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At least 739 records · Page 41Linked to original sources
PubMed1989

A new method of modified radical mastectomy for breast cancer.

We have developed a new type of modified radical mastectomy, the method and clinical results of which are reported herein. In this operation, axillary dissection is performed by the following two approaches. Firstly, the axillary contents are dissected from the highest possible subclavicular point to the pectoralis minor muscle, after partially cutting the sternocostal origin of the pectoralis major muscle. The second approach is from the posterior aspect of the pectoralis minor muscle to the lateral portion of the latissimus dorsi muscle. Parasternal dissection can also be performed for stage II and IIIa cancers with a central or medial tumor. After lymph node dissection, the detached edge of the sternocostal origin of the pectoralis major muscle is resutured to cover the parasternal region. Thus, complete dissection of the axillary nodes is performed whilst preserving the pectoralis major and pectoralis minor muscles. Good clinical results were achieved with respect to radicality, cosmetic effects and function in 28 patients with stage I, II, and IIIa breast cancers who were followed up for between 5 to 8 years. This new operation may therefore be adopted for the majority of patients with Stage I, II, or IIIa cancers, unless massive infiltration into the pectoralis major muscle has occurred. Preservation of both the pectoralis major and pectoralis minor muscles results in a good cosmetic appearance, good functioning of the arm and easy reconstruction of the breast following mastectomy.

Adult↗
PubMed2002

Skin-sparing mastectomy and immediate breast reconstruction: a prospective cohort study for the treatment of advanced stages of breast carcinoma.

BACKGROUND: Recent published series demonstrate the safety and effectiveness of skin-sparing mastectomy (SSM) with immediate reconstruction for the treatment of early-stage breast carcinoma. Although several reports have retrospectively evaluated outcomes after breast reconstruction for locally advanced disease (stages IIB and III), no study has specifically considered immediate breast reconstruction after SSM for locally advanced disease. METHODS: From 1996 to 1998, 67 consecutive patients with breast carcinoma underwent SSM with immediate reconstruction and were prospectively observed. From this group of patients, those with locally advanced disease (stage IIB, n = 12; stage III, n = 13) were analyzed separately. Tumor characteristics, adjuvant therapy, type of reconstruction, operative time, complications, hospital stay, and incidence of local recurrence and distant metastasis were noted. RESULTS: Breast reconstruction consisted of a transverse rectus abdominis myocutaneous flap (n = 22) or a latissimus flap plus an implant (n = 4). The median operative time was 5.5 hours; the average hospital stay was 5.2 days. Complications required reoperation in three patients (12%): partial skin flap necrosis in two and partial abdominal skin necrosis in one. Surgery on the opposite breast for symmetry was required in one patient (4%). Postoperative adjuvant therapy was not significantly delayed (median interval, 32 days). With a median length of follow-up of 49.2 months (range, 33-64 months), local recurrence was present in only one patient (4%), with successful local salvage treatment, and distant metastasis was present in four patients (16%). CONCLUSIONS: SSM with immediate reconstruction seems safe and effective and has a low morbidity for patients with advanced stages of breast carcinoma. Local recurrence rates and the incidence of distant metastasis are not increased compared with those of patients who have had modified radical mastectomies without reconstruction.

Adult↗
PubMedDate not supplied

Florid juvenile (cellular) fibroadenomatosis in the adolescent: a case for subcutaneous mastectomy?

Juvenile or giant fibroadenoma (JF) is an uncommon fibroadenoma variant usually presenting in adolescence. Although these masses are benign, when multiple and bilateral, they present a complex challenge to the attending surgeon, both in diagnosis, and in selection of the most appropriate therapy. Treatment is usually surgical and ranges from simple excision to subcutaneous mastectomy with reconstruction. We report an unusual case of refractory JF, initially treated with combined hormonal and surgical treatment but ultimately requiring bilateral subcutaneous mastectomies to prevent tumor regrowth. This case highlights the occasional difficulty in the management of macromastia in the adolescent female.

Adolescent↗
PubMed2002

Complex regional pain syndrome post mastectomy.

Complex regional pain syndrome includes the previously termed condition reflex sympathetic dystrophy. It is a chronic pain disorder diagnosed on the basis of symptoms and skin changes and is known to have a psychological element. It is a rare complication after surgery, especially mastectomy. We present two females who developed this syndrome after undergoing mastectomy for chronic mastalgia. These cases demonstrate that amputation of an organ for chronic pain can result in reflex sympathetic dystrophy developing in a nearby limb.

Adult↗
PubMed1998

Seroma with fibrous capsule formation requiring a surgical resection after a modified radical mastectomy: report of a case.

Seroma formation is the most common complication of a modified radical mastectomy for breast cancer. Although various management or risk factors for seroma formation have been previously reported, little has been published concerning seromas with fibrous capsule formation which ultimately require a surgical resection. We herein present a case who developed a seroma with a fibrous capsule after a modified radical mastectomy for breast cancer, in spite of an uneventful intraoperative and postoperative course. The seroma was refractory to all conventional treatments, and thus finally required a surgical resection.

Axilla↗
PubMed2000

Delayed infection of a lymphocele following mastectomy with immediate breast reconstruction: report of a case.

We report herein a rare case of delayed infection of a lymphocele following mastectomy with immediate breast reconstruction. A 38-year-old woman presented to our hospital 7 months after undergoing a left-modified radical mastectomy with an immediate breast reconstruction, following the sudden development of a giant mass in the left thoracoabdominal region as well as a high fever and shivering. Ultrasonography and a computed tomographic scan revealed massive fluid retention extending from the left axilla to the lower abdominal region. Puncture drainage was performed three times and the injection of an antibiotic directly into the cyst resulted in resolution of the fluid. This massive retraction of fluid was considered to have resulted from a delayed infection of an axillary lymphocele.

Adenocarcinoma↗
PubMed2000

Women's regrets after bilateral prophylactic mastectomy.

BACKGROUND: Primary prevention strategies such as chemopreventive agents (e.g., tamoxifen) and bilateral prophylactic mastectomy (PM) have received increasingly more attention as management options for women at high risk of developing breast cancer. METHODS: A total of 370 women, who had registered in the Memorial Sloan-Kettering Cancer Center National Prophylactic Mastectomy Registry, reported having undergone a bilateral PM. Twenty-one of these women expressed regrets about their decision to have a PM. A psychiatrist and psychologist interviewed 19 of the women about their experiences with the PM. RESULTS: A physician-initiated rather than patient-initiated discussion about the PM represented the most common factor in these women. Psychological distress and the unavailability of psychological and rehabilitative support throughout the process were the most commonly reported regrets. Additional regrets about the PM related to cosmesis, perceived difficulty of detecting breast cancer in the remaining breast tissue, surgical complications, residual pain, lack of education about the procedure, concerns about consequent body image, and sexual dysfunction. CONCLUSIONS: Although a PM statistically reduces the chances of a woman developing breast cancer, the possibility of significant physical and psychological sequelae remains. Careful evaluation, education, and support both before and after the procedure will potentially reduce the level of distress and dissatisfaction in these women. We discuss recommendations for the appropriate surgical and psychiatric evaluation of women who are considering a PM as risk-reducing surgery.

Adult↗
PubMedDate not supplied

Beyond palliative mastectomy in inflammatory breast cancer--a reassessment of margin status.

BACKGROUND: Inflammatory breast cancer is a locally advanced tumor with an aggressive local and systemic course. Treatment of this disease has been evolving over the last several decades. The aim of this study was to assess whether current therapies, both surgical and chemotherapeutic, are providing better local control (LC) and overall survival (OS). We also attempted to identify clinical and pathologic factors that may be associated with improved OS, disease-free survival (DFS), and LC. METHODS: A 25-year retrospective review performed at the City of Hope National Medical Center identified 90 patients with the diagnosis of inflammatory breast cancer. RESULTS: Of the 90 patients identified with inflammatory breast cancer, 33 received neoadjuvant therapy (NEO) consisting of chemotherapy followed by surgery with radiation (n = 26) and without radiation (n = 7). Fifty-seven patients received other therapies (nonNEO). Treatments received by the nonNEO group consisted of chemotherapy, radiation, mastectomy, adrenalectomy, and oophorectomy, alone or in combination. The median follow-up was 28.9 months for the NEO group and 17.6 months for the nonNEO group. Borderline significant differences in the OS distributions between the two groups were found (P = .10), with 3- and 5-year OS for the NEO group of 40.0% and 29.9% and for the nonNEO group of 24.7% and 16.5%, respectively. DFS and LC were comparable in the two groups. Lower stage was associated with an improved OS (P < .05). The 5-year OS for stage IIIB was 30.9%, compared to 7.8% for stage IV. In those patients with stage III disease who were treated with mastectomy and rendered free of disease, margin status was identified by univariate analysis to be a prognostic indicator for OS (P < .05). The 3-year OS, DFS, and LC for patients with negative margins were 47.4%, 37.5%, and 60.3%, respectively, compared to 0%, 16.7%, and 31.3% in patients with positive margins. CONCLUSIONS: This study suggests that in patients with inflammatory breast cancer and nonmetastatic disease, an aggressive surgical approach may be justified with the goal of a negative surgical margin. Achievement of this local control is associated with a better overall outcome for this subset of patients. The ability to obtain negative margins may further identify a group of patients with a less aggressive tumor biology that may be more responsive to other modalities of therapy.

Adult↗
PubMed2006

No nodal cutoff in node-positive breast cancer women treated with mastectomy.

PURPOSE: To search for a prognostic cutoff in the number of involved axillary lymph-nodes, in T1-T2 node-positive (N+) breast cancer treated with mastectomy without radiotherapy. MATERIALS AND METHODS: Women aged 51-64 years presenting with a first primary T1-T2, N+, M0 unilateral carcinoma diagnosed in 1988-97 were selected from the SEER 9-registries. Cutoffs from 1 to 23 nodes were scanned with Cox models that included diagnostic year, age, area, race, marital status, histology, grade, hormone receptors, tumor location, size, and nodes examined. Outcomes were breast cancer specific and any-cause death. RESULTS: The overall mortality hazard ratio of a higher number of involved nodes as compared with a lower number ranged from 1.78 [95% confidence 1.58-1.99] with 1-node cutoff, to 3.65 [2.52-5.29] with 23-nodes cutoff. Breast cancer specific mortality hazard ratio ranged from 1.99 [1.73-2.29] with 1-node cutoff, to 4.63 [3.11-6.91] with 23-nodes cutoff. The graph of the hazard ratios showed a continuously increasing risk of overall and breast cancer specific mortality, without any identifiable cutpoint change. CONCLUSION: The results show no prognostic cutoff in the number of involved axillary lymph nodes in patients who did not receive radiotherapy. The rationale of nodal cutoff as an indicator for post-mastectomy adjuvant treatment in node-positive patients should be questioned.

Breast Neoplasms↗
PubMed1982

Treatment of primary breast cancer without mastectomy. Review of the literature.

During the 54-year period between 1927 and 1981, at least 4,290 patients with breast cancer treated with lumpectomy and/or radiotherapy as the primary therapeutic modality have been described. In all but two of the 24 reported studies, survival rates, even to 30 years, were similar to those of patients treated with variations of radical mastectomy, and the cosmetic result following treatment that preserved the affected breast was judged good to excellent by 81 to 85 percent of the patients so treated. The two exceptions were both in series of patients treated with doses of radiation known to be inadequate by current standards. We all have the responsibility of offering our patients the most effective treatment available with the fewest possible short-term and long-term side effects. This goal requires a constant, careful reevaluation of our treatments and results, as well as an open mind. According to available data, the combination of lumpectomy, axillary node dissection, external beam radiotherapy and iridium implant constitutes an acceptable alternative to mastectomy as treatment for primary cancer of the breast.

Adult↗
PubMed1987

Adjuvant chemotherapy after conservative surgery plus irradiation versus modified radical mastectomy. Analysis of drug dosing and toxicity.

In a cohort of 764 evaluable patients with primary breast cancer, we have compared the ability to deliver full doses of adjuvant chemotherapy in two patient groups: one undergoing conservative breast surgery plus irradiation and the other having modified radical mastectomy as primary treatment for the cancer. We have also analyzed the toxicities of the concurrent radiation and chemotherapy. The group having irradiation had significantly more moderate leucopenia, which caused a short delay (median, three weeks) in the overall time necessary to complete the planned chemotherapy. However, among those patients who completed the planned chemotherapy cycles, the fraction who received more than 85 percent average drug doses was 96 percent or higher in all but one small subgroup. Interaction between the irradiation and chemotherapy caused mild breast skin reactions in 42 percent of patients so analyzed and worse reactions in 12 percent. When follow-up tracings were performed, mild electrocardiogram abnormalities occurred in 19 percent of patients, apparently because of the irradiation. We conclude that intravenous adjuvant chemotherapy, as administered in this study, can be delivered as intensely with conservative primary treatment as after mastectomy and that toxicity is mild, rarely requiring intervention or treatment discontinuation.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1976

Radical mastectomy in a patient with coexistent Graves' disease.

A patient with the coincidental occurrence of thyrotoxicosis and medullary carcinoma of the breast is reported. Survivorship was considered optimal by performance of a mastectomy without the six to eight weeks' delay required to achieve euthyroidism by antithyroid drugs or radioiodine. The hyperthyroidism was controlled with propranolol, permitting an uneventful radical mastectomy.

Adult↗
PubMed1978

Surgical morbidity after mastectomy operations.

The records of 146 consecutive patients with mastectomy operations over a three year period were reviewed. Of these, ninety-three (63.6 per cent) had one or more complications secondary to surgery. There were 175 complications, of which complications, of which 107 (73.2 per cent) were wound-related. Seroma formation occurred most frequently but was of minor consequence. The incidence of flap necrosis was 19.1 per cent, with cellulitis or suppurative infection appearing in thirteen patients. Immediate postoperative edema of the arm was fairly rare (2.7 per cent) and appeared related to delayed wound healing. Postoperative complications after total, modified radical, and radical mastectomy present problems unique from those seen after other major surgery, in that local complications predominate. The very nature of the procedure, with the creation of large thin skin flaps, extensive axillary dissection, and an open wound for a prolonged period of time, predisposes to wound morbidity.

Adult↗
PubMed1981

Patient acceptance of mastectomy for cancer.

Of 300 women who had mastectomy for breast carcinoma, 278 (93 percent) responded to a questionnaire about how well they accepted loss of a breast. Of those responding, 73 percent stated that they had no appreciable adverse reaction to the extent of the operation. Twenty patients (7 percent) cited major work, social or sexual problems resulting from mastectomy. Among the 20, sexual problems--cited by 85 percent--predominated. Four (1 percent) of the 278 patients expressed major dissatisfaction with the cosmetic result of an external prosthesis. Two of these patients and four others had surgical reconstruction of the breast, which was satisfactory in five.

Breast↗
PubMed1986

Early discharge after modified radical mastectomy.

Thirty-nine patients underwent modified radical mastectomy and were discharged with their suction drains and sutures in place after a mean postoperative stay of 4.7 days. Drains and sutures were removed at the first office visit. There were no infections, and late seromas developed in only 21 percent of the patients. Another group of patients were hospitalized until drainage effluent from their tubes was less than 30 ml/day, at which time the drains were removed and the patients discharged. This group had a mean postoperative stay of 9.5 days, and an incidence of late seroma of 43 percent. These data suggest it is both safe and effective to discharge patients 3 to 5 days after mastectomy at considerable potential cost savings due to the reduced hospital stay.

Adult↗
PubMed1982

Experience with 250 cases of subcutaneous mastectomy.

Subcutaneous mastectomy is a recognised form of curative treatment in cases of carcinoma lobulare in situ and of any atypical proliferative mastopathy. Moreover a subcutaneous mastectomy should be recommended for these patients when multiple biopsies have been performed and long-term mammographic supervision is no longer possible. By using all the existing skin and subcutaneous tissue a good aesthetic result can be achieved and prostheses should only be used in cases where the existing tissues cannot provide an adequate breast reconstruction. The operative technique developed by Schrudde is described and the results of 250 cases are presented.

Adult↗
PubMed1984

The results of breast reconstruction following mastectomy.

This paper is a retrospective study of the techniques, complications and results of breast reconstruction following mastectomy in 82 patients, 66 of whom had breast cancer. The mean length of follow-up was 3 years 8 months. Of the 74 patients who were reviewed 61 were pleased with the results. Eight patients died, 7 of them from disseminated breast cancer. In our experience breast reconstruction is a very worthwhile procedure in motivated patients and may reduce the psychiatric morbidity of mastectomy.

Adult↗
PubMed1995

Silicone injection granulomas of the breast: treatment by subcutaneous mastectomy and immediate subpectoral breast implant.

Silicone leakage from silicone breast prostheses with or without rupture of the prostheses is of great concern. Silicone injection for breast augmentation is still common in Asia, even though silicone injection induced granulomas and associated malignancy have been reported. A series of 24 women who had bilateral silicone injection granulomas in their breasts, requiring subcutaneous mastectomies and immediate breast reconstruction, is presented. Most of the patients had had one silicone injection into each breast. The patients' average age was 37.5 years and removal of the granulomas was done 3-20 years (mean 8.4 years) after the silicone injections. All patients had breast lumps and some had mastitis (21%) and dermatitis (16%) but none had palpable axillary lymph nodes. Mammograms showed diffuse, multiple granulomas of various sizes. Subcutaneous mastectomies were done via inframammary incisions. Immediate breast reconstruction was carried out with double-lumen silicone/saline implants or textured saline-filled implants inserted subpectorally via a separate axillary incision. The implants were entirely covered by the pectoralis major muscle and partially dissected serratus anterior fascia. Two cases had wound infections (8%) as early complications, and two cases developed hypertrophic scars (8%). At 6-41 months follow-up (mean 21.4 months), 69% of the patients had Baker II and 31% of the patients had Baker III breast capsular contractures.

Adult↗