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PubMed1991

Identification of stressors, level of stress, coping strategies, and coping effectiveness among Egyptian mastectomy patients.

The purpose of this study was to identify stressors, level of stress, coping strategies, and coping effectiveness in Egyptian female mastectomy patients. A total of 64 women who had had mastectomies participated in the study. Coping effectiveness was measured by McNett's Coping Effectiveness Questionnaire (MCEQ). Factor analysis and reliability measures were established on MCEQ using the study sample. Data were collected using a structured interview method. Participants were also asked about age, education, and time since mastectomy. These data were examined in an effort to predict coping effectiveness. The participants reported five stressors: hope for cure, treatment effectiveness, fear of the unknown, progression of the disease, and pain. The treatment effectiveness stressor had the highest mean level of stress. There was a significant difference in the level of stress among the five stressors. Coping strategies reported were categorized into four groups: faith, compliance with the medical regimen, seeking information and social support, and self-distraction. Coping effectiveness was significantly and positively correlated with age and time since mastectomy, which accounted for 35% of the variance in coping effectiveness. Findings suggest that continuing assessments of Egyptian mastectomy patients' needs, further research studies, and an intervention program to ameliorate cancer-related anxiety and to help cancer patients cope effectively may be helpful.

Adaptation, Psychological↗
PubMed1991

Effect of closing dead space on incidence of seroma after mastectomy.

Seromas are a significant cause of morbidity after modified radical mastectomy. The effect of closing dead space by suturing skin flaps to underlying muscle combined with early removal (48 hours postoperatively) of closed suction drains on formation of the seroma was evaluated prospectively in 37 patients. Thirty-three underwent modified radical mastectomy for invasive carcinoma while four underwent total mastectomy with a level 1 axillary dissection for multifocal intraductal carcinoma. Seromas occurred in three, all were minor, two required one aspiration only and one required two aspirations. Two were seromas of the lower flap while one was an axillary seroma. Except for one patient who had a wound hematoma develop, no other instances of morbidity were noted. Closing dead space by suturing skin flaps to underlying muscle combined with early removal of closed suction drains is associated with a low incidence of seroma formation after mastectomy. Use of this technique has important economic and clinical implications for patients who had mastectomy.

Body Fluids↗
PubMed1990

A reappraisal of prophylactic mastectomy.

The concept of prophylactic mastectomy was nurtured in the shadow of the radical mastectomy. It evolved as preferable to the mutilation caused by the procedure. It developed during a time when the difference between benignancy and malignancy was not as clear and when patients with benign disease were thought to be at significant risk. The idea of surgical prophylaxis accompanied by a superior cosmetic result, in comparison to the radical mastectomy is a noble one. In retrospect, however, it is clear that the indications were ill defined, based often on unfounded risk and predicated on patient and physician anxiety. The scope of risk in carcinoma of the breast has been narrowed, with new information identifying only specific subsets of women with proliferative types of benign disease as more susceptible to the subsequent development of carcinoma. Extensive reviews of material taken at biopsy that had been validated longitudinally have provided data to substantiate this contention. The concept of familial high risk must take into account the number of affected family members, at age diagnosis, menopausal status and bilaterality. The majority of indicants that motivated and propitiated the performance of the bulk of prophylactic mastectomies have lost their relevance. Prophylactic mastectomy for carcinoma, therefore, can perhaps be reserved for women with biopsy-proved, high-risk lesions or an exceptional familial risk, or both, or hereditary risk. Such women must choose for themselves and accept the uncertainty of hypothetic risk reduction, life-long continued surveillance and an altered body image. Guiding patients in the decision should involve a multidisciplinary team composed of a surgical oncologist, geneticist, pathologist, psychotherapist and plastic surgeon. As a concept, the reduction of risk is appealing, but remains yet to prove itself superior to rigorous clinical surveillance with high-quality mammography. The experience reflected in the literature of a seemingly low rate of subsequent carcinoma cannot be judged, because it seems that operations were applied indiscriminantly to patients selected by unknown means and from an unknown population pool. Success based on protecting those not at increased risk only invalidates the operation further. Most surgical and medical oncologists recognize that carcinoma of the breast is either localized or disseminated at the time of the initial diagnosis.(ABSTRACT TRUNCATED AT 400 WORDS)

Breast Neoplasms↗
PubMed1977

Recurrent operable breast cancer following incomplete mastectomy.

Forty patients have been treated with recurrent operable breast cancer after having undergone procedures less extensive than modified radical mastectomy as a treatment of the primary, with or without radiation therapy. Initial pathology was invasive cancer in 21 patients, and treatment (excision or simple mastectomy, with or without radiation therapy) has been offered as the treatment of choice. Completion of radical mastectomy was done here in 30 patients, extended radical mastectomy in 3, and local excision in 7. Eleven received postoperative radiation therapy. The overall 5-year survival rate from the time of treatment, free of disease, was 40 per cent, and the 10-year survival rate was 20 per cent. If initial treatment included radiation therapy, survival was improved (12/25 vs 4/15 having no radiation therapy). Axillary nodal involvement was extensive, with 13 patients having positive level III nodes. Such patients should be followed closely in order to detect recurrence earlier. Adjuvant radiation therapy and chemotherapy trials post mastectomy should be evaluated in the hope of improving survival.

Adult↗
PubMedDate not supplied

Nonobesity at the time of mastectomy is highly predictive of 10-year disease-free survival in women with breast cancer.

25 unselected women with operable breast cancer were followed after radical mastectomy until they died of recurrent cancer (non-survivors), or for 10 years if there was no recurrence (survivors): all the women still alive at 10 years were clinically and radiographically disease-free. Survivors and non-survivors were compared with respect to premastectomy height, and deviation from ideal weight. There were 16 women in the survivor group; at the time of mastectomy, they averaged 11% above ideal weight and only 4 of them (25%) were obese (20% or more above ideal weight). There were 9 women in the non-survival group; they averaged 51% above ideal weight at the time of mastectomy and all of them were obese, as defined. The intergroup difference in mean deviation from ideal weight was very highly significant (P less than 0.0001). Of the 13 women who were obese at mastectomy, only 4 (31%) became survivors, while 100% of the 12 women who were non-obese at mastectomy became survivors; the difference in percent survival was very highly significant (P less than 0.005). Separate evaluation of the roles of height and weight showed that height was not a factor and weight accounted entirely for the observed differences. It appears that maintenance of nonobesity may be a more effective way of decreasing mortality from breast cancer than any other measure proposed to date.

Adult↗
PubMed1993

Influence of mastectomy techniques on estrogen and progesterone receptor analysis in carcinoma of the breast.

Gradual tumor tissue devascularization during mastectomy is thought to decrease estrogen (ER) and progesterone (PgR) receptor activity. To determine whether or not hormone receptor values could be influenced by different mastectomy techniques, 62 patients with carcinoma of the breast had a Tru-cut needle (Baxter Healthcare Corporation) biopsy (premastectomy sample) and underwent modified radical mastectomy (postmastectomy sample) either before (group 1, 40 patients) or after (group 2, 22 patients) axillary lymph node dissection. When the two surgical procedures were compared in 33 patients in whom it could be assessed, no significant tendency (p = 0.51 for ER and p = 0.36 for PgR) for the postmastectomy sample to have hormone receptors levels less than samples taken at biopsy was detected. Overall, in the two groups (44 assessable patients), comparison with respect of each patient, between premastectomy and postmastectomy samples showed that the variations in either ER or PgR receptor values, determined by immunoenzymatic assays, were not statistically significant (p = 0.32 for ER and p = 0.21 for PgR). The current results indicated the relative stability of steroid receptors during the two modified radical mastectomy procedures and suggested that a systematic reference determination of hormone receptors on biopsy before modified radical mastectomy is unnecessary.

Aged↗
PubMed1993

Immediate, bilateral transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction after mastectomy.

Although breast reconstruction has been shown to provide psychological benefits in mastectomy patients, there is reluctance to perform immediate, bilateral TRAM flap reconstruction because of concerns regarding magnitude of the procedure, length of hospitalization, potential complications, and long-term recovery. Between June, 1990 and March 1992, 15 patients underwent immediate, bilateral TRAM flap reconstruction following bilateral mastectomy at the University of Michigan Hospitals. Diagnoses included lobular carcinoma in situ (nine patients), strong family history of breast cancer (five), or bilateral breast cancer (one). Invasive breast cancer was present in three patients. Three modified radical mastectomies and 27 simple mastectomies were performed. Bilateral pedicle TRAM flap reconstruction was carried out at the same time in all patients (30 flaps total). Marginal loss occurred in one flap (3%). Additional complications included marginal necrosis of the abdominal donor site wound (one), wound infection (two), and abdominal donor site hernia (one). Median hospital stay was 7 days. Median follow-up was 13 months (range 4-25 months). All patients have resumed their accustomed pre-operative activity patterns. These findings demonstrate that immediate, bilateral TRAM flap reconstruction is a safe and effective option for breast reconstruction after mastectomy.

Abdominal Muscles↗
PubMedDate not supplied

Subcutaneous mastectomy with axillary dissection for early breast cancer.

From 1983 to 1990, subcutaneous mastectomy with axillary dissection was carried out for 46 patients with early breast cancer including three bilateral breast cancer patients (four breasts). Cancer cells were recognized histopathologically in the resection margins of small mammary gland resting under the nipple in four cases, and the remaining 42 cases underwent a curative resection. Multicentric lesions were found out histopathologically by continuous sections in five cases (six breasts). There was no difference in the prognosis using the case-control comparison method between 34 patients with ipsilateral invasive carcinoma who underwent a subcutaneous mastectomy in this study group and 34 patients who underwent a radical or modified radical mastectomy in the control group. Cosmetic results of the subcutaneous mastectomy were evaluated in 37 patients, and 9 were excellent, 17 were good, 9 were not so good and 2 were poor. Subcutaneous mastectomy with axillary dissection was an effective operation for early breast cancer including multicentric lesions and some non-invasive ductal carcinomas from the prognostic and cosmetic standpoints.

Adult↗
PubMed1976

Evaluation of dissection of the axilla in modified radical mastectomy.

Fifty consecutive unselected patients with infiltrating carcinoma of the breast underwent radical mastectomy in two consecutive stages. The initial operation was a modified radical mastectomy, with preservation of the pectoral muscles, and the second stage, a procedure to transform the initial operation into a standard radical mastectomy. An analysis of the location and the number of the lymph nodes recovered in the two stage operation shows that a so-called modified radical mastectomy is inadequate to ensure the clearing of the axilla. Lymph nodes were recovered at the second stage of the operation in 36 patients, and seven of these patients had metastasis. Modified radical mastectomy was effective in erradicating the lymph nodes of the lower part of the axilla but inadequate for lymph nodes at levels II and III and, especially, the interpectoral lymph nodes.

Adult↗
PubMed1998

[Do indications remain for total mastectomy for cancer?].

Does radical mastectomy for cancer remain needed? Breast conserving treatment may be achieved by surgery, primary chemotherapy followed by radiotherapy and surgery. This article attempts at defining (according to clinical and pathological parameters of the tumor and patient's characteristics), when conservative treatment is not allowed and radical mastectomy must be performed. Mastectomy must be performed first when there are multiple tumors or a tumor too large with respect to the breast volume or diffuse microcalcifications on mammograms. Sometimes the stage of pregnancy, a personal history of collagen vascular disease or prior radiotherapy or the willing of the patient lead to perform radical mastectomy. Secondary mastectomy is necessary in case of failure of conservative treatment or recurrence after breast conserving treatment.

Breast Neoplasms↗
PubMed1998

[The immediate reconstruction of the breast after a mastectomy for carcinoma. Our experience].

The authors surgically treated 281 consecutive women with breast cancer by breast conservation techniques (45.2%) or by mastectomy (38.8%), during a four-year period. Forty-five of these 281 patients (16%) were treated in the same period of time by mastectomy and immediate reconstruction (IR) of the breast. IR of the breast was performed by inserting a submuscular tissue expander at the same time of mastectomy (first stage of reconstruction). A second operation allowed the replacement of the expander with a prosthesis (second stage of reconstruction) and the simultaneous symmetrization of the contralateral breast (not always performed, however). In some cases nipple-areola complex was eventually reconstructed with a delayed surgical procedure (third stage of reconstruction). In the present paper the authors analyze the results and outline the advantages of IR. This easy and safe technique slightly increased the average operative time of a mastectomy, did not interfere with routine oncological follow-up, did definitely reduce patient's psychological trauma following mastectomy. The authors conclude that IR of the breast undoubtedly plays a major role in the so called "onco-plastic"" surgical management of breast cancer.

Adult↗
PubMed1989

Psychological distress after initial treatment for breast cancer: a comparison of partial and total mastectomy.

This study of the relation between type of mastectomy and psychological distress was based on all newly diagnosed breast cancer patients with localized or regional disease who were surgically treated in seven Quebec City hospitals in 1984. Among 235 eligible patients, 227 (96%) participated in a home interview 3 months after diagnosis and 205 of these women gave a second interview approximately 15 months later. The Psychiatric Symptom Index (PSI) was used to measure the severity of symptoms of psychological distress. At 3 months, 38.8% of partial mastectomy patients had high PSI scores compared to 25.8% of women treated by total mastectomy (OR = 1.8, p = 0.044). Fifteen months later, percentages with high scores were identical, 35.1%, in the two treatment groups. Age appeared to modify the surgery-distress relation. These results suggest that partial mastectomy does not protect against psychological distress after breast cancer. Moreover, they highlight the importance of adequate preparation and support for all breast cancer patients, regardless of type of initial surgery.

Adult↗
PubMed2001

Outpatient mastectomy: clinical, payer, and geographic influences.

OBJECTIVE: To determine (1) the use of outpatient services for all surgical breast procedures for breast cancer and (2) the influence of payer and state on the use of outpatient services for complete mastectomy in light of state and federal length-of-stay managed care legislation. DATA SOURCES: Healthcare Cost and Utilization Project representing all discharges from hospitals and ambulatory surgery centers for five states (Colorado, Connecticut, Maryland, New Jersey, and New York) and seven years (1990-96). STUDY DESIGN: Longitudinal, cross-sectional analyses of all women undergoing inpatient and outpatient complete mastectomy (CMAS), subtotal mastectomy (STMAS), and lumpectomy (LUMP) for cancer were employed. Total age-adjusted rates and percentage of outpatient CMAS, STMAS, and LUMP were compared. Independent influence of state and HMO payer on likelihood of receiving an outpatient CMAS was determined from multivariate models, adjusting for clinical characteristics (age < 50 years, comorbidity, metastases, simple mastectomy, breast reconstruction) and hospital characteristics (teaching, ownership, urban). PRINCIPAL FINDINGS: In 1993, 1 to 2 percent of CMASs were outpatient in all states. By 1996, 8 percent of CMASs were outpatient in Connecticut, 13 percent were outpatient in Maryland, and 22 percent were outpatient in Colorado. In comparison, LUMPs were 78 to 88 percent outpatient, and by 1996, 43 to 72 percent of STMASs were outpatient. In 1996, women were 30 percent more likely to receive an outpatient CMAS in New York, 2.5 times more likely in Connecticut, 4.7 times more likely in Maryland, and 8.6 times more likely in Colorado compared to New Jersey. In addition, women with Medicare, Medicaid, or private commercial insurance were less likely to receive an outpatient CMAS compared to women with an HMO payer. CONCLUSIONS: LUMP is an outpatient procedure, and STMAS is becoming primarily outpatient. CMAS, while still primarily inpatient, is increasingly outpatient in some states. Although clinical characteristics remain important, the state in which a woman receives care and whether she has an HMO payer are strong determinants of whether she receives an outpatient CMAS.

Adult↗
PubMed2001

Factors influencing choice between mastectomy and lumpectomy for women in the Carolinas.

BACKGROUND AND OBJECTIVES: The Carolinas have been documented to have a low rate of breast-conserving surgery. The purpose of this study was to determine factors that influence women's choice between mastectomy and lumpectomy. METHODS: An anonymous questionnaire was designed for the study and was mailed to women on the mailing lists of cancer organizations in North and South Carolina. Women who had initially been treated in 1995-1998 were included. RESULTS: The rate of breast-conserving surgery (BCS) was 18% and actually declined from a high of 23% in 1995. The highest rate of BCS was in private hospitals rather than academic health science centers. Fifty-four of the 212 respondents believed they were given a choice between mastectomy and BSC and, of these, only 15% (n = 80) chose BSC. Women in the two treatment groups differed in education and income. Sources of treatment-related information included cancer organizations, popular media, friends, family, and the Internet. The most important factor to both groups was perceived probability of cure. Avoidance of radiation treatments was a factor among the mastectomy group. CONCLUSIONS: The low rate of BCS for the region was confirmed. Many women are still unconvinced that BSC offers as great a likelihood of cure as mastectomy.

Adult↗
PubMed1995

Mastectomy as the preferred treatment for breast cancer among new immigrants from the former USSR.

Sixty-four new immigrant patients with primary breast cancer who arrived in Israel since 1990 were compared to 322 Israeli women with primary breast cancer. New immigrant patients had a more advanced stage at diagnosis (stage III+IV 28% vs. 13% respectively, P = 0.00005); larger mean tumor size (3.08 +/- 1.7 cm vs. 2.25 +/- 1.4 cm respectively, P = 0.00002); and more involved lymph nodes (3.8 +/- 5.3 vs. 1.8 +/- 3.3 P = 0.0002). Forty-seven percent of new immigrants had breast-conserving surgery compared to 69% of the Israelis (P = 0.0004). In stage II 51% of the new immigrants had conservative surgery compared to 74% in the Israeli group (P = 0.03). Mastectomy was recommended to 39 Israeli patients and to six immigrants. Only 19% of the Israeli group requested mastectomy compared to 44% in the new immigrant group. Most of the new immigrant patients chose mastectomy although breast-conserving surgery was an equal alternative. The reasons for choosing mastectomy as the preferred mode of treatment were related to economic problems, different life concepts, and other priorities. Constant surveillance and considerable enlightenment are needed in the new immigrant population, so that they will be able to separate the disease and its treatment from their paramedical problems.

Breast Neoplasms↗
PubMed1994

Rationale for elective contralateral mastectomy with immediate bilateral reconstruction.

BACKGROUND: Women with breast cancer treated by mastectomy with immediate breast reconstruction can get exceptionally good results if the reconstruction is performed with autogenous tissue using the transverse rectus abdominis myocutaneous (TRAM) flap. Bilateral reconstruction with TRAM flaps is also possible, but only if both breasts are reconstructed at the same time. To avoid the possibility of subsequently developing contralateral malignancy and having to undergo assymetrical reconstruction with a different technique, some patients have chosen the alternative of bilateral mastectomy with bilateral immediate reconstruction. This is only reasonable if the incidence of failure in bilateral breast reconstruction is very low. METHODS: We prospectively studied reconstructive outcomes in 100 patients who had breast cancer and who underwent bilateral mastectomy and reconstruction (using implants as well as TRAM flaps). We also reviewed the histologic findings in 88 prophylactically removed high-risk breasts. RESULTS: Successful outcomes were initially achieved in 95 patients; of the 5 failures, two were successfully reconstructed with alternative techniques for an overall success rate of 97%. Of the 63 patients reconstructed with bilateral TRAM flaps, all but one (98%) were successful on the first try. TRAM flap reconstructions were significantly more likely to be successful than were those based on implants (p = 0.05). Previously unsuspected invasive cancer was found in 3 patients (3.4%), whereas carcinoma in situ was found in 5 patients (5.7%) and in another 18 patients (20%) cellular atypia was present. CONCLUSIONS: Bilateral breast reconstruction has a low incidence of failure, particularly if TRAM flaps are used. For selected patients, elective contralateral mastectomy with immediate bilateral reconstruction is a reasonable treatment alternative provided that the necessary expertise is available and the patients clearly understand the risks.

Adult↗
PubMed2003

Breast-conserving surgery has equivalent effect as mastectomy on stage I breast cancer prognosis only when followed by radiotherapy.

BACKGROUND AND PURPOSE: Early-stage breast cancer is increasing and consequently the use of breast-conserving surgery (BCS). We examined the effect of mastectomy and BCS on overall and breast cancer survival in routine health care in Geneva, Switzerland. PATIENTS AND METHODS: We included all stage I breast cancers treated by surgery (n=1046) recorded at the Geneva Cancer Registry between 1988 and 1999. The effect of treatment type was evaluated by Cox models, which accounted for confounders. RESULTS: Overall, 780 (75%) women had BCS with radiotherapy, 57 (5%) BCS alone and 209 (20%) mastectomy. The overall 10-year survival was 86, 56, and 72%, respectively. The effect of BCS with radiotherapy was similar to that of mastectomy for both breast cancer mortality (adjusted hazard ratio (HR), 0.67; 95%CI, 0.31-1.38) and other causes of mortality (HR, 0.79; 95%CI, 0.49-1.28). Women with BCS alone had higher mortality from breast cancer (HR, 3.95; 95%CI, 1.59-9.84). CONCLUSIONS: This retrospective study shows that BCS plus radiotherapy is the predominant treatment in routine practice for stage I breast cancer in Geneva, with the same effect on survival as mastectomy. In this data set the addition of radiotherapy to BCS substantially reduces mortality from breast cancer without increasing other causes of mortality after 10 years of follow-up.

Aged↗
PubMed1992

Are modified radical mastectomies done for T1 breast cancers because of surgeon's advice or patient's choice?

Clinical trials show that T1 breast cancers are equally well treated with breast-conserving surgery as with modified radical mastectomy. However, the Colorado Central Cancer Registry indicates that, for the past 5 years, the majority of women (72%) with T1 breast cancer in Colorado have undergone modified radical mastectomies. A questionnaire was sent to 175 general surgeons to determine the reasons for the high number of modified radical mastectomies still being performed. The results indicate that one group of surgeons (34% of those responding) believes each type of surgery has equal survival rates but unknowingly influences the patient to choose modified radical mastectomy, with a subtly biased presentation. Education of both surgeons and patients is needed to increase the number of patients with T1 breast lesions who can benefit from breast-conserving therapy.

Attitude of Health Personnel↗