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PubMed2006

Nipple sparing mastectomy with immediate breast reconstruction: a short term analysis of our experience.

Breast cancer surgery has greatly changed over the past decades; nowadays skin-sparing mastectomy (SSM) and immediate reconstruction is considered a valid oncological option to achieve good aesthetic results. The success of SSM led to several studies aimed to investigate NAC involvement whose removal increases the patient's sense of mutilation. In this study the Authors investigate the incidence of recurrences in nipple sparing mastectomy (NSM) comparing it with the other techniques to assess the actual risk of tumor involvement of the NAC; besides, they analyse the patients' satisfaction and the NSM impact on quality of life through the utilization of a questionnaire. Clinical complications, aesthetic as well as oncological and psychological results have been analysed. They conclude that in selected cases NSM can be performed without additional risks because the incidence of recurrence after NSM is similar to that of radical mastectomy. Moreover, the aesthetic and psychological outcome are considered positive by the patients.

Adult↗
PubMed1991

The oncologic risks of skin preservation at mastectomy when combined with immediate reconstruction of the breast.

Most oncologic surgeons agree that removal of the nipple, the areola and any recent scar at the site of the biopsy is necessary during a mastectomy for treatment of carcinoma of the breast. There is less agreement about what should be done with the remaining uninvolved mammary skin. Its preservation facilitates the performance of immediate reconstruction of the breast and can lead to improved aesthetic results, but many oncologists fear that this practice could lead to an increased incidence of local tumor recurrence. To determine if that fear was justified, 87 patients who had undergone unilateral or bilateral mastectomy with immediate reconstruction for treatment of early carcinoma of the breast were studied. Preservation of uninvolved skin was used in all instances. All patients had a documented follow-up study of 12 months or more; the average follow-up time was 23.1 months. One peripheral local recurrence was observed. This 1.2 per cent rate of early local recurrence is lower than that reported from several series using modified radical mastectomy without skin preservation or immediate reconstruction, and suggests that skin preservation does not confer additional risks of local recurrence of carcinoma of the breast in properly selected patients.

Breast Neoplasms↗
PubMedDate not supplied

A randomized clinical trial to investigate the usefulness of the addition of prednisolone to tamoxifen as adjuvants to mastectomy in primary breast cancer patients with a high risk of recurrence: a preliminary report.

The efficacy of the addition of prednisolone to tamoxifen as adjuvants to mastectomy in patients with primary breast cancer who were at a high risk of recurrence was investigated in a randomized trial. Primary carcinomas were collected from a series of 169 patients with loco-regional disease, undergoing mastectomy. The activities of alpha-glycerolphosphate dehydrogenase and 6-phosphogluconate dehydrogenase in the carcinomas were estimated biochemically and the ratio of the two enzymes was used to as the parameter to determine the risk of recurrence. 116 patients with a high risk of recurrence within five years of mastectomy were then randomized to either tamoxifen (2x20 mg/day) or tamoxifen+prednisolone (3x2.5 mg/per day) until recurrence. The patients are currently followed quarterly. The data were analysed at a median follow-up of 26 months (range 7-62 months). The probabilities of both disease-free and overall survival were not significantly different in either arm of the trial, indicating that there is no advantage in combining prednisolone with the antioestrogen. Recently, similar findings in terms of response have been reported for patients with metastatic disease treated with the same combination, raising doubts over the role of prednisolone in the management of patients with endocrine treatments.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Comparison of conservative surgery and radiotherapy with mastectomy in the treatment of early breast cancer.

We have compared overall survival, and local and distant recurrence-free survival in patients with early breast cancer treated by mastectomy, with patients treated by wide local excision and radiotherapy. To do this, we reviewed a consecutive, unselected series of patients presenting with early breast cancer (T0-T2, N0-N1b, UICC) between 1973 and 1981 to one surgeon (J.-C.G.) and one radiotherapist (H.T.F.). The mean follow-up was 9 years (minimum 6 years, maximum 14 years). Only 9 patients received any adjuvant therapy. At 10 years the relapse-free survival was 65% for both groups of patients; the overall 10-year survival was 70% for patients treated by wide local excision and radiotherapy, and 67% for patients treated by mastectomy. The actuarial loco-regional recurrence rate at 10 years was 15% for patients treated by wide local excision and 13% for patients treated by mastectomy. There were no significant differences in overall survival, loco-regional and distant relapse-free survival between the two groups of patients. Our results support other reports that conservative surgery and radiotherapy in early breast cancer does not adversely affect long-term prognosis.

Adult↗
PubMed1990

[Aspects of parasternal lymphnode dissection in radical mastectomy for breast cancer].

In order to clarify the surgical aspects for parasternal lymphnode dissection to improve prognosis in patients with breast cancer, we have retrospectively investigated a total of 319 patients with breast cancer who underwent radical mastectomy with parasternal lymphnode dissection. During the 13 years from 1974 to 1986, 418 patients with breast cancer underwent radical mastectomy. Of these, 319 underwent combined dissection of the parasternal lymphnodes. Among these 319 cases, 36 (11.3%) showed pathologically-confirmed positive lymphnode metastasis. In those cases involving a tumor of diameter greater than 5 cm and more than 4 positive metastatic axillar lymphnodes, then the positive parasternal lymphnode metastasis was higher than 30%. The 5-year survival rate was 88.9% for negative parasternal lymphnode metastasis and 44.7% for positive cases (p less than 0.01 logrank test). The standard adjuvant chemotherapy, chemo-endocrine therapy and radiation therapy, each did not significantly affect or improve prognosis. We conclude that parasternal lymphnode positivity is an important factor in radical mastectomy affecting prognosis and a more powerful adjuvant chemotherapy must be developed to improve prognosis.

Breast Neoplasms↗
PubMed1989

[Indications, technique, results and value of modified radical mastectomy].

Modified radical mastectomy is the most frequent operation performed for therapy of primary breast cancer. In T1 breast cancer patients the breast-conserving therapy is used in up to 40-60% of the patients. In T2 breast cancer patients modified radical mastectomy is still the most frequently used regimen (72-79%). Tumor, breast and psychological characteristics as well a technical facilities must be considered, when determining if modified radical mastectomy is indicated. The operation technique is presented.

Breast↗
PubMed1989

[Psychosocial aspects of bilateral subcutaneous reduction mastectomy in breast cancer].

The authors administered a questionnaire to 56 women with breast cancer who had bilateral subcutaneous mastectomies after Stroembeck/Beller since 1985. In this study, psychological aspects were investigated. There was no change in social behavior; isolation was not noticed. The negative effects on the body image were well accepted and discussed with relatives and friends. Psychological or emotional suffering was rare compared to patients with simple mastectomy. No change in sexual behavior was reported. The sexual function of the mamillae was significantly reduced. Although some cosmetic deformities were obvious, most patients would again choose the subcutaneous reduction mastectomy as operation of choice.

Adaptation, Psychological↗
PubMed1989

[Lymphovenous anastomoses in the prevention of post-mastectomy edema of the arm].

Analysis of the clinical and experimental data has prompted the authors to try surgical correction of an impaired lymph drainage in the arm after radical mastectomy by effecting lymphovenous anastomoses. These anastomoses are intended to eliminate lymphostasis, the principal reason of a postmastectomy edema, by draining the lymph, outflowing from the arm, to the vein. The optimal sites for the formation of a lymphovenous anastomosis have been found the cubital fossa and the anterointernal surface of the lower third of the shoulder. The formation of such an anastomosis simultaneously with radical mastectomy eliminates operation lymphorrhea of the wound already by days 4-5 postoperation, this facilitating the wound healing. Such an approach to radical mastectomy technique may completely prevent the development and progress of a postmastectomy edema of the arm.

Anastomosis, Surgical↗
PubMed1989

Perceptions of postmastectomy patients. Part II. Social support and attitudes towards mastectomy.

To measure the relationships among social support, attitudes toward mastectomy, and self-esteem in women postmastectomy, the Mastectomy Attitude Scale (MAS), the Norbeck Social Support Questionnaire (NSSQ), and Rosenberg's Self-Esteem Scale (RSE) were used. A factor analysis of the MAS yielded six factors that were used in regression analyses. Stepwise regression was used to identify variables that significantly contributed to women's self-esteem. Covariates in the analyses were age, years of education, marital status, and adjuvant chemotherapy. The women (n = 456) averaged 54 years in age, had slightly more than a high school education (mean = 13.0 years), and were predominately married (80%); almost half had adjuvant chemotherapy (45.6%). The overall regression model was significantly (df = 16,440; F = 15.12, p less than 0.0001) and accounted for 35.5% of the variance. Seven of the 16 variables were significant accounting for the following percentages of variance: sexuality, 21.1%; outlook, 5.8%, appearance satisfaction, 3.1%; emotions, 1.3%; college education, 1.2%; adjuvant chemotherapy, 0.6%; and age (60-69), 0.6%. Thus, women's attitudes toward mastectomy accounted for a greater proportion of the variance in their self-esteem than did social support and other demographic variables.

Aged↗
PubMed1986

Modified radical mastectomy with immediate breast reconstruction.

The authors reviewed 100 consecutive patients with breast cancer treated by modified radical mastectomy and immediate breast reconstruction in order to assess the safety and efficacy of this procedure in terms of cancer control. The study began in 1978 and is continuing. The procedure involves a two-team approach with both the general surgeon and the plastic surgeon interviewing the patient preoperatively. Virtually all breast reconstruction involved the use of a submuscular silicone saline type of implant. The median follow-up is 36 months. Slightly over half of these cases were Stage 0 or Stage I. There have been eight recurrences, including five local or regional and three distant. No patient has died of her disease at this point. Cosmesis was equal to or superior to that seen in delayed breast reconstruction. There have been no hidden recurrences. Postoperative depression has been significantly less. We conclude that modified radical mastectomy with immediate breast reconstruction is a safe and effective alternative to modified radical mastectomy alone.

Adult↗
PubMed1988

[Necessity of adjuvant therapy after radical mastectomy based on a study of patients with negative nodes, who have recurrent breast cancer].

The status of the regional lymph nodes influences the prognosis of women with breast cancer who have received a radical mastectomy. To investigate the characteristics of patients with negative nodes who have had a recurrent breast cancer, a statistical study has been carried out involving 279 women who had received a radical mastectomy in our hospital from July 1970 to October 1986. From this study we conclude that systemic adjuvant therapy after radical mastectomy is necessary for patients with negative nodes who have had a breast cancer greater than 2.1 cm (T2) in diameter or a solid-tubular carcinoma.

Adult↗
PubMed1988

Tumor to fascia margin as a factor in local recurrence after modified radical mastectomy.

A new problem has arisen for surgeons now that the pectoralis major muscle is routinely left in place after mastectomy. When the pathologist reports a tumor close to the fascial margin, there has been uncertainty regarding the significance of this finding. In the present study, the histories of 346 women with negative nodes who underwent modified radical mastectomy and had an uninvolved plane under the breast were reviewed. The distance from tumor to fascia was recorded by the pathologist, and the patients were divided into "Close" and "Not Close" groups. The "Close" group (90 patients) had tumors within one low power field (4 millimeters) of the fascia while the "Not Close" group (256 patients) had tumors more than 4 millimeters from the fascial margin. Twelve of the patients had local recurrence within an average follow-up period of 47 months, and a variety of analyses failed to show a statistically significant difference in local recurrence rates between the two groups. The results of this study indicate that tumor to fascia margin, as recorded by the pathologist, is not a strong determinant of local recurrence provided the areolar plane between the breast and the underlying fascia appears uninvolved at the time of mastectomy.

Axilla↗
PubMedDate not supplied

Subcutaneous mastectomy, indications and techniques.

In this paper the indications, the technique and our personal experience with 45 subcutaneous mastectomies (S.C.M.) are reviewed. A bilateral S.C.M. is mainly a prophylactic operation, indicated in patients with premalignant breast disease and in high risk patients with widespread fibrocystic disease. A unilateral S.C.M. is indicated in patients who have already had a mastectomy for carcinoma and whose remaining breast has an increased risk for also developing a carcinoma. The technique which we nowadays prefer, consists of a S.C.M. with immediate submuscular prosthetic reconstruction. The operation is done through a transverse incision for small non ptotic breasts and following a Mc Kissock reduction mammoplasty pattern for large ptotic breasts. The nipple-areola complex is transposed on a wide dermal pedicle. Both the subcutaneous and submuscular spaces are drained and early postoperative mobilisation of the prosthesis is advised. Our experience with 45 subcutaneous mastectomies is reviewed. The complications have been few and occurred mainly in earlier cases where the prosthesis was inserted subcutaneously. Neither necrosis nor circulatory embarrassment of nipple-areola complex were encountered.

Breast Neoplasms↗
PubMed1986

[Long-term results of the radical treatment of patients with breast cancer using sterno-axillary mastectomy].

2,023 patients with breast tumors of medial and central localization (aged up to 60 years) received radical treatment at the Institute and oncological dispensaries of the Republic in 1967-1981 (extensive mastectomy after Urban-Kholdin-680; mastectomy after Halsted-1,343). Extensive mastectomy appeared to considerably improve 5-year survival results in patients with T1-3NO, 1MO tumors.

Axilla↗
PubMed1987

Early discharge after mastectomy. A safe way of diminishing hospital costs.

In order to assess the risks and benefits of early discharge after major breast surgery, the authors analyzed 73 consecutive private patients who underwent operations by four surgeons over a 1-year period. Patient's ages ranged from 34 to 84 years, with a mean of 56.2 years. One patient was excluded from analysis because thoracotomy with a pulmonary resection was performed during the same hospitalization. Thirty-seven patients underwent total mastectomy with complete axillary dissection, 30 underwent segmental mastectomy with complete axillary dissection, and five underwent total mastectomy alone. For each patient the chest wall and axilla were drained by means of one or two Jackson-Pratt (American Heyer Schulte Corp., Goleta, CA) closed suction drains. Prior to discharge, all patients were instructed in the proper technique of drain care and were directed to record the daily drainage. Patients were discharged when they were fully mobile, did not require injectable narcotics, and felt capable of taking care of the drains as outpatients. The length of postoperative stay ranged from 1 to 9 days (mean 2.9), with all but three patients being discharged by the fifth postoperative day. Patient acceptance of early discharge with drains was excellent. Drains were pulled on an outpatient basis, usually within 7 to 10 days after surgery. Complications were observed in twelve patients (18%), consisting of seromas (8 patients), cellulitis (2 patients), and minimal superficial skin necrosis (2 patients). All complications were managed easily on an outpatient basis. We conclude that early discharge with Jackson-Pratt drains remaining in place is safe, well tolerated by patients, and has tremendous potential for substantial cost savings.

Adult↗
PubMed1985

Prophylactic mastectomy for precancerous and high-risk lesions of the breast.

The candidates for prophylactic mastectomy are those who have a family history of breast cancer, multiple fibrocystic masses that have been biopsied or are too numerous to biopsy appropriately, or patients who previously have had cancer in one breast. The decision to perform the subcutaneous mastectomy is one that must be made by the surgeons involved, in consultation with the patient and her husband. The data from subcutaneous mastectomies appear promising and the technical results have improved as experience has been gained. However, 5 to 10 more years are necessary to determine whether this procedure decreases the incidence of breast cancer in these high-risk patients.

Adult↗
PubMed1985

[Postoperative radiation in stage II breast cancer treated by radical mastectomy].

The results of 260 cases of stage II female breast cancer treated by radical mastectomy with or without postoperative radiation (group I or II) in our hospital from April 1964 to December 1978 are analysed retrospectively. In all, the primary lesions were equal to or less than 5 cm in diameter and the axillary lymph nodes were involved pathologically. In group I (137 cases), the 3,5,10-year survival rates were 67.9%, 52.8% and 40.5% respectively but in group II (123 cases) they were 61.0%, 49.6% and 28.9%. The former was higher than the latter but there was no significant statistical difference between them (P greater than 0.05). The incidence of local recurrence was 22.6% in group I, 32.1% in group II (P greater than 0.05). The recurrence rate of the ipsilateral supraclavicular lymph nodes was 1.4% in group I, 15.2% in group II, the former was much lower than the latter (P less than 0.05). The distant metastasis rate in group I was similar to that in group II. The results show that the postoperative radiation can reduce the local recurrence, particularly in the ipsilateral supraclavicular lymph nodes but can not reduce the distant metastasis rate. In addition, it is suggested that the postoperative radiation likely improve the 10-year survival rate of radical mastectomy. Reviewing the current literature, the authors believe that the postoperative radiation really avails against stage II breast cancer treated by radical mastectomy.

Adult↗
PubMed1979

Breast reconstruction following mastectomy for malignant disease: a surgical oncologist's point of view.

The various factors that enter into the decision and recommendation for breast reconstruction after mastectomy must include the time and number of procedures which may be required and the probability of recurrent cancer, but most of all, the degree of enthusiasm of the woman herself for the procedure. Only a small percentage of women who initially express interest in reconstruction actually carry it through to completion, for many reasons. What may have been considered initially as a "must" may lose its attractiveness with the passage of time and the realization that mutilation need not be an absolute synonym for mastectomy. Since there is no perfect reconstruction yet available, there cannot be any arbitrary and dogmatic rules established to separate the "should's" from the "should not's". We must await more technical advances from innovative surgeons and biomedical scientists before that millennium arrives. Concurrently, we must endeavor to find techniques of earlier and earlier detection, in the ultimate hope that the diagnosis of breast cancer may be made at a time early enough in its natural history that mastectomy would no longer be required and cure would be guaranteed!

Breast↗