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PubMed1988

[Ulcerated cancers of the breast: results of modified mastectomy. Apropos of 64 cases].

Although, happily, at the present time the actual tendency in mammary neoplastic disease is being increasingly orientated towards conservative treatment, a fairly large number of total mastectomies are still being performed in patients diagnosed at a late stage. The frequency, technical aspects and precise local and general prognosis of this affection are discussed in relation to 63 breast cancers treated surgically between 1975 and 1984. These so-called "trimming" mastectomies represent 4.22% of overall total mastectomies performed during the same period. The surgical technic employed was the Patey type total mastectomy with either primary suturing after-wide separation of borders or closure with a thoraco-epigastric fasciocutaneous flap with internal pedicle. Actuarial survival was satisfactory: 58% at 2 years, 34% at 5 years, survival being significantly better in patients with lack of glandular invasion. This surgical technic should be considered, in combination with other therapy, for these patients, who should not be classed as "unrecoverable".

Adult↗
PubMed1987

Successful treatment of stages IIIa and IIIb carcinoma of the breast by mastectomy in the elderly high risk patient using local anesthesia.

Modified radical mastectomy has served as the standard surgical treatment for patients with operable carcinoma of the breast. Recent data suggest that lumpectomy combined with radiation therapy is adequate treatment for smaller carcinomas of the breast. However, large carcinomas of the breast may still require a modified radical mastectomy for adequate local treatment or until lesser procedures are proved sufficient. This study was done to describe the use of local anesthesia and modified radical mastectomy (with sparing of the pectoralis minor muscle) in 17 patients who were considered a poor risk for general anesthesia and had Stages IIIa and IIIb carcinomas of the breast. Patient acceptance was excellent in 14, moderate in two and poor in one patient. Blood loss never exceeded 75 milliliters and a mean of 120 milligrams of Xylocaine (lidocaine) was used. No apparent central nervous system toxicity was observed. Mean time on the surgical service was 2.7 days. Modified radical mastectomy can be successfully accomplished in patients considered a "poor risk" for general anesthesia and with locally advanced carcinoma of the breast using local anesthesia with minimal blood loss and excellent patient acceptance.

Aged↗
PubMed1986

[Modified radical mastectomy and lymphocyte subsets of regional lymph nodes].

Whether or not regional lymph nodes in tumor-bearing hosts possess special immunological properties, still remains an important problem in the management of breast cancer. Regional lymph node cells from 22 patients with breast cancer were immunologically studied using monoclonal antibodies, OKT-3, 4, 8, OK-M 1, Leu-7, and laser flow cytometry. Among these patients, 13 early cancer patients underwent modified radical mastectomy (Auchincloss operation or Patey operation) and 9 underwent standard radical mastectomy (resection of breast, pectoralis major muscle and axillary dissection). More helper T lymphocytes defined by OKT-4 were found in regional lymph nodes in modified radical mastectomy patients in comparison with standard radical mastectomy patients. In patients given the modified operations, NK activity defined by OK-M 1 or Leu-7 were significantly increased, especially in lateral axillary lymph nodes. Also, OK-M 1 lymphocytes and Leu-7 lymphocytes were increased in lymph nodes without metastasis rather than those with metastasis. These findings suggest that regional lymph nodes may have defence mechanisms against the spread of tumor cells in early cancer patients.

Axilla↗
PubMed1986

[Prognosis of breast cancer--20 years experience in radical mastectomy].

From 1958 to 1982, 1,035 patients with breast cancer were treated by operation in our hospital. The follow up rate was 100% and 804 were followed for more than 5 years. Radical mastectomy was performed in 695 of the 804 patients, the rest were treated by simple mastectomy, modified radical mastectomy and extended radical mastectomy. The 5, 10, 15 and 20 year survival rates were 71.8%, 58.2%, 48.8% and 41.8%. According to the UICC TNM classification, the 5, 10, 15 and 20 year survival rates of stage I were 84.5%, 77.0%, 58.3% and 75.0%, of stage II, 72.8%, 57.4%, 53.5% and 58.8%, and of stage III, were 55.3%, 44.7%, 36.5% and 8.0%, respectively.

Breast Neoplasms↗
PubMed1982

Microsurgical composite tissue transplantation: indications and technical considerations in breast reconstruction following mastectomy.

Twenty-six patients are presented who underwent reconstruction of the breast and thorax following mastectomy. A successful result ensued in 96 percent of the patients. Indications for the use of microsurgical composite tissue transplantation in breast reconstruction following mastectomy include. 1. Inability to employ an island latissimus dorsi musculocutaneous flap 2. Previous failure of an island latissimus dorsi musculocutaneous flap 3. The restoration of form and contour with minimal secondary donor deformity The present series includes 12 patients who underwent reconstruction utilizing the vascularized groin flap and 14 utilizing the contralateral latissimus dorsi musculocutaneous flap. The advantages and disadvantages of the different donor tissues are presented and contrasted with other vascularized donor tissue also employed in breast reconstruction following mastectomy. Technical modifications correlating the limitations of the donor tissue to the complexities of the recipient site and contributing to successful transplantation are detailed. The authors wish to emphasize that microsurgical composite tissue transplantation for reconstruction of the breast following mastectomy has applicability in only a small carefully selected subgroup of patients--approximately 9 percent.

Back↗
PubMed1982

Modified radical mastectomy for carcinoma of the breast.

The technique of modified radical mastectomy (total mastectomy and axillary dissection) as carried out by members of the Breast Service at Memorial Sloan-Kettering Cancer Center is presented. As described by Patey, the pectoralis minor muscle is removed to facilitate dissection of the upper levels of the axilla. Care is taken to preserve the principal neurovascular bundle to the pectoralis major muscle. Indications for and complications of the procedure are indicated, with particular emphasis given to selection of patients for modified radical mastectomy or radical mastectomy.

Axilla↗
PubMedDate not supplied

Modified radical mastectomy: definition and role in breast cancer surgery.

The reasons for the dramatic change during the past decade in the United States regarding the surgical treatment of patients with potentially curable invasive breast cancers from the classical radical mastectomy to the modified radical mastectomy are discussed. The various types of modified radical mastectomy are described and the indications for their use as part of a moderate selective surgical approach to breast cancer are discussed in detail. The results obtained in 846 patients with potentially curable breast cancers who were followed for ten years or more are presented: 80.3% had less than a radical mastectomy including an absolute, no evidence of disease, survival rate of 63% and a local recurrence rate of 7.8%, along with ease of breast reconstruction when the pectoralis major muscle is preserved. These results, as compared to those obtained with other types of surgical approach and with primary radiotherapy, offer a most favorable comparison.

Breast Neoplasms↗
PubMed1980

Results of partial mastectomy in 173 patients followed for from five to ten years.

A series of 173 selected patients was treated by partial mastectomy. Eighteen per cent of these also had axillary dissection and another 18 per cent were irradiated. The survival rate at five years was 76 per cent. In the earlier patients, despite adverse selection in terms of age and associated disease, 44 per cent survived for ten years. Twenty per cent of these patients required some form of additional treatment for the control of local or regional disease, but mastectomy was required in only 7.5 per cent. In the others, the cosmetic results were good. Although there is an increased risk of local or regional reappearance of the cancer that may require secondary treatment, partial mastectomy is a satisfactory method of treatment for selected patients with carcinoma of the breast who wish to have some of the breast tissue preserved. These patients should be warned of the increased risk of having to have a second operation for local recurrence, but they can be assured that, in terms of survival, the results seem comparable with those reported after total mastectomy. It is possible that the use of excisional biopsy and axillary sampling followed by external and interstitial radiation with iridium seeds may further increase our ability to save the breast.

Breast Neoplasms↗
PubMed1994

[Initial results of immediate reconstruction of the breast following mastectomy].

OBJECTIVE: Evaluation of the results of immediate reconstruction after mastectomy for breast cancer by means of a silicone implant. DESIGN: Retrospective analysis. SETTING: Department of Surgical Oncology of the Dr Daniël den Hoed Cancer Centre and Department of Surgery of the Zuiderziekenhuis, Rotterdam, the Netherlands. METHOD: From September 1990 till July 1993, 37 immediate reconstructions of the breast after mastectomy were performed in 35 patients by means of a silicone implant. Indications for the treatment, consequences for further oncological treatment, additional plastic surgery, and complications of the reconstruction were evaluated. RESULTS: The indications for mastectomy and immediate reconstruction were local recurrence after breast conservative treatment (6 operations), multifocal disease (8), extensive in situ carcinoma (8), non-radically removed tumour at lumpectomy (5), anticipated poor cosmetics after breast conservative treatment (6), prophylactic ablation of the breast (2), and patient preference (1). 5 patients received adjuvant systemic chemotherapy, which could be administered without delay, and without negative influence on the result of the breast reconstruction. Additional plastic surgical treatment consisting of reconstruction of the areolar complex and correction of the breast symmetry, was performed in 5 and 3 patients respectively. In 8 of the 37 reconstructions (22%) complications were encountered. The main complications were haematoma (2), infection (4), implant removal (3), capsular contracture (2), skin necrosis (2), and luxation of the implant (1). CONCLUSION: Immediate reconstruction after mastectomy is a valuable treatment modality in breast cancer.

Adult↗
PubMed1993

A comparison between scalpel and electrocautery in modified radical mastectomy.

OBJECTIVE: To compare the effects of a conventional cold scalpel and electrocautery in modified radical mastectomy. DESIGN: A non-randomised controlled trial. SETTING: Teaching hospital in Southern Taiwan. SUBJECTS: 101 consecutive patients with primary breast cancer who underwent modified radical mastectomy between July 1987 and June 1989. INTERVENTIONS: The 44 patients during the first year were allocated to have skin flaps fashioned conventionally with a cold scalpel and the 57 patients during the second year, by electrocautery. MAIN OUTCOME MEASURES: Morbidity and mortality among the 101 patients who underwent modified radical mastectomy. RESULTS: The groups were comparable in regard to age, menopause, cancer stage, weight of specimen and histological type of cancer. The mean blood loss was 567 ml when scalpel was used and 150 ml when electrocautery was used (p < 0.001). The postoperative fall in packed cell volume was significantly greater in the scalpel group (0.75 [0.26] compared with 0.28 [0.15], p < 0.001) and more patients in this group required transfusion (9 compared with 0, p < 0.01). There were no deaths in either group. There were no significant differences in operation time, total post-operative Hemovac drainage, postoperative hospital stay, the number of lymph nodes removed, the number of metastatic lymph nodes, and postoperative complications between the groups. CONCLUSION: Electrocautery is a safe, convenient and rational method for constructing skin flaps in modified radical mastectomy, and patients do not need blood transfusions.

Breast Neoplasms↗
PubMed1993

[Surgical technique of subcutaneous/skin preserving tumor-adapted mastectomy].

Subcutaneous mastectomy as a procedure to prevent breast cancer has been abandoned because of the insufficient resection of breast tissue and the high rate of complications. Including the recent experiences in reconstructive breast surgery the subcutaneous mastectomy allows a degree of tissue resection comparable to total mastectomy with a lower rate of complications. Surgical technique, our own results and new indications for subcutaneous mastectomy are presented.

Adult↗
PubMed1993

Effect of closing dead space on seroma formation after mastectomy--a prospective randomized clinical trial.

To evaluate the effect of closing dead space on seroma formation after mastectomy, 39 patients undergoing 40 mastectomies with axillary node clearance were randomized to undergo suturing of skin flaps to underlying muscle or conventional skin closure. Duration of closed suction drainage, 72 h, and shoulder exercises, commencing on the first post-operative day, were standardized for both groups. Closed suction drainage was significantly less (P < 0.05) in the group that had flaps sutured, 272 +/- 46 ml vs 393 +/- 39 ml. Also fewer patients in the flap sutured group developed seromas, 5 (25%) vs 17 (85%) chi 2 = 12.2 P < 0.001. Three patients in the group that had conventional skin closure had breakdown of wound edges, two developing a prolonged serous discharge, while none occurred in the sutured group. A functional range of shoulder motion was attained at 6 months in 14 (70%) patients in the flap sutured group compared with nine (45%) in the conventional skin closure group (P = NS). These results confirm the value of suturing skin flaps to underlying muscle in reducing local morbidity after mastectomy and suggest that this technique should be included in the closure of all mastectomy wounds.

Aged↗
PubMed1996

[Mastectomy with immediate reconstruction for invasive breast cancer. Comments on indications and technique. A series of 112 cases].

A series of 112 mastectomies with immediate breast reconstruction performed in women with invasive cancer of the breast were followed for a mean of 30 months to determine cancer outcome, morbidity and aesthetic results of the different surgical techniques. The patients were divided into 3 groups according to indications: 49 cases with local recurrence after conservative treatment; 37 cases of large or multifocal tumours operated after chemotherapy and radiotherapy; 26 cases after tentative conservative surgery with incomplete tumourectomy. A total of 98 patients (87.5%) were irradiated before mastectomy with immediate breast reconstruction. Twenty-eight simple implants, 50 musculocutaneous flaps using the latissimus dorsi with implant and 34 musculocutaneous flaps with the rectus abdominis. During follow-up 16 patients died and cancer relapsed in 13 surviving patients. Seven local recurrences were observed. In all cases of early relapse, which may have possibly been triggered by immediate breast reconstruction, the patients had very poor prognosis criteria. Surgery took longer for mastectomy with immediate breast reconstruction using the rectus abdominis flap and required transfusion in 88% of the cases. Combining all the techniques, 19% of the patients had postoperative complications and 25% late sequellae. The aesthetic results were considered as good immediately after surgery in 14% of the patients with a simple implant, in 45% of those with a latissimus dorsi flap and in 81% of those with a rectus abdominis flap. Second surgical procedures to improve the aspect were performed in half the patients with a simple implant giving 50% good results, in 40% of the patients with a latissimus dorsi flap giving 68% good results and in 12% of the patients with a rectus abdominis flap giving 84% good results. In this series, patient satisfaction was closely related to the aesthetic quality of the results. Integrated into a well-planned multidisciplinary protocol, mastectomy with immediate breast reconstruction does not appear to affect the cancer outcome. Immediate breast reconstruction is a complex procedure and requires experience in plastic surgery to reduce the number of complications and to improve aesthetic results. Reconstruction with a rectus abdominus flap appears as the superior technique.

Adult↗
PubMed1998

[A case of cardiac rupture which occurred 34 years after mastectomy].

We experienced a case of cardiac rupture associated with mastectomy. A 78-year-old woman, who underwent left mastectomy 34 years before, complained of bleeding from a chest tumor located on the operative scar of the left mastectomy and postoperative irradiation. The tumor was noticed 10 months prior and became larger and repeated bleeding. It was first diagnosed as hemangioma by nearby practitioner. She was referred to the university hospital because of uncontrollable bleeding from the tumor. Without definite diagnosis, the tumor ruptured suddenly 52 days after the admission and the patient lapsed into the state of hemorrhagic shock and cardiopulmonary resuscitation was performed. Following emergency operation was performed on stand-by of cardiopulmonary bypass (CPB). The operation was successful with the aid of partial CPB and the final diagnosis of cardiac rupture was determined during the surgery. A case of cardiac rupture after mastectomy and radiation is rare, and this is the first report in the Japanese literature to date. The patient could be saved because the operation was performed on stand-by CPB.

Aged↗
PubMed1998

Effect of Nancy Reagan's mastectomy on choice of surgery for breast cancer by US women.

CONTEXT: While the actions of popular figures are believed to influence the behavior of the general public, including health care decisions, little research has examined such an effect. OBJECTIVE: To determine whether a temporal association exists between use of breast-conserving surgery (BCS) for treatment of breast cancer and Nancy Reagan's mastectomy in October 1987. DESIGN/SETTING: Population-based observational cohort study. PATIENTS: Two sources of data: (1) 82 230 women aged 30 years and older who were included in the Surveillance, Epidemiology, and End Results tumor registry because of a diagnosis of local or regional breast cancer from 1983 to 1990; and (2) 80057 female Medicare beneficiaries aged 65 to 79 years who received inpatient surgery for local or regional breast cancer in 1987 or 1988. MAIN OUTCOME MEASURE: Percentage of use of BCS vs mastectomy over time. RESULTS: Compared with women undergoing surgery for breast cancer in the third quarter of 1987 (just prior to Mrs Reagan's mastectomy), women were 25% less likely to undergo BCS in the fourth quarter of 1987 (odds ratio [OR], 0.75; 95% confidence interval [CI], 0.66-0.85) and in the first quarter of 1988 (OR, 0.76; 95% CI, 0.67-0.86). In subsequent quarters, the rate returned to the baseline. In multivariate analyses, the decline was significant among white but not nonwhite women. It was most prominent among women aged 50 to 79 years in the central and southern regions of the country, and most sustained among women living in areas with lower levels of income and education. CONCLUSIONS: Celebrity role models can influence decisions about medical care. The influence appears strongest among persons who demographically resemble the celebrity, and those of lower income and educational status.

Adult↗
PubMed2003

Better cosmetic results and comparable quality of life after skin-sparing mastectomy and immediate autologous breast reconstruction compared to breast conservative treatment.

Preoperative chemotherapy (PCT) can be used in large primary breast cancer to facilitate breast conservative surgery (BCS). Cosmetic results of BCS are influenced by the size of the residual tumour, relative to the size of the breast. After mastectomy, immediate breast reconstruction (IBR) with autologous tissue provides excellent cosmetic outcome and has proven to be safe in breast cancer patients. Besides improving overall and disease free survival, Quality of Life (QoL), body image and cosmetic outcome are also important issues after treatment for breast cancer. In this study, Health-Related-Quality of Life (HRQL) and body image were evaluated, in patients treated with PCT, followed by BCS, or skin-sparing mastectomy (SSM) and perforator-flap breast reconstruction. Additionally, clinical observers assessed cosmetic outcome. All participants were evaluated by the Medical Outcomes Study (MOS) 36-item Short Form Health Status Survey (SF-36, 36 items) and a study-specific questionnaire. An external panel evaluated standardised photographs of the breasts. For all patients, norm-based scores of physical and mental health state are comparable with the general population, except for vitality (VT) score, which is somewhat lower. No significant differences can be observed between both groups. The majority of the patients were satisfied with the appearance of their breasts. The cosmetic results, assessed by the clinical team, were significantly better for patients having IBR, compared to BCS. The mean score was 7.5/10 for IBR, versus 6.0/10 for BCS (p<0.0001).Breast conserving treatment or mastectomy with reconstruction may yield comparable results of QoL, but cosmetic outcome is better after SSM and perforator-flap reconstruction. Patients must be offered both options, and clinicians should stress that both are equally effective.

Adult↗
PubMedDate not supplied

Locally advanced breast cancer in the elderly: curettage mastectomy.

AIMS AND BACKGROUND: Locally advanced breast tumor represents 5-20% of new cases diagnosed every year. The purpose of this study was to report our experience and to compare it with the literature. METHODS: From 1998 to 2003 at the Molinette Hospital in the Turin University Third Division of General Surgery, there were 34 cases of breast cancer in older women (between 70 and 94 years of age), 14 of which (41.18%) were locally advanced breast tumor. We evaluated the type of surgical intervention and anesthesia used, muscular invasion, the presence of receptors positive to estrogens and progesterone, the operative mortality, the percentage of local-regional recurrence, and relapses after a period of time. RESULTS: Among the patients with locally advanced breast tumor, 21.43% (3/14) were at stage IIIA and 78.57% (11/14) at stage IIIB. In 14.29% (2/14) of the cases, Patey's radical mastectomy was performed, in 57.14% (8/14) Halsted's radical mastectomy, and in 28.57% (4/14) a simple mastectomy with the removal of the fascia of the major pectoral muscle. Three (21.43%) patients underwent a second intervention for local-regional disease. None of the patients had distant metastasis in the first 2 years after the operation. Mortality after 2 years was 23.1% (3/13). None of the patients who underwent surgery had adjuvant therapy, usually because it was refused by the patients themselves or their families. All the negative and positive hormone receptor patients received tamoxifen. CONCLUSIONS: Locally advanced breast tumors are frequent in elderly women. In the past, there has been a tendency to surgical under-treatment. As regards locally advanced breast tumor, curettage operations represent the only possibility to improve the quality of life of the elderly. These should be performed after carefully evaluating a series of variables in the general and local condition of the patient, the aggressiveness of the intervention and the life expectancy.

Aged↗
PubMed1999

Retrospective study of the skin-sparing mastectomy in breast reconstruction.

The final appearance of the reconstructed breast is greatly dependent on the relative amounts of skin and breast tissue excised at the time of the mastectomy and on the exact location of the skin incision. A complete mastectomy may be performed using modified skin incisions to avoid the sacrifice of unnecessary breast skin. The type of skin-sparing incision used varies based on the exact location of the tumor and the size of the breast, but it always includes the nipple-areola complex and the biopsy site. The presence of local recurrence, distant disease, or death was determined in 50 consecutive patients who had skin-sparing mastectomies and immediate breast reconstruction between 1985 and 1991 to ascertain the safety of the procedure. The period of follow-up ranged from 23 to 121 months, with a mean of 57 months and a median of 51.5 months. There was no local recurrence, active distant disease was present in five patients, two patients died of distant disease, and there were two unrelated deaths.

Breast Neoplasms↗