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PubMed1984

Time-limited thematic group with post-mastectomy patients.

Twenty-four post-mastectomy women participated in thematic time-limited groups. About half of the women reported that the groups helped them a lot, and in these women a significant decrease in psychological distress, especially anxiety and depression, was found. In the few who reported they were not helped, an increase in psychological distress was found, especially in hostility. The main concerns of the post-mastectomy women are described, as well as the need to develop predictors about who can benefit from time-limited groups. The preliminary data seems to indicate that patients became less prone to improvement with time (after the operation) and that patients who have the wish to share their experience with others do especially well in groups.

Adaptation, Psychological↗
PubMed1988

Psychosocial consequences of mastectomy: levels of morbidity and associated factors.

Psychosocial morbidity was examined in 90 consecutive patients with Stage I or II breast cancer aged under 70 treated by mastectomy. In the two years after surgery, the prevalences of depression and anxiety of clinical degree were generally under 10%--less than half of those reported in early controlled studies in the United Kingdom. However, cancer patients aged under 50 showed significantly higher prevalences compared with cancer patients aged 50 or above and compared with matched control subjects with benign breast disease. Social and work problems were common at all ages. Sexual problems were more severe than mood disturbance. Patients at risk of mood disturbance could be predicted by a combination of age, measures of emotional lability and whether or not they were receiving chemotherapy. The results of this study are consistent with those of other recent reports from the United Kingdom and United States, which show that following mastectomy, mood disturbance of clinical degree may be considerably less common than has previously been supposed.

Adaptation, Psychological↗
PubMed1984

Effects of mastectomy and vagotomy on grooming behavior of the rat: possible involvement of prolactin.

Surgical interventions such as unilateral mastectomy or vagotomy affect plasma prolactin (PRL) levels. Right-side mastectomized rats exhibiting high levels of plasma PRL showed increased grooming behavior. Left-side mastectomized rats with low levels of plasma PRL performed poor grooming activity. Bilateral mastectomy that caused a slight increase in plasma PRL levels was followed by enhanced grooming behavior. Both left and right vagotomy resulted in a significant increase in plasma PRL levels. However, only left-side vagotomized rats exhibited increased levels of grooming behavior, while no difference between right-side vagotomized rats and controls occurred. It is possible that changes in plasma PRL levels induced by surgical interventions affect grooming activity of the rat. However, the hypothesis that the integrity of peripheral organs is important for the display of grooming behavior cannot be ruled out.

Animals↗
PubMed1988

Isolated local-regional recurrence following mastectomy for adenocarcinoma of the breast treated with radiation therapy alone or combined with surgery and/or chemotherapy.

The results of radiation therapy alone or combined with surgery and/or chemotherapy are reported for 47 patients who presented with local and/or regional recurrence without evidence of distant metastases following initial management of adenocarcinoma of the breast with radical or modified radical mastectomy (43) or simple mastectomy (4). Patients were treated between October 1964 and March 1983 at the University of Florida; all have a 2-year minimum follow-up and 42/47 (89%) have had follow-up for greater than or equal to 5 years. The overall actuarial local-regional control rates were 80% at 2 years, 68% at 5 years, and 61% at 10 years. The 5-year actuarial local-regional control rates by site and extent of disease were as follows: single chest wall nodule, 92%; multiple chest wall nodules, 49%; regional lymph nodes, 66%; and multiple sites, 64%. The 5- and 10-year actuarial determinate disease-free survival rates for all patients were 41 and 17%, respectively. The 5- and 10-year actuarial survival rates for all patients were 50 and 34%, respectively.

Adenocarcinoma↗
PubMed1989

Effects of breast cancer and mastectomy on emotional support and adjustment.

Wortman and Dunkel-Schetter (J. Soc. Issues 35, 120-155, 1979) have argued that victims of misfortune are likely to experience reduced social support at a time when support is needed most. The resulting self-doubt and isolation are thought to increase the victims' distress. Hypotheses derived from their analysis were tested by administering social and emotional adjustment inventories to 301 women who had undergone a mastectomy as treatment for breast cancer, and to 100 women diagnosed as having benign breast lumps (no-cancer, no-mastectomy controls). As expected, perceived emotional support was positively correlated with adjustment. However, contrary to Wortman and Dunkel-Schetter's analysis, the cancer patients perceived greater emotional support from friends and family than did the controls. In addition, these cancer 'victims' were no more socially or emotionally maladjusted than women without cancer.

Adult↗
PubMed1989

The post-mastectomy pain syndrome and the effect of topical capsaicin.

Eighteen patients with the post-mastectomy pain syndrome (PMPS) form the basis of this study. PMPS probably occurs in a minority of women after mastectomy. The onset of persistent pain usually occurred immediately or very shortly after the operation. The pain location or sensory findings implied involvement of the territories of other cutaneous branches of the intercostal nerves as well as the intercostobrachial nerve. A variety of treatment approaches were unsatisfactory. Twelve of 14 patients completing treatment with topical 0.025% capsaicin showed improvement after 4 weeks and 8 (57%) were judged to be good or excellent responses. Six months after the trial's completion 50% of those followed continued to have good pain relief. This therapy should now be subjected to a randomized, double-blind, placebo-controlled trial.

Administration, Topical↗
PubMed1982

Aspects of breast cancer control: is prophylactic mastectomy a feasible modality?

Even though mammographic techniques have improved and small tumors of 0.5 cm in diameter can be detected, decreased breast cancer mortality has not yet resulted. Because small tumors may cause systemic spread, in many patients breast cancer at the time of diagnosis is a systemic disease which is incurable. A reduction in breast cancer mortality seems possible by prophylactic bilateral mastectomy in women at extraordinary high risk of breast cancer. These are patients with (a) breast cancer in mother and sister, (b) breast cancer in mother or sister and a combination of various risk factors (early menarche - late menopause, nulliparity, late first pregnancy), (c) noninvasive malignant breast disease (carcinoma in situ), (d) therapy-resistant fibrocystic disease with intolerable pain and/or extreme anxiety (carcinophobia, and (e) benign breast neoplasia with malignant potentials (cellular atypia = precancerosis). Also, in breast cancer patients without regional and systemic spread and who are at high risk for developing cancer in the other breast, prophylactic contralateral mastectomy may be indicated. These are patients with (a) unilateral invasive breast cancer in the premenopause and a family history (mother or sister) of breast cancer, (b) unilateral invasive lobular carcinoma or tubular (ductal) carcinoma, and (c) unilateral invasive breast cancer and precancerous lesions in the other breast.

Adult↗
PubMed1988

Prognostic implications of age in breast cancer patients treated with tumorectomy and irradiation or with mastectomy.

Conservation breast treatment is of particular interest to young women, but whether saving the breast carries a penalty in shorter survival or local-regional recurrent disease has not been well-established. At The University of Texas M.D. Anderson Hospital and Tumor Institute at Houston, 1161 patients treated prior to 1983 with Stage I or II breast cancer were reviewed. Of these patients, 378 were treated with tumorectomy plus irradiation, and 783 were treated with radical or modified radical mastectomy. The two patient groups were compared relative to local-regional disease recurrence and overall and disease-free survivals. Local recurrences in the breast appear to be more frequent in patients less than or equal to 35 years of age treated with tumorectomy and irradiation than in patients older than 35 years, but in patients aged less than or equal to 50 or greater than 50 or less than or equal to 35 or greater than 35 years, there was no significant statistical difference between tumorectomy and irradiation or mastectomy nor was there a difference in disease-free survival. Overall survival rates favored patients treated by tumorectomy and irradiation.

Adult↗
PubMed1992

Post-mastectomy radiotherapy following adjuvant chemotherapy and autologous bone marrow transplantation for breast cancer patients with greater than or equal to 10 positive axillary lymph nodes. Cancer and Leukemia Group B.

Between 2/87 and 2/91, 49 women with operable breast cancer involving greater than or equal to 10 axillary nodes were treated following mastectomy, with four cycles of Cyclophosphamide, Adriamycin, 5FU, followed by high doses of Cyclophosphamide, Cisplatin, Carmustine (HDCT) with autologous bone marrow transplant support. Forty patients received local-regional radiotherapy (generally to the chest wall, internal mammary, supraclavicular, +/- axillary nodal areas; minimum 44-50 Gy, 1.8-2 Gy/fraction, +/- 10-15 Gy scar boost; standard radiation techniques). The first nine patients did not receive local-regional radiotherapy. Three developed a local-regional failure (6-12 months after HDCT); six are without evidence of disease. Local-regional radiotherapy (LR XRT) was delivered to the subsequent 40 patients following HDCT+autologous bone marrow transplant. Six received less than 44 Gy of the planned local-regional radiotherapy due to significant toxicity and one of these failed locally. Only one local failure was observed among the 34 patients who received greater than or equal to 44 Gy. Two additional patients developed distant metastases. None of these 40 patients have failed in the axilla despite the fact that the axilla was irradiated in only 18 cases. Overall, 36/40 (90%) of these patients are without evidence of disease 4-30 months following HDCT (approximately 10-36 months after mastectomy, median 22 months). Radiotherapy was interrupted or discontinued because of progressive dyspnea, thrombocytopenia, or neutropenia in nine patients. Further studies to determine the roles of local-regional radiotherapy and HDCT in the development of these toxicities are underway. These encouraging results suggest that HDCT + autologous bone marrow transplant+local-regional radiotherapy may improve the survival rate in these high risk patients. A national randomized study to test the efficacy of this HDCT regimen is currently underway (Cancer and Leukemia Group B#9082 and Southwest Oncology Group #9114).

Adenocarcinoma↗
PubMed1995

A blended beam technique to decrease toxic effects of post mastectomy irradiation by combining and sequentially mixing electrons and photons.

We studied 24 patients with Stage II or Stage III breast carcinoma, post total mastectomy, who had received adjuvant loco-regional irradiation (16 patients) or were irradiated for chest wall recurrence (8 patients), along with systemic chemotherapy and/or hormonotherapy. A technique is described for combining and sequentially mixing electron and photon beams. This blended beam method results in less severe acute and chronic skin reactions. Dose distribution to the chest wall and mediastinum are improved compared to the traditional photon-only techniques. At a median followup of four years our expected loco-regional control rates are not compromised. This technique is recommended for selected post mastectomy patients to reduce toxic effects of chest wall irradiation, particularly when chemotherapy lowers skin tolerance and the reserves of the heart, lung and bone marrow.

Aged↗
PubMed1992

Mastectomy or tamoxifen as initial therapy for operable breast cancer in elderly patients: 5-year follow-up.

135 consecutive patients aged over 70 years with operable primary breast cancer (clinically maximum diameter 5 cm) were randomised to either wedge mastectomy or tamoxifen 20 mg twice daily as initial therapy. The mean time from randomisation is now 65 months. There was no difference between the two groups in terms of overall survival or cause of death. Likewise, the groups were similar for site of initial metastatic disease and the probability of developing metastatic disease. However, failure of locoregional control was significantly greater in the tamoxifen group. The optimum treatment for elderly patients with operable breast cancer includes mastectomy.

Aged↗
PubMed1995

Ten-year results comparing mastectomy to excision and radiation therapy for ductal carcinoma in situ of the breast.

The 10-year results of 300 patients with ductal carcinoma in situ (DCIS) without microinvasion are reported; 167 treated with mastectomy and 133 treated with excision and radiation therapy. There was a significant difference in disease-free survival at 10 years, in favour of those treated with mastectomy, 98% versus 81% (P = 0.0004). Multivariate analysis confirmed nuclear grade as the only significant predictor of local recurrence (P = 0.02) or invasive local recurrence (P = 0.03) in patients with DCIS treated with excision and radiation therapy. There was no difference in breast cancer-specific survival or overall survival between the two treatment groups.

Adult↗
PubMed2004

Personal health behaviors in women who have undergone risk-reducing mastectomy.

BACKGROUND: Risk-reducing mastectomy (RRM) remains an effective yet controversial modality for the primary prevention of breast cancer. Is the choice of RRM consistent with a generally proactive healthy lifestyle? METHODS: The National Prophylactic Mastectomy Registry is a volunteer database comprised of 460 women who have undergone bilateral RRM. Each patient received a questionnaire drawn from the Centers for Disease Control Behavioral Risk Factor Surveillance System. Their responses were compared with gender-specific national data from the Centers for Disease Control. RESULTS: Women in the RRM group were statistically more likely to engage in risk-reducing personal health behavior including not smoking, exercising, maintaining their health, and taking advantage of screening programs. CONCLUSIONS: Women in the registry who underwent RRM practiced a more "healthy" lifestyle than gender-matched controls. Therefore, the decision to have prophylactic surgery may have been part of a proactive approach toward their overall physical well-being.

Adult↗
PubMed2005

Immediate breast reconstruction with definitive anatomical implants after skin-sparing mastectomy.

One-stage breast reconstruction with definitive implants was the original method of breast reconstruction. It gave a round breast with a fixed shape. Lack of skin after mastectomy was the main concern who led to the development of techniques to provide 'new' breast skin such as autogenous reconstruction and tissue expanders. This made the use of definitive implants almost obsolete. Since skin-sparing mastectomy (SSM) basically removes the mammary gland and the nipple-areolar complex preserving almost all mammary skin, it makes the use of definitive implants in immediate breast reconstruction possible again. Moreover, the advent of anatomically shaped implants overcomes the drawback of round shape: the anatomical implant with hyperprojected lower pole and short upper pole matches very well the profile of a real breast. The authors report their experience in 36 immediate breast reconstruction after SSM with short upper pole-hyperprojected silicone gel prostheses carried out between October 2001 and October 2003. In most cases SSM is performed through a circumareolar incision. Axillary dissection is preferably performed through the same incision. The anatomical implant is placed in a submuscular position superiorly and in a subfascial pocket inferiorly. Because of skin redundancy and easy distension of subfascial tissue in the inferior pole of the breast, the implant fills the skin of the inferior mammary pole without needing any skin expansion. Whenever possible, the skin incision is closed with a purse-string suture. The skin will look very wrinkled at the end of the surgery, but it will flatten out in a few weeks. The contralateral breast is simultaneously corrected, if needed. Outcome was assessed by evaluation of photographs performed by the authors, by the patients themselves and by a blinded group of surgeons who evaluated breast volume and shape, breast symmetry, and overall outcome. More than 90% of each of these parameters was scored as good or excellent. Complication rates was low with a 8.3% rate. The use of definitive implants in immediate breast reconstruction after SSM is a one-stage breast reconstruction with low morbidity and very good results, and it is associated with high level of patient and surgeon satisfaction.

Adult↗
PubMed2005

Two staged breast reconstruction following prophylactic bilateral subcutaneous mastectomy.

The aim of this retrospective study was to evaluate the results in patients who underwent bilateral subcutaneous mastectomy (BSCM) for prophylaxis against invasive breast cancer. All patients were operated on with the same protocol regarding indications and surgical method. Reconstruction was completed in two stages with tissue expanders and permanent round or shaped rough textured gel filled silicone implants. The study includes 52 patients with a mean age of 39.5 years operated on in the period 1991-2000; the period of follow-up ranged between 3 and 12 years with a mean of 7. In this series, not a single case of invasive cancer developed, and the aesthetic results are considered very satisfactory. This data strengthens the case of subcutaneous mastectomy as a valid prophylactic operation.

Adult↗
PubMed2006

Large fasciocutaneous perforator based V-Y advancement flap for large post-mastectomy wound reconstruction--our experience with three cases.

Old and frail patients with advance breast malignancy require mastectomy which often results in large defects requiring soft tissue cover. We present three cases of large fasciocutaneous perforator based V-Y advancement flaps for reconstruction of large post-mastectomy wounds in older patients with large tumours. This technique reduces the morbidity of patients who have severe co-existing morbidity factor in addition to the advance breast disease.

Aged, 80 and over↗
PubMed2004

Mastectomy and reconstruction--an unusual solution to intractable breast pain.

Breast pain is a common complaint which usually subsides with simple reassurance or sometimes medication. This paper describes the case of a 41-year-old woman suffering from severe non-cyclical breast pain that had proved resistant to a battery of medical treatments. The pain was so disabling that it drove the patient to contemplate suicide. At the patient's request, a bilateral subcutaneous mastectomy with immediate implant reconstruction was performed, resulting in a complete resolution of the pain. Non-cyclical breast pain is less common than cyclical breast pain and tends to be more difficult to treat. This case suggests that mastectomy may be an appropriate option of last resort in the treatment of severe intractable breast pain.

Adult↗
PubMed2004

Skin-sparing mastectomy and immediate breast reconstruction: incidence of recurrence in patients with invasive breast cancer.

The aim of this study was to investigate whether skin-sparing mastectomy (SSM), which is gaining increasing importance and gives well-accepted cosmetic results, provides adequate treatment of the patients' oncologic disease. From 1995 to 2003, 60 patients diagnosed with invasive breast cancer were treated with SSM and complete axillary dissection. All patients underwent immediate breast reconstruction after primary surgery. Patients were treated either with a latissimus dorsi flap or with a transversus rectus abdominis myocutaneous flap. Depending on the intraoperative analysis of frozen sections, 14 patients were treated with preservation of the nipple-areola complex. During a median follow-up of 52 months (4-92 months), four local recurrences (6.6%) occurred. One patient was also found to have contralateral breast carcinoma. Three patients developed distant metastases, and two patients died of their disease a mean of 18 months after primary therapy. Factors associated with local recurrence were tumor size, poor tumor differentiation, and positive node involvement. SSM followed by immediate breast reconstruction is an alternative to modified radical mastectomy in a subset of patients with invasive breast cancer. The risk of local recurrence is low and is associated with such factors as tumor stage, poor tumor differentiation, and node-positive disease. This procedure does not increase the risk of distant metastases, which is comparable to that after other surgical approaches.

Breast Neoplasms↗