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PubMed1979

Reconstruction of the breast after mastectomy for cancer.

General surgeons are taking a more active role in the treatment of all the problems which face the patient who undergoes mastectomy. For many of these women, an important part of their adjustment is achieved by reconstruction of the breast. The number of women requesting reconstruction of the breast after mastectomy is increasing, and more women faced with mastectomy are asking their general surgeons for information about the procedure. It is hoped that as reconstruction of the breast becomes more widely appreciated, women will be encouraged to perform more frequent self-examinations and to seek earlier treatment of carcinoma of the breast. It is tempting to speculate that one ultimate benefit may be an improvement in the survival figures associated with this disease.

Breast↗
PubMed1977

[Local regional recurrences after radical mastectomy. Studies of 50 cases].

Resection of locoregional recurrences was performed after mastectomy in 50 cases in the period 1961-1974. An incidence of 2% to 35% is reported for such recurrences, which are due to a variety of factors. In the present series, attention was directed to age at mastectomy and at recurrence, size of primary tumour, presence of axillary metastases, and details of menarche, menopause and pregnancy. Mean age at mastectomy was 50 yr and at recurrence 53 yr. Tumour diameter ranged from 2 to 5 cm in 73% of cases. Lympho node metastases were present in 42%. In 80%, the recurrence was paracicatricial, in 13% parasternal, and in 7% axillary. Treatment consisted of resection, radiochemotherapy or endocrino-ablative management.

Adult↗
PubMed1977

The role of mastectomy in locally advanced breast cancer.

The role of mastectomy in locally advanced breast cancer remains to be established. Experience at the Breast Clinic at the Provincial Hospital, Port Elizabeth, strongly suggests that mastectomy improves local control. The addition of mastectomy to a basic regimen of radiotherapy and adjuvant chemotherapy now forms the basis of a prospective clinical trial.

Adult↗
PubMed1982

Immediate breast reconstruction after mastectomy using a rectus abdominis myodermal flap without an implant.

In the authors' opinion there is no physical reason for a waiting period after total mastectomy before the breast is reconstructed. If the duration of the patient's survival is limited, the sooner the breast is reconstructed the better. The authors do not use silicone implants that may be blamed for the appearance of recurrent tumour but reconstruct the breast with a vertical rectus abdominis myodermal flap immediately after the mastectomy. The flap is an island of skin, fat and muscle extending from the xiphoid to the pubis; it receives its blood supply from the perforators of the superior-inferior epigastric vascular axis on the same side as the mastectomy. The rectus abdominis muscle is the pedicle and carrier of the vessels that feed the ellipse of skin. The flap is doubled on itself and thus forms a cone. It is then passed into the breast area by undermining the intervening bridge of skin. Nipple and areola are grafted onto the flap. This operation enables a wide resection, so that the principles of cancer management are not compromised.

Abdominal Muscles↗
PubMed1981

[Anatomo-surgical considerations on the indications and technic of Patey's radical mastectomy].

After expressing some considerations on "conservative operations" and "limited resections" for cancer of the breast, the Authors describe the technique of performance of modified Patey's radical mastectomy. This operations is less destructive than Halsted's but nevertheless gives a sufficient guarantee of radicality, as confirmed by an examination of the most recent literature. The procedure also allows better aesthetic results to be achieved with subsequent plastic surgery. From the data reported in literature on comparison between the five-year results after radical mastectomy according to Halsted and modified radical mastectomy according to Patey, it can be seen that the survival rate is roughly the same. The local relapse rates both in the cases with lymph node involvement are likewise similar, irrespective of technique. This evidences that Patey's operation is correctly indicated in carcinomas of the breast not yet locally advanced.

Breast Neoplasms↗
PubMed1982

Phantom breast syndrome in young women after mastectomy for breast cancer. Physical, social and psychological aspects.

Phantom breast syndrome (PBS) developed in 11 out of 31 (35.5%) consecutive young women, who had undergone mastectomy for breast cancer. Six to 21 months after operation the patients were asked to take part in a follow-up investigation in which physical sequelae, social condition, and psychological reactions were assessed and related to the presence of PBS. There was no correlation between PBS and postsurgical physical sequelae, those who had received adjuvant radiotherapy, or the side on which mastectomy was performed. Socially, the group with PBS was dominated by women with an occupation outside the home. The psychological examination showed that the group with PBS had a definite predominance of women with a severely damaged body image and impaired sexual function in comparison to the group without PBS. However, the predominance did not reach a statistically significant level. Sexual identity, anxiety, affective disorder or changes in close family relationships did not reveal any distinct pattern. In our opinion, the appearance of PBS should be seen in relation to complex psychological reactions to the mastectomy.

Adult↗
PubMed1982

Brachial plexus block for pain relief after modified radical mastectomy.

Brachial plexus block using an intraclavicular approach was performed at the completion of surgery in 47 patients having modified radical mastectomies. In 48 control patients having similar operations, brachial plexus block was not performed. Of the 47 patients in whom brachial plexus block was performed, 26 (55%) required analgesia during the first 24 hours after the operation, whereas 44 (91%) of the 48 control patients required analgesics (p less than 0.0005). The time elapsed between the end of anesthesia and requirement of the first analgesic was significantly longer when the brachial plexus was blocked (p less than 0.001). The efficacy, simplicity, and safety of blocking the brachial plexus at the completion of surgery following modified mastectomy demonstrate that this technique could be routinely used for the relief of postoperative pain in patients having modified radical mastectomies.

Analgesics↗
PubMed1981

[Are there still indications for subcutaneous mastectomy?].

There are many indications for subcutaneous mastectomy with immediate reconstruction using silicone implants because of the relatively simple technique. The risk of malignant change in simple mastopathy is minimal. However, the inadequacy of an operative technique that leaves behind unknown quantities of breast tissue and the frequently bad cosmetic results make all indications appear doubtful. For these reasons subcutaneous mastectomy should be abandoned and simple mastectomy with immediate reconstruction is to be preferred for the following conditions: (1) Diffuse, painful, simple mastopathy that has been repeatedly biopsied; (2) Non-invasive carcinoma, either intra-duct or in situ.

Breast Neoplasms↗
PubMed1981

The effect of pregnancy on the prognosis of carcinoma of the breast following radical mastectomy.

During the interval from 1940 to 1970, 41 patients treated for primary operable carcinoma of the breast had subsequent pregnancies. Of 27 patients with axillary nodes negative for tumor, nine had first trimester abortions and 14 had pregnancies occur less than two years following mastectomy. Fourteen patients had axillary nodes positive for tumor, seven having first trimester abortions and eight pregnancies having occurred within two years of mastectomy. No detrimental effect of subsequent pregnancy could be demonstrated, even among patients with positive axillary nodes or among those whose pregnancies occurred less than two years following mastectomy. Abortion could not be demonstrated to improve the survival rate. We conclude that pregnancy need not be avoided or terminated among those patients who are apparently free of a recurrence after undergoing treatment for carcinoma of the breast.

Abortion, Therapeutic↗
PubMedDate not supplied

Reconstruction of the breast after mastectomy for carcinoma.

Over a period of five years 20 primary and 60 secondary reconstructions after mastectomy for cancer were performed. The breast mound was created by a silicone implant. In cases of Halsted mastectomy an additional silicone implant was used for the missing anterior axillary fold in a secondary procedure. The reconstruction of the nipple--areola complex was also delayed for several weeks after the implantation. The graft was taken either from the opposite areola or from labia minora in bilateral cases. The remaining breast was adapted for symmetry. Subcutaneous or prophylactic total mastectomy was performed in the high risk group. The main late complication remained the capsular contracture. Local recurrences or general metastasis developed in 5 cases and received appropriate treatment.

Breast↗
PubMedDate not supplied

Reconstruction of the breast following mastectomy.

The experience with 300 reconstructions after mastectomy over a ten year period is reported. The whole reconstruction was performed in one stage, including latissimus dorsi flap, volume replacement by a double lumen prosthesis and nipple-areola reconstruction. In 50% of the cases adjustment of the opposite breast has been necessary to achieve symmetry. Prophylactic subcutaneous or total mastectomy was done in the high risk group. Twenty-six patients have undergone immediate reconstruction at the time of the mastectomy, but the psychological reaction of these patients is less positive, because they have not lived with the deformity. There are few early complications despite of the extended operation. No local recurrence has occurred. The best results are obtained with the latissimus dorsi flap because of maximum protection for the implant and better correction of the absent anterior axillary fold.

Breast↗
PubMedDate not supplied

[Modified subcutaneous mastectomy. Apropos of 916 cases].

Modified subcutaneous mastectomy was described by one of us in 1968; its approach, the dissection of the gland, plastic reconstruction of shape and volume are completely different from the subcutaneous mastectomy performed by plastic surgeons. 3 different time periods were studied to explain clearly evolution in the technic and indications. During many years retrospective studies made it possible to build a procedure according to the new diagnostic means for infraclinical breast cancer and to the constant improving prosthetic material. Therefore our indications for modified subcutaneous mastectomy are as following: suspicious mastopathies are the best indications with a performing choice of the radiologic images which require histologic control some evolutive or evoluated mastopathies some small infiltrating tumors developing in a highly dystrophic glandular surrounding. The numerous in situ cancers accompanying them argue for this choice. some big phyllod tumors or phyllod's recurrences.

Breast Implants↗
PubMed1994

Breast reconstruction following mastectomy.

Breast reconstruction after mastectomy for malignant breast disease is a viable option that should be offered to all women undergoing mastectomy. Reconstruction can be done either at the time of the mastectomy or at any convenient time in the postoperative period when the oncologic care givers and the patient feel comfortable with the decision. Reconstruction of the breast will not interfere with either further therapy or the detection of recurrent tumor. Today more and more women who are fully informed about reconstruction opt for the treatment. No contraindications to reconstructive surgery arise for the properly selected patient.

Breast Neoplasms↗
PubMed1995

Immediate transverse rectus abdominis musculocutaneous flap reconstruction after mastectomy.

BACKGROUND: This study examines the early and long-term outcomes of immediate transverse rectus abdominis musculocutaneous (TRAM) reconstruction of the breast after mastectomy. STUDY DESIGN: The records of all patients undergoing mastectomy and immediate TRAM breast reconstruction between December 1989 and October 1993 were reviewed retrospectively using hospital and breast care center databases. RESULTS: Fifty-three patients underwent a total of 73 immediate TRAM breast reconstructions. Reconstruction was successfully completed in all patients, using 46 pedicle flaps and 27 free tissue transfers. There were no flap losses or cardiopulmonary complications. Overall, the complication rate was 26 percent (29 percent for pedicle TRAM and 22 percent for free TRAM flaps). The median follow-up period among the 53 patients was 22.6 months (range of three to 48 months). All patients employed preoperatively resumed their occupations postoperatively. CONCLUSIONS: Our experience indicates that immediate TRAM breast reconstruction is a safe and viable option for patients seeking reconstruction at the time of mastectomy.

Adult↗
PubMed1995

[Primary breast reconstruction after mastectomy for breast cancer].

Primary breast reconstruction in connection with mastectomy is a well-established procedure. The reconstruction may be carried out by the submuscular implantation of a prosthesis, in some cases preceded by tissue expansion. In situations where there is insufficient skin--or muscle-coverage, a musculocutaneous transposition flap may be used. The aim of breast reconstruction is to prevent the psychosocial sequelae of mastectomy. From experiences with secondary reconstruction, it seems that the reconstruction especially helps correct loss of feminine identity and negative body-image. Certain investigations indicate that primary reconstruction results in a clearly reduced postoperative psychological stress, whereas the extent of social and sexual sequelae seems not to vary when compared to results of secondary reconstruction. Conditions for adjuvant treatment as well as for follow-up concerning loco-regional tumour reappearance do not seem to be affected by the reconstruction. In studies published to date, consisting of relatively small patient groups and short observation periods, numbers without relapse and overall survival are found to be equivalent to that following mastectomy without reconstruction.

Breast Implants↗
PubMed1993

Fibrin adhesive in radical mastectomy.

OBJECTIVE: To find out if fibrin adhesive glue applied locally would reduce the incidence of seroma after modified radical mastectomy for breast cancer. DESIGN: Prospective randomised study. SETTING: City hospital, Sweden. SUBJECTS: 68 women undergoing modified radical mastectomy with axillary clearance for breast cancer. MAIN OUTCOME MEASURES: Amount of postoperative drainage, number of seromas aspirated volumes; length of hospital stay, influence of surgeon operating. RESULTS: Seromas developed in a total of 40/68 patients (59%), 23/36 in the fibrin adhesive group (64%) and 17/32 in the control group (53%); p = 0.5 (95% confidence interval of the difference--0.13 to 0.34). There were no significant differences in the volume of aspirations or in hospital stay. The skill of the surgeon influenced the incidence of seromas, but the differences were not significant (p = 0.5). CONCLUSION: Local application of a fibrin adhesive glue has no effect on the incidence of seroma formation after modified radical mastectomy.

Adult↗
PubMed1993

[A case of long surviving inflammatory breast cancer with bone metastasis, treated by intra-arterial infusion chemotherapy followed by extended mastectomy].

Since there is no established therapeutic strategy in the treatment of stage IV breast cancers and there are cases with bone metastases from the breast showing long survival, the authors usually perform due local control in cases with bone metastases. The present case is an inflammatory carcinoma of the breast with bone metastasis for which doxorubicin hydrochloride was administered via the subclavian and internal thoracic arteries followed by extended mastectomy. The patient is being treated with tamoxifen citrate and doxifluridine and shows no other metastasis at this writing, four years and seven months after the mastectomy. Bone scintigraphy of the patient indicated disappearance of the bone metastases. Since there are long surviving cases among those with a poor prognosis involving inflammatory breast cancer with concomitant bone metastasis, it is necessary to treat cases with locally advanced breast cancer by preoperative intraarterial infusion together with mastectomy, ie, sufficient local control.

Bone Neoplasms↗
PubMed1993

Late recurrence of ductal carcinoma in situ at the cutaneous end of surgical drainage following total mastectomy.

A 40-year-old woman underwent upper outer quadrantectomy breast biopsy which revealed extensive intraductal carcinoma, predominantly comedocarcinoma type, with high nuclear grade. Involved ducts were transected at the edge of the biopsy. Total mastectomy with low axillary lymph node dissection was performed 2 weeks later, showing residual intraductal carcinoma in the upper inner quadrant and no evidence of metastasis. Eight years later, the patient developed two separate foci of recurrent, invasive ductal carcinoma at the exit sites for mastectomy drainage in the subcutaneous skin of the upper abdomen. The mastectomy scar was clinically free of tumor. The biological basis for this unusual sequela of treated intraductal carcinoma is discussed together with its importance for management of early breast cancer.

Axilla↗