent en bloc excision of the primary lesion with gross examination of margin status by the surgeon and pathologist. All suspicious areas were reexcised, and the specimen was inked, serially sectioned at 2-3 mm intervals and examined with hematoxylin and eosin (H&E) stains. Specimens with tumor <2 mm from a margin were considered margin-positive and those with all tumor > or =2 mm from the margin were designated margin-negative. One hundred fourteen (45%) of the 255 segmental resections were considered to have grossly tumor-free margins, and intraoperative reexcision was not performed. Ninety-six (84%) of these specimens had histologically negative margins. Gross examination prompted intraoperative reexcision in 141 (55%) cases. Ninety-five (67%) of these 141 resections had tumor-free margins on histopathology. Overall, the final margin was involved in 64 of the 255 partial mastectomies. Seventeen (27%) women with initially margin-positive resections underwent mastectomy, while 46 (72%) underwent reexcision, which was margin-negative in 41 (89%). After a median follow-up of 42 months, there have been eight (3.5%) local recurrences. The initial margin-positive rate was similar in ductal carcinoma in situ (DCIS) (30%) and invasive carcinoma (24%). Margin status was correlated with nodal status; there was no correlation with age, tumor size, grade hormone receptor status, or type of diagnostic biopsy. Gross examination of the resection specimen does not reflect margin status in at least 25 per cent of women undergoing partial mastectomy for breast malignancy. Other techniques for evaluation of margin status should be considered to reduce the need for reexcision of involved margins. We are currently designing a prospective clinical trial to examine the efficacy of new techniques for intraoperative evaluation of margin status.

Adult↗
PubMed1991

[The prognostic relevance of locoregional recurrence following mastectomy in breast carcinoma].

Local-regional recurrence following mastectomy is not always a sign of poor prognosis. In an attempt to determine these subgroups of patients we analysed 149 patients of our radiation oncology clinic treated between 1978 and 1988 with local or regional recurrence (LR) following mastectomy. Average follow up was 66 months, 47% of these patients developed their recurrence in the first two years, 78% in five years, 90% of the local-regional recurrence appeared in the first ten years. Prognostic features which predicted a poor prognosis in combination with locoregional recurrence after mastectomy were identified; early local recurrence (less than two years from mastectomy) (p less than 0.001), large tumor size T3 and T4 primary) (p less than 0.001), less than five involved axillary lymph nodes (p less than 0.001), negative hormone receptor status, histological grading 3 and 4, lymphangiosis carcinomatosa in the tumor site (p less than 0.05), the presence of tumor-necrosis in the primary tumor (p less than 0.001) and appearance despite of postoperative irradiation (p less than 0.05). Prognosis of patients with more than five involved axillary lymph nodes did not change by local-regional recurrence. The local recurrence did not influence survival in: late local recurrence (more than two years from mastectomy), small tumor size (T1 and T2), negative axillary status, positive hormonal status, histologic grading 1 and 2 and absence of tumor-necrosis or lymphangiosis carcinomatosa in the primary tumor. We conclude that local-regional recurrence is in fact under the above defined circumstances not a sign of systemic disease. With insufficient local therapy it can under these conditions be cause of progressive tumor spread. Thus we strongly support intensive local therapy for local-regional recurrence.

Breast Neoplasms↗
PubMedDate not supplied

Chest wall relapse after mastectomy for ductal carcinoma in situ: a report of 10 cases with a review of the literature.

Local chest wall relapse following mastectomy for ductal carcinoma in situ (DCIS) is an unusual event. We report on 10 cases of patients treated with mastectomy for DCIS who subsequently experienced a chest wall relapse as the first site of recurrence. To our knowledge, this is the largest reported collection of postmastectomy chest wall relapses for DCIS. The tumor registry and medical records from Yale-New Haven Hospital of all patients treated for ductal carcinoma in situ were reviewed. Individual records and radiation therapy charts of those patients sustaining a chest wall relapse following mastectomy were reviewed in detail. All pathology from the original mastectomy, as well as from the chest wall relapse, was re-reviewed by the pathologist. All chest wall relapses were treated with radiation therapy, with or without adjuvant systemic therapy. Of the 10 cases, 9 patients remain alive without evidence of disease. Young patient age, multiquadrant disease, and the presence of residual normal breast tissue were common features among these chest wall relapses. Pathological features of the original mastectomies and chest wall relapses are presented and discussed. Postmastectomy chest wall relapses in patients with DCIS are an uncommon event. Patients treated aggressively with resection of the lesion followed by radiation therapy to the chest wall have a favorable prognosis.

Adult↗
PubMed2006

[Chronic post-mastectomy pain].

BACKGROUND: Surgery results in chronic pain in 7-80 percent. One of the most studied is chronic post-mastectomy pain. The prevalence was 40-50 percent in studies performed abroad. As this problem has not yet been studied in the Czech Republic, a retrospective prevalence study was performed to asses the extent of the problem and risk factors for development of chronic post-mastectomy pain. METHODS AND RESULTS: After ethic committee approval an anonymous questionnaire was developed and distributed in various oncology department and patients'organisations. Response rate was 100 percent, 330 questionnaires were processed. Chronic post-mastectomy pain (lasting longer than 3 months after surgery) was described by 69 (20.9 per cent) women. The pain was permanent in 17 and transient in 46 cases, not specified in 6 cases. The pain intensity was predominantly mild or moderate. Risk factors were younger age (below 55-60 years, p=0.0098), less extensive surgery (tumourectomy vs. mastectomy, p=0.0017), intensive post operative pain (p=0.0002) and radiotherapy (p=0.0174). Trend in chemotherapy (p=0.0778) was observed. CONCLUSIONS: The prevalence of chronic post-mastectomy pain was lower in our study comparing to studies in other countries. The reason remains obscure in spite of detailed analysis.

Chronic Disease↗
PubMed1991

[A randomized study of tumor resection versus mastectomy in breast cancer. 2. 6-year results of the DBCG-82TM (Danish Breast Cancer Cooperative Group) protocol].

The Danish Breast Cancer Cooperative Group (DBCG) conducted a randomized trial to compare breast conservation with mastectomy in patients suffering from mammary carcinoma. From January 1983 to March 1989 the trial recruited a total of 1,153 women. Of these 905 patients (79%) were randomly assigned to one of two treatment options, whereas 248 patients (21%) refused randomization. Of the randomized patients, 90% received the surgical option to which they had been originally assigned. As regards breast conservation, the tumour was excised with the object of tumour-free margins on gross examination, and radiotherapy was administered subsequently to residual breast tissue. Mastectomy was performed as a modified radical procedure. The axilla was dissected in all instances. Patient and tumour characteristics were similar in the two random groups. The median follow-up time was 40 months. At 6 years of life table analysis the probability of recurrence free survival was 70% in the breast conservation group compared with 66% in the mastectomy group. Survival figures were 79% compared with 82%, respectively. Short-term follow-up did not disclose any significant difference between results of breast conservation compared with those of mastectomy. On the other hand, in the non-randomized group the patients undergoing breast conservation had a significantly poorer outcome than the patients treated with mastectomy.

Adult↗