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PubMed2000

[Reexcision and perioperative brachytherapy in the treatment of local relapse after breast conservation: a possible alternative to mastectomy].

Breast conserving surgery and postoperative radiotherapy became widely accepted in the last two decades for the treatment of early invasive breast cancer. In spite of adequate surgery and radiotherapy, the rate of ipsilateral breast tumor recurrence is approximately 10%. In such cases salvage mastectomy is the standard treatment, however wide reexcision of the recurrent tumor is also a reasonable option for selected patients. The risk of second local relapse is higher following further breast conservation compared to mastectomy. The authors report the technique of tumor reexcision combined with intraoperative implantation and perioperative high dose rate (HDR) bracytherapy of the tumor bed for the salvage of recurrence in a previously irradiated breast. One can perform two operative interventions at the same time with this method. Irradiation can be started safely within 48 hours after surgery. A review of the literature is also performed by the authors to demonstrate the role and indication of perioperative brachytherapy in the treatment of breast tumor relapse and other cancer recurrences. Reexcision is a practicable alternative to mastectomy for solitary, parenchymal breast tumor relapse measured 2 cm or less in diameter. Perioperative brachytherapy may decrease the risk of second relapse without increasing radiation side effects. Further prospective study is required to define the value of the prescribed method in comparison with salvage mastectomy.

Aged↗
PubMed2000

[Skin sparing incision mastectomy and immediate TRAM flap breast reconstruction].

OBJECTIVE: In order to achieve a high-quality reconstructed breast, we improved the operation method using the skin sparing incision mastectomy and immediate TRAM flap breast reconstruction. METHODS: Patients with duct carcinoma in situ were selected to undergo mastectomy with a skin sparing incision. The site of the previous biopsy incision was marked around the areola, and then the preferred skin sparing incision included the nipple-areola complex and a margin around the biopsy site for the non-ptotic breast. The excised skin was replaced as precisely as possible with the TRAM flap skin immediately. While the mastectomy was being performed the TRAM flap was incised and elevated. The pedicled or free TRAM flap has been used for 34 patients. Nipple-areola reconstruction was made at the second stage. RESULTS: The results of the skin sparing breast reconstruction are better than other breast reconstruction techniques in the breast's shape, colour, sensation, symmetry and incision scar. CONCLUSIONS: Skin sparing incision mastectomy with immediate TRAM flap breast reconstruction technique is an ideal breast reconstructive method for the patients with breast duct carcinoma in situ. The advantages of the method include 1. The TRAM flap is an autograft without rejection; 2. The reconstructed breast has good shape and better sensation than other autograft reconstructive techniques since most breast skin has been spared; 3. The symmetry of the reconstructed breast with the contralateral breast is improved.

Adult↗
PubMed2002

Gynecomastia: complications of the subcutaneous mastectomy.

Gynecomastia is a benign enlargement of the male breast secondary to gland proliferation. Subcutaneous mastectomy is performed for symptomatic patients and in those desiring cosmetic changes. The aim of this study was to assess the risk factors and complications associated with the operation. We retrospectively examined the records of all patients undergoing a subcutaneous mastectomy for gynecomastia. Ninety-one patients were identified. We conducted telephone interviews with 52 patients and performed 65 subcutaneous mastectomies on those 52 patients. Thirty of the 65 procedures (46%) developed complications. These included sensory changes, pain, seromas, scarring, breast asymmetry, hematomas, and wound infection. No preoperative risk factors were significant for postoperative complications. Eighteen of 22 cases with drains placed intraoperatively developed complications as compared with 12 of 43 cases without drains (P = 2.6 x 10(-7)). Specimens removed from the patients who had drains placed were significantly larger than those from patients who did not have drains placed (P = 1.5 x 10(-5)). However, specimen size was not an independent risk factor for development of a complication (P = 0.14). We found a relatively high complication rate in subcutaneous mastectomy for gynecomastia. Most complications are minor with no long-term effect. Drain placement was the only risk factor associated with postoperative complications.

Adolescent↗
PubMed2003

Mastectomy without drain at pectoral area: a randomized controlled trial.

OBJECTIVES: Mastectomy is still one of the standard alternative procedures for the management of female breast cancer. Axillary node dissection is also performed to establish the accurate staging. After operation, the axilla must be drained because of lymphatic leakage. Whether the raw surface at the pectoral area should be drained or not is an interesting controversial point. The authors conducted a randomized controlled trial to compare outcomes after modified radical mastectomy (MRM) with and without drainage at the pectoral area. METHODS: Sixty patients who agreed to be treated with MRM and had given their consent were enrolled. Mastectomy was performed to remove the breast tissue proper by scalpel in order to minimize tissue injury. The axillary contents were removed by sharp instrument. After bleeding had stopped, patients were randomly allocated to one or other of 2 groups: group I (n = 30): only 1 drain was inserted at the axilla area; group II (n = 30): 2 conventional drains were inserted into the pectoral area and axilla area. The size of tube drain and negative suction pressure were constant in all cases. Volume of contents was recorded daily. Subcutaneous seroma or hematoma were carefully observed and confirmed by ultrasonography 3-5 days after operation. Overall drainage contents and complications were compared. RESULTS: The mean weight of breast tissue of group I was 632.1 g and group II 654.0 g (p = 0.81). Total drainage contents (median) from the two groups were 250 cm3 and 231 cm3 respectively (p = 0.796). Complications occurred in 1 case in group I and 2 cases in group II (p = 0.35). None of the above differences were statistically significant. CONCLUSION: Mastectomy by scalpel can be performed without drainage at the pectoral area. Overall complications in the conventional group and the group without drain did not differ significantly.

Adult↗
PubMed1992

[The use of CO2-laser and blood loss during mastectomy].

The problem of radical treatment of breast cancer which largely contributes nowadays to overall cancer incidence in female population is far from being solved. In view of the significance of surgical treatment of breast cancer, the study was initiated to clear up relations between blood loss and kind of surgery. Three groups of patients were assessed for blood loss: subjected to standard mastectomy, modified mastectomy and mastectomy with application of CO2-laser. The blood loss reached 351.2 +/- 11.2 ml, 303.0 +/- 10.8 ml and 155.0 +/- 12.4 ml, respectively. The results evidence the advantage of CO2-laser application in mastectomy in respect to reducing blood loss.

Blood Loss, Surgical↗
PubMed1992

Axillary versus combined axillary and pectoral drainage after modified radical mastectomy.

Initial attempts to obliterate dead space and minimize fluid accumulation in patients after mastectomy using closed suction drainage, used insertion of a single axillary drain. Today, surgeons often insert two drains in the postoperative wound, one in the axilla and the other beneath the pectoral flaps. The current study was done to determine whether or not there is an advantage in using two drains rather than a single axillary drain after mastectomy. A randomized, clinical trial was conducted with 84 women undergoing modified radical mastectomy. Thirty-seven patients had one axillary drain and 47 had two drains placed postoperatively, one in the axilla and the other beneath the pectoral flaps. Follow-up results were obtained four weeks postoperatively for complication data, including seroma and hematoma formation, flap necrosis and infection. The average total drainage was 870.4 milliliters per patient in the group with one drain and 997.4 milliliters per patient in the group with two drains (p value not significant). The overall complication rate in the group with one drain was 35.0 percent compared with a rate of 31.9 percent for all complications observed in the group with two drains. These differences did not reach statistical significance. Comparing the frequency of each complication in the two groups again showed no significant difference. However, the data suggest a trend toward an increased incidence of flap necrosis in the group with two drains that used a drain beneath the pectoral flaps. Use of a single axillary drain after modified radical mastectomy seems to result in no increase in postoperative complications, is less costly and may assist in reducing the incidence of flap necrosis.

Adult↗
PubMed2003

[The psychological impact of mastectomy on women with breast cancer].

OBJECTIVE: To investigate the psychological impact of mastectomy on women with breast cancer. METHODS: Questionnaires were answered by 90 patients after mastectomy for breast cancer. The data were collected and analyzed regarding the age, occupation, education, income and living place of the patients. Their psychological changes were compared and evaluated statistically using chi-square analysis. RESULTS: Mastectomy caused psychological impact on half of the patients, which included fear of cancer, feeling of body incompleteness, inconvenience in working and social communication, less sexual act and low spirit. 79 percent of the patients considered breast reconstruction unnecessary. 54 percent did not know that the breast could be reconstructed. The patient feelings differed with the age, occupation, income and living place. CONCLUSION: Mastectomy hurts patient psychological health.

Age Factors↗
PubMed2004

Residual breast tissue in the skin flaps after Patey mastectomy.

BACKGROUND & OBJECTIVES: Patey mastectomy implies complete removal of breast tissue. Likely area where residual breast tissue may be left is under the skin flaps. There is no study examining left over breast tissue under the Patey mastectomy skin flap. The present study was undertaken to study the presence of residual breast tissue in skin flaps after Patey mastectomy in patients with breast cancer. METHODS: In 37 patients of breast cancer undergoing Patey mastectomy, biopsy from under the skin flap at central point of 4 quadrants (upper outer, upper inner, lower inner and lower outer), 3 cm from cut margin of skin was taken to examine for residual breast tissue. RESULTS: In 8 of 37 (21.6%) cases residual breast tissue and in 3 of these (37.5%) tumour tissue was found under the skin flap. INTERPRETATION & CONCLUSION: Overall in 21.6 per cent biopsies from under the skin flap revealed information of probable therapeutic importance. This information may in future serve as an additional prognostic factor to consider irradiation to reduce the incidence of local recurrence in flap positive patients.

Adult↗
PubMed1992

[Surgical treatment of local recurrence after mastectomy].

This paper deals only with local recurrence of a mammary carcinoma, not with all locoregional recurrences. The surgical treatment of a true local recurrence depends on the freedom from metastases, on the type of the primary operation, whereas the localisation and the size of the recurrence are of minor importance. If no metastases can be found, the operative treatment of the recurrence is the method of choice leading to cure of part of the patient. Simple excision of the tumor is insufficient; the second operation must be radical. When a segmentectomy or a lumpectomy was performed as primary operation, the recurrence must be treated with a modified mastectomy. The status after modified mastectomy with or without primary reconstruction must be converted into a radical mastectomy. A local recurrence after radical mastectomy must be removed by chest wall resection.

Breast Neoplasms↗
PubMed2004

[Quality of life in women after mastectomy].

The aim of the study was evaluation of quality of life of women after radical mastectomy. It was assumed that cancer of the breast, treatment and results could cause the decrease of quality of life. 107 women aged from 40 to 75 years after radical mastectomy were examined. Questionnaire made by G. Hansen at Norwegian University of Sport and Physical Education was used in all women. Questionnaire consists of 4 parts and contains 87 questions concerning general and medical data, quality of life and physical activity. Examined women had not any problems in daily activity. Most of them (about 70%) had difficulty in physical effort, particularly using upper extremities. 60% of women did not work, but they had a hobby (about 70%). Housework and daily activity were less efficient in 80% women after radical mastectomy. We observed a change in psychical status of examined women. They had some problems with concentration, irritation, irritability and sleep. These problems did not influence the family relationships and contacts with other people. Instead we noticed change in self-rating of women after radical mastectomy. Removal of breast--attribute of femininity--changed sexuality, consciousness of femininity and appearance of an image. We observed "half woman complex" in examined women. Women evaluated status of their body and quality of life from 3 to 5 in 7-gradual scale.

Activities of Daily Living↗
PubMed2004

Lymphatic mapping improves staging and reduces morbidity in women undergoing total mastectomy for breast carcinoma.

Lymphatic mapping (LM) and sentinel lymph node biopsy (SLNB) have become widely accepted in the setting of breast conservation surgery. We hypothesized that LM can be extended to women undergoing total mastectomy, being technically feasible, yielding highly accurate and sensitive results, improving axillary staging, and reducing postoperative morbidity. Between 1995 and 2003, 99 women (mean age 59 years, range 34-87) underwent 100 mastectomies with LM using blue dye alone. Fifty-nine operations (60%) were followed by a completion axillary lymph node dissection (ALND). Ninety per cent of patients had invasive carcinoma; 10 per cent had in situ carcinoma. Mean tumor size was 2.5 cm (range 0.3-8 cm). One hundred fifty-nine sentinel nodes (SNs) (mean 1.65, range 1-5) were successfully identified in 96 (96%) axillae. Twenty-five (25%) sentinel nodes revealed nodal metastases. Five of 25 (20%) SNs had micrometasteses. Three patients had a false-negative SN, yielding a sensitivity of 91 per cent. The accuracy of LM was 97 per cent. No patient who underwent SLNB alone developed lymphedema, axillary seroma formation, infection, or restricted arm movement. This was contrasted with patients undergoing ALND, where 10 (16%) developed lymphedema and 2 (3%) developed an infection. Ten (25%) patients developed axillary paresthesias after SNB compared with 47 (78%) patients after ALND (P < 0.0001). LM in the setting of mastectomy is accurate and sensitive. This technique improves axillary staging and decreases morbidity. Patients who are not candidates for breast conservation should be offered LM and SLNB at the time of mastectomy.

Adult↗
PubMed1992

One-day hospitalization following modified radical mastectomy.

Postoperative management of patients following modified radical mastectomy has changed dramatically in recent years. Historically, patients usually remained in the hospital with closed suction drainage until the amount of drainage had decreased sufficiently for them to be removed. The feasibility of early discharge on the day following surgery was studied in a prospective manner in 29 consecutive breast cancer patients; 27 underwent unilateral modified radical mastectomy and 2 bilateral mastectomies by a single surgeon. All patients were instructed before surgery about planned early discharge and drain care. Twenty-seven of 29 patients (93.3%) were discharged the day following surgery. However, 2 patients refused discharge and were discharged on postoperative Day Two, and one patient was readmitted for confusion. Drains were removed in the office an average of 5.07 days after surgery. Forty-five per cent of patients developed a seroma that required aspiration at least once. No significant long-term sequela were experienced as a result of early discharge. The average hospital cost was reduced by $2,474.00 or 36 per cent (P less than 0.001) as compared to other surgeons in the same medical center who held to traditional postoperative care. The authors conclude that discharge on the day following surgery for patients undergoing a modified radical mastectomy is safe and cost effective.

Adult↗
PubMed1992

Immediate breast reconstruction at the time of mastectomy for breast cancer.

Immediate breast reconstruction avoids or lessens the psychosocial trauma associated with a disfiguring mastectomy. The complications seen in this small patient sample are not in excess of those seen in patients undergoing delayed reconstruction. Fifteen immediate breast reconstructions were performed at the time of mastectomy for cancer. Flap or implant reconstruction alone was determined on an individual basis. No delays in the initiation of adjuvant chemotherapy or hormone therapy were caused by the reconstructions. There were no instances of total flap loss or wound infection. One implant was lost due to exposure. Other complications were similar to those associated with modified radical mastectomy alone. These preliminary results suggest that immediate breast reconstruction at the time of mastectomy may be offered with safety to newly diagnosed breast cancer patients.

Adult↗
PubMed1992

Does surgical experience influence mastectomy complications?

Mastectomy remains the most commonly performed surgical procedure for breast cancer, and complications such as infection or wound breakdown (which may relate to the experience of the operator) could expensively prolong hospital stay and retard the administration of additional therapy. We examined the complications, hospital stay and cost of therapy of total mastectomy and axillary node clearance in 164 women, comparing these between four grades of surgeon: registrar (67 operations), senior registrar (58), part-time consultant (21) and professor (18). Our policy, for local reasons, was to perform mastectomy whenever possible rather than select lesser surgical or non-surgical management options. There was no significant difference between operators when the percentage of seromas requiring aspiration (9, 3, 5, 6), infection (16, 7, 23, 11), or wound breakdown (7, 3, 5, 6) were compared. Neither the length of hospital stay (9.3 +/- 6.9, 8.2 +/- 4.7, 9 +/- 7.3, 9.2 +/- 11.2 days), nor cost (2005, 1939, 1966, 1927 rands) differed. Surgical experience did not significantly influence mastectomy complications.

Aged↗
PubMed2005

Evaluation of skin perfusion after nipple-sparing mastectomy by indocyanine green dye. Preliminary results.

The aim of the study was to investigate the blood supply of the normal nipple areola complex (NAC) and the spared areola complex after a nipple-sparing mastectomy using the analysis of the fluorescence from the indocianine green dye (ICG) injection. Between December 2002 and July 2003 we performed the ICG analysis in 10 cases of healthy breasts and in 9 patients after a nipple-sparing mastectomy and one patient after subcutaneous mastectomy. In all cases, the resulting fluorescence was measured in three different zones: nipple, areola, surrounding mammary skin. Three parameters of the fluorescence curve (slope, maximum intensity, time to achieve a maximum level) were recorded. On the healthy breast, the nipple showed a very high perfusion as compared to the other zones. On the contrary, after the mastectomy the fluorescent pattern was completely altered, being the perfusion of the nipple very low. In conclusion, these preliminary results confirm the applicability and the importance of the ICG technique for evaluating the perfusion of the healthy and spared areola after surgery. Because of the small number of patients further studies are needed.

Female↗
PubMed1991

Breast reconstruction following mastectomy: an update.

Breast reconstruction today is a realistic and vital part of total breast cancer treatment. All physicians should be well informed on current methods of reconstruction so that they can present the facts to their patients in an encouraging, yet realistic manner. Recent developments in breast reconstruction after mastectomy have included the increase utilization of immediate breast reconstruction at the time of mastectomy, the improvement and refinement of the TRAM flap, the increased use of the "free" flap transfer of the TRAM flap which increases blood supply to the flap, texturing of implants which appears to increase their stability on the chest wall and reduce the incidence of capsular contracture or firmness, and the introduction of the newer autogenous tissue methods including the LTTF, gluteal, and latissimus dorsi flaps. Plastic surgeons are charged with the task of becoming proficient in breast reconstruction procedures in order to offer the mastectomy patient a safe, realistic facsimile breast that will be trouble free. Fortunately, there are several good options for restoring the breast after mastectomy. The method of reconstruction should be chosen by matching the desires of informed patients with the indications and contraindications in each case. In general, silicone reconstruction is expedient and satisfactory in most patients. However, it cannot compete with autogenous tissue transfer for severe chest wall defects, covering irradiated areas, creating a large, ptotic breast, or providing a natural appearing, soft breast mount.

Breast Neoplasms↗
PubMed1990

Reasons why mastectomy patients do not have breast reconstruction.

Breast reconstruction after mastectomy is valuable, yet only a small percentage of eligible patients ever have reconstruction. Little has been done to determine why so few patients proceed with reconstructive surgery. A homogeneous population of mastectomy patients, some of whom underwent breast reconstruction while others did not, were surveyed regarding their attitudes about breast reconstruction. A total of 245 women were surveyed. One-hundred and fifty-eight (64 percent) responded, 71 of whom had been reconstructed while 87 had not. Comparison of the responses of the two groups suggests factors that play a role in determining whether the mastectomy patient will accept or decline the option of breast reconstruction. Considerations that made it less likely that a woman would pursue reconstruction included advanced age at the time of mastectomy, concern about complications from further surgery, uncertainty about outcome, and fear about the effect of reconstruction on future problems with breast cancer. Marital status, receiving chemotherapy, or knowing a patient who had a bad result from reconstruction did not affect the decision. An awareness and understanding of these factors may be helpful to physicians in counseling patients and in increasing the number of women who enjoy the benefits of breast reconstruction.

Adult↗
PubMed1989

[Electrophysiological study on the atrophied pectoralis major muscle after modified radical mastectomy].

In order to clarify the cause of the atrophy of the pectoral muscles after modified radical mastectomy, twenty patients who had had the operation at Nagasaki Chuo National Hospital 40 days to 2 years prior to this study, were investigated by electromyography. Of 20 subjects, 11 had the operation to preserve the pectoralis major muscle and 9 had the operation to preserve both the pectoralis major and minor muscles. The results were as follows: 1) Electromyography revealed some damages to the pectoral nerves in 16 cases of 20 (80%). In 12 cases, development of fibrillation potentials was observed at rest, while motor unit potentials disappeared during voluntary contraction. These findings suggest the damage to the nerves including neutrotomy. 2) The regions with macroscopic muscular atrophy remarkably coincided with those with neurogenic changes on electromyography. This suggests that the atrophy of the pectoralis major after modified radical mastectomy might be mainly caused by the damage to the pectoral nerves. 3) The mastectomy preserving only the pectoralis major tends to cause damage to nerves innervating the sternocostal part of the pectoralis major more frequently than the mastectomy preserving both the pectoralis major and minor muscles. The abdominal part was frequently damaged irrespective of the types of the operation.

Action Potentials↗