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PubMed1984

Recurrent macromastia after subcutaneous mastectomy.

Management of sudden unrelenting breast growth in a young woman included use of antiestrogen hormone therapy and subcutaneous mastectomy. Later, massive breast growth again occurred during pregnancy, requiring a repeat postpartum subcutaneous mastectomy. The dramatic response to a specific antiestrogen agent and the subsequent massive regrowth of breast tissue after subcutaneous mastectomy suggests that breast tissue is extremely sensitive to circulating hormones in certain patients with macromastia. The unusual nature of this patient's recurrent macromastia warrants this review of reports of similarly affected patients and discussion of general concepts in the medical and surgical management of the disorder.

Adult↗
PubMed1995

Improved aesthetics in breast reconstruction: modified mastectomy incision and immediate autologous tissue reconstruction.

A common detraction from the aesthetic results of breast reconstruction is the presence of a transverse mastectomy scar and the patch-like effect of the paler abdominal skin contrasting with the thoracic skin. The technique described involves a modified mastectomy approach in which the breast parenchyma and nipple are first mobilized through a periareolar incision and then removed, along with the axillary lymph nodes, through an axillary counter-incision. A de-epithelialized transverse rectus abdominis musculocutaneous flap is then used to fill the empty "skin brassiere," effectively replacing the glandular defect, and a small patch of skin is exteriorized to match the areolar defect. Excellent symmetry can be attained usually without having to manipulate the opposite breast. After nipple-areolar reconstruction, the breast looks quite normal without the usual stigmas of mastectomy. In 21 breast reconstructions performed since 1991, there has been no incidence of skin flap necrosis or local recurrence.

Adult↗
PubMed1996

Seroma prevention in a rat mastectomy model: use of a light-activated fibrin sealant.

Seroma formation following mastectomy and axillary dissection remains a common and significant problem contributing to patient morbidity and health-care costs. Previous data have suggested that fibrin sealant (FS), a biological adhesive, is capable of controlling lymphatic leakage and assisting with skin graft adhesion. In this study, the use of an experimental, light-activated FS under development by CryoLife (CFS) was evaluated in a rat mastectomy model in order to reduce seroma formation. CFS is a premixed form of FS, containing an inactivator that is reversed in the presence of light, causing sealant to form. In this model, rats underwent mastectomy and extensive dissection of the axillary lymphovasculature. Next, 1 ml of saline or FS was applied to the operative site and the wound was closed. Three groups of animals were evaluated 5 days postoperatively by measuring the volume (in milliliters) of seroma able to be aspirated from the surgical site. The saline control group (N = 20) had a seroma volume (mean +/- standard deviation [SD]) of 4.2 +/- 2.9 ml, while a form of CFS containing human fibrinogen (80 to 100 mg per milliliter) and human thrombin (20 U per milliliter) (N = 20) had a significantly smaller seroma volume of 1.1 +/- 1.6 ml (p < 0.001 analysis of variance). University of Virginia (UVA) FS, containing human fibrinogen (20 mg per milliliter) and bovine thrombin (500 U per milliliter) (N = 20), had a seroma volume of 2.0 +/- 1.6 ml (p < 0.01, compared to control; p > 0.2, compared to CFS). Thus, this form of CFS significantly reduced seroma formation compared to saline control and also appeared to result in a smaller fluid accumulation than with UVA FS, although this trend was not statistically significant. These data suggest that the use of CFS may help to reduce seroma formation in humans.

Animals↗
PubMed2001

Skin-sparing mastectomy with staged tissue expander reconstruction using a silicone gel prosthesis and contralateral endoscopic breast augmentation.

Women with an A or B cup-size breast with no ptosis or glandular ptosis underwent a skin-sparing mastectomy through a periareolar incision. A submuscular tissue expander was placed for immediate reconstruction. The periareolar incision was closed using a modified pursestring technique. The reconstructed breast was expanded to a C cup size. The expander was removed and replaced with a silicone gel prosthesis. At the time of tissue expander removal, the contralateral breast underwent endoscopic augmentation. Nipple-areolar reconstruction was performed during a third stage to cover the mastectomy scar. Implant reconstruction of the breast frequently results in a breast mound that has greater upper breast fullness than the opposite breast. By augmenting the opposite breast, better symmetry is achieved. Burden WR. Skin-sparing mastectomy with staged tissue expander reconstruction using a silicone gel prosthesis and contralateral endoscopic breast augmentation.

Breast Implants↗
PubMed1982

Simple mastectomy and axillary node sampling (pectoral node biopsy) in the management of primary breast cancer.

Axillary node sampling was introduced as a means of defining those patients whose primary breast cancer was treated by simple mastectomy in whom postoperative radiotherapy could be avoided safely. The authors have initiated controlled randomized trials in Cardiff and Edinburgh which have indicated that, provided that nodes are identified for histologic examination, simple mastectomy, node sampling, and selective radiotherapy give equal survival rates to routine radical treatment, whether this is by surgery or radiotherapy. Provided sampling of nodes is adequate and histologically proven, locoregional control also is satisfactory. A current randomized trial comparing this policy with Patey mastectomy has allowed comparative studies of axillary node status. These and follow-up data indicate that for a valid assessment, three to four nodes should be identified by the surgeon for histologic examination, the false negative rate being less than 10%.

Axilla↗
PubMed1992

Long-term phantom breast syndrome after mastectomy.

UNLABELLED: Phantom breast syndrome after mastectomy has already been reported by us and other authors. The temporal course, character, and extent of these phenomena, however, have not yet been elucidated. OBJECTIVE: To investigate in a prospective study the incidence, clinical picture, and temporal course of phantom breast syndrome during a 6-year period. DESIGN: One-hundred twenty women who embarked on consecutive postoperative control or treatment at our department during a 1-year period were interviewed by a standard questionnaire 3 weeks after the operation. Of these, 110 patients were interviewed 1 year later and 69 were interviewed again 6 years later. PATIENTS: The median age at the first interview was 54 years (Quartile (Q)1 = 45 years; Q3 = 62 years) and at the third interview 6 years later, 60 years (Q1 = 51 years; Q3 = 68 years). RESULTS: The incidence of phantom pain and nonpainful phantom sensations was 13.3% and 15.0%, respectively, 3 weeks after mastectomy, 12.7% and 11.8%, respectively, after a year, and 17.4% and 11.8%, respectively, after 6 years. We found significant relationships between preoperative pain and phantom breast syndrome, but no significant relationship between age and the occurrence of this syndrome. Neither postoperative sequelae nor cancer treatment including radiotherapy seemed to affect the occurrence of phantom breast syndrome. Pain in the scar, which was clearly distinguishable from phantom pain, was present in 35.0% of the patients 3 weeks postoperatively, in 22.7% after 1 year, and persisted in 30.9% 6 years later. CONCLUSIONS: The present incidence of phantom-related phenomena is close to the incidence reported by others. However, persistent phantom pain after mastectomy may be more common than usually expected. Also, the persistence of pain in the scar seems to be more common than generally expected.

Age Factors↗
PubMedDate not supplied

Adjustment issues related to bilateral prophylactic mastectomy in women at elevated risk of developing breast cancer.

Breast cancer is the most common cancer diagnosis for North American and Western European women. Increased knowledge in availability of genetic testing has helped to identify those women at high risk of eventually developing breast cancer. This has resulted in more women considering bilateral prophylactic mastectomy as a viable preventative option. Although the efficacy of the procedure has been established, much less is known about the psychological impact of undergoing this procedure. In order to assess these factors, we reviewed what is currently known about the psychological impact of undergoing bilateral prophylactic mastectomy. Searches were conducted and inclusion criteria revealed articles that focused on the psychological components involved with undergoing a bilateral prophylactic mastectomy. The findings are summarized and fell broadly into one or more of the following three areas: (1) satisfaction or regret following the surgery, (2) psychosocial functioning after the surgery, and (3) predictors of quality of life. Plastic surgery nurses have a unique opportunity to impact important psychological considerations, such as expectations of the early postoperative period, body image concerns, and psychological distress.

Activities of Daily Living↗
PubMed1977

Reconstruction of the breast after mastectomy.

We have described our techniques for reconstruction of the breast after a simple mastectomy, a modified radical mastectomy, and a radical mastectomy. Inadequate skin cover must be relieved, preferably by transposition of a thoracoepigastric flap. Not only must a mound be created, but also a nipple-areola complex. The areola can be constructed by nipple-sharing techniques from the opposite breast or by the use of the labia minora and/or the labia majora. However, we advise preservation and banking of the nipple-areola (or areola) by the ablative surgeon, when possible. The remaining breast usually requires some modification to match the reconstructed one.

Breast↗
PubMed1979

Alternatives to subcutaneous mastectomy.

It is our belief that subcutaneous mastectomy often leads to complications, with poor results. In addition, because a considerable amount of breast tissue may be left behind, its value as a prophylactic operation must be questioned. Two alternatives are presented. In our experience, these lead to fewer complications with a more thorough removal of the mammary gland, and achieve a better appearance. The alternatives are (1) simple mastectomy with secondary reconstruction; (2) the type of mastectomy described by Spira--with primary reconstruction using a subpectoral silicone prosthesis covered by muscle and an inferiorly-based dermal flap.

Adenofibroma↗
PubMed1980

Paget's disease of the breast after subcutaneous mastectomy and reconstruction with a silicone prosthesis.

Eight years after subcutaneous mastectomy for extensive fibrocystic disease, a patient developed Paget's disease of the breast associated with an underlying infiltrating duct cell adenocarcinoma. We emphasize the need for meticulous examination of the subcutaneous mastectomy specimen and long-term follow-up examination of the breasts in patients treated with subcutaneous mastectomy.

Breast Diseases↗
PubMed1980

The subcutaneous mastectomy cripple: surgical rehabilitation with the latissimus dorsi flap.

Despite the advances in reconstruction after subcutaneous mastectomy, we have seen a group of patients who have developed disabling complications of their surgery. These patients have become "subcutaneous mastectomy cripples." In general, these patients have two primary reconstructive problems: (1) inadequate coverage of their silicone implant, and (2) loss of breast skin from infection and ischemic necrosis of skin flaps. The latissimus dorsi flap easily corrects these two defects. We have presented our experience with the "subcutaneous mastectomy cripple" and described the use of latissimus dorsi muscle and musculocutaneous flaps in their management.

Adult↗
PubMed1983

Reversed reconstruction in subcutaneous mastectomy: insertion of the prosthesis in advance.

A new approach to reconstruction in subcutaneous mastectomy has been presented. It involves insertion of the prosthesis in advance as the first stage. After a review of 22 consecutive cases of subcutaneous mastectomy, we are convinced that it is the method of choice. In our opinion, most of the complications following subcutaneous mastectomy with augmentation can be diminished by using this technique. Another outstanding advantage is that the patient has less psychological trauma.

Adult↗
PubMed1990

Aesthetic results following partial mastectomy and radiation therapy.

This study was undertaken to determine the aesthetic changes inherent in partial mastectomy followed by radiation therapy in the treatment of stage I and stage II breast cancer. A retrospective analysis of breast cancer patients treated according to the National Surgical Adjuvant Breast Project Protocol B-06 was undertaken in 57 patients from 1984 to the present. The size of mastectomy varied between 2 x 1 cm and 15 x 8 cm. Objective aesthetic outcome, as determined by physical and photographic examination, was influenced primarily by surgical technique as opposed to the effects of radiation. These technical factors included orientation of resections, breast size relative to size of resection, location of tumor, and extent and orientation of axillary dissection. Regarding cosmesis, 80 percent of patients treated in this study judged their result to be excellent or good, in comparison to 50 percent excellent or good as judged by the plastic surgeon. Only 10 percent would consider mastectomy with reconstruction for contralateral disease. Asymmetry and contour abnormalities are far more common than noted in the radiation therapy literature. Patients satisfaction with lumpectomy and radiation, however, is very high. This satisfaction is not necessarily based on objective criteria defining aesthetic parameters, but is strongly influenced by retainment of the breast as an original body part.

Adult↗
PubMed1993

Various methods of breast reconstruction after mastectomy: an economic comparison.

This study is an economic comparison of various methods of breast reconstruction after mastectomy. The hospital bills of 287 patients undergoing breast reconstruction at three institutions from June of 1988 to March of 1991 were analyzed. The procedures examined included mastectomy, implant and tissue-expander reconstruction, and TRAM and latissimus pedicle flaps, as well as free TRAM and free gluteal flaps. These procedures were subdivided into those which were performed at the time of mastectomy and those performed at a later admission. In addition, auxiliary procedures (i.e., revision, nipple reconstruction, tissue-expander exchange, and contralateral mastopexy/reduction) also were examined. Where appropriate, these procedures were subdivided into those performed under general or local anesthesia and by inpatient or outpatient status. Data from the three institutions were converted to N.Y.U. Medical Center costs for standardization. A table is presented that summarizes the costs of each individual procedure with all the pertinent variations. In addition, a unique and novel method of analyzing the data was developed. This paper describes a menu system whereby other data regarding morbidity, mortality, and revision rates may be superimposed. With this information, the final cost of reconstruction can be extrapolated and the various methods of reconstruction can be compared. This method can be applied to almost any complex series of multiple procedures. The most salient points elucidated by this study are as follows: The savings generated by performing immediate reconstruction varies between $5092 (p < 0.05) for free gluteal flaps and $10,616 (p < 0.05) for pedicled TRAM flaps.(ABSTRACT TRUNCATED AT 250 WORDS)

Breast Neoplasms↗
PubMed1999

Radiotransparency of the triglyceride mammary prosthesis: a quantitative analysis with mastectomy specimens.

Breast cancer is the most frequent malignant tumor in women. It is estimated that 10 percent of women will present with a breast cancer during their lives. It is well known that mammography is the best technique for the early diagnosis of nonpalpable tumors, thus improving life expectancy. However, mammary prostheses may hide between 23 and 82 percent of the normal mammary tissue in mammography, and thus may delay the diagnosis of malignant mammary tumors, making prognosis worse. To solve this problem, oil-filled prostheses have been developed. In this study, 14 mastectomy specimens were used. Mammograms of the tissue pieces alone and also mammograms of the tissue pieces covering a 270-cc Trilucent prosthesis were used to verify whether the prosthesis allows observation of malignant signs in mammography. Mammograms were evaluated by an independent experienced radiologist. The following variables were studied: number of mammograms necessary to examine each specimen; kilovoltage and milliamperage necessary for each mammogram; number of microcalcification groups (malignant); number of macroscopic calcifications (benign); and rarefaction areas that were suspected for malignancy. All of these variables were measured for both mammograms for which the mastectomy specimens were covering and those for which the specimens were not covering the prothesis. Finally, the kilovoltage and milliamperage increases necessary to visualize the mammograms with mastectomy specimens covering the prosthesis were determined. Statistical analysis of the results obtained was performed. There were no significant differences in the number of mammograms (p = 0.391), the number of microcalcifications (p = 0.890), the number of macrocalcifications (p = 0.239), and finally in the presence of rarefaction areas (p = 1.000) observed in the mammograms in specimens either covering or not covering the prosthesis. However, there were significant differences (p < 0.001) between the kilovoltage and milliamperage applied to carry out the mammograms of specimens with and without the prosthesis. Thus, Trilucent prostheses allow visualization of the microscopic and macroscopic calcifications as well as rarefaction areas in mammograms. However, these mammograms required a higher kilovoltage and milliamperage compared with specimens not covering the prosthesis. To explore the whole gland, it might be necessary to perform two series of mammograms: one to detect the area shadowed by the prosthesis and one to observe the rest of the peripheral gland.

Breast Implants↗
PubMed2003

The psychological effect of mastectomy with or without breast reconstruction: a prospective, multicenter study.

A multicenter, prospective study ( = 103) examined the psychological implications of women's decisions for or against breast reconstruction. Recognized measures of anxiety, depression, body image, and quality of life were completed before the operation, and 6 and 12 months later. A reduction in psychological distress over the year following the operation was evident in each surgical group (mastectomy alone or immediate or delayed reconstruction), indicating that reconstructive surgery can offer psychological benefits to some women; however, others report improved psychological functioning without this surgical procedure. In contrast to existing retrospective research, the prospective design enabled the process of adjustment during the first year after the operation to be examined. The results indicate that breast reconstruction is not a universal panacea for the emotional and psychological consequences of mastectomy. Women still reported feeling conscious of altered body image 1 year postoperatively, regardless of whether or not they had elected breast reconstruction. Health professionals should be careful of assuming that breast reconstruction necessarily confers psychological benefits compared with mastectomy alone.

Adult↗
PubMed2003

Technical aspects and outcome after prophylactic mastectomy and immediate breast reconstruction in 30 consecutive high-risk patients.

The purpose of this study was to evaluate a consecutive series of patients operated on with prophylactic mastectomy and immediate breast reconstruction with implants, focusing on preoperative assessment, technical aspects of surgical outcome, and number of postoperative complications on a short-term basis. Thirty consecutive healthy women with an increased risk of breast cancer who were therefore operated on with bilateral prophylactic mastectomy and immediate breast reconstruction are reported. A multidisciplinary approach with a geneticist, general surgeon, plastic surgeon, specially trained nurse, psychologist, gynecologist, and oncologist was used preoperatively, with thorough information provided to the patient about the surgery. Eleven patients had gene mutations, and in all patients, the geneticist had performed a risk assessment. The mean age of the patients was 41 years. The technique was modified over time with smaller or special incisions and tailor-made adjustments for each patient. Great care was taken to remove all breast tissue. The tops of the breast nipples were regrafted for cosmetic purposes, and the base was sent for histopathologic examination. In most cases, permanent expander prostheses with detachable valves were used. The areolas were tattooed, if they were not left in place. No patient had occult cancer or carcinoma in situ. Four postoperative complications occurred, including two hematomas, one infection (treated with antibiotics), and one pneumothorax in a patient with severe asthma. All reconstructions were fulfilled. The mean hospital stay was 5.7 days. The time from mastectomy to the final tattooing of the areolas was 260 days. All patients returned to normal daily activities after fulfilled reconstruction.

Adult↗
PubMed2005

Patterns of care for immediate and early delayed breast reconstruction following mastectomy.

BACKGROUND: The purpose of this study was to analyze factors associated with immediate or early (up to 4 months) postmastectomy reconstruction and to update and extend knowledge of patterns of care for reconstruction, using data from a large, population-based surveillance program. METHODS: Procedures included analysis of data for 27,703 women diagnosed with breast carcinoma who underwent mastectomy in the National Cancer Institute's Surveillance, Epidemiology, and End Results Program between 1998 and 2000. Descriptive, univariate, and multivariate logistic regression analyses were used to estimate the odds of selecting immediate or early reconstruction while simultaneously considering independent variables. RESULTS: Results of multivariate analyses showed that, for those women who underwent reconstruction, the proportion of black women was approximately one-third less than that of white women (odds ratio, 0.64; 95 percent CI, 0.55 to 0.74). Women who chose reconstruction were between two and four times more likely [odds ratio range, 2.27 (95 percent CI, 2.04 to 2.52) to 3.56 (95 percent CI, 2.53 to 4.58)] to be younger compared with those women aged 65 years and older, and were nearly 75 percent more likely to be diagnosed at the in situ stage compared with those diagnosed at later stages. Women choosing reconstruction were significantly less likely to live in Iowa and Seattle/Puget Sound and more likely to live in Detroit and Atlanta compared with women in San Francisco/Oakland, Connecticut, Hawaii, New Mexico, and Utah, and were significantly less likely to have never married or be widowed compared with married women. Women undergoing reconstruction were more than twice as likely to have had mastectomy with removal of the uninvolved contralateral breast. CONCLUSIONS: Results of this study updated previous research and showed that immediate or early reconstruction is used by a small but increasing proportion of women diagnosed with breast carcinoma who undergo mastectomy. Previous knowledge was extended by showing that use of reconstruction is most strongly associated with patient age and removal of the uninvolved contralateral breast and, to a lesser magnitude (but still significantly), with race, stage, marital status, and geographic location.

Adult↗