Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “MASTECTOMY”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 793 records · Page 44Linked to original sources
PubMed1983

Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy.

64 women with operable breast cancer were randomly allocated at the time of mastectomy to a group receiving immediate breast reconstruction or to a control group to whom breast reconstruction was offered 12 months later. The objective of the trial was to determine whether immediate breast reconstruction affected the psychosocial morbidity of mastectomy. Immediate reconstruction reduced the psychiatric morbidity assessed 3 months after operation, predominantly in women with unsatisfactory marriages. Women who underwent reconstruction had more freedom of dress and were less likely to be repulsed by their own naked appearance than women who did not undergo reconstruction. Sexual and social morbidity were not affected.

Breast↗
PubMed2000

The influence of patient geometry on the selection of chest wall irradiation techniques in post-mastectomy breast cancer patients.

BACKGROUND AND PURPOSE: To evaluate three chest wall (CW) irradiation techniques: wide tangential photon beams, direct appositional electron field and electron arc therapy with regards to target coverage and normal tissue tolerance. MATERIALS AND METHODS: Thirty-two post-mastectomy breast cancer patients were planned using three CW irradiation techniques. Computed tomography (CT) simulation was done on all patients and clinical target, heart and lung volumes were contoured. For each technique, dose distributions and dose-volume histograms (DVH) were calculated. Pass/fail criteria were applied based on volumetric target and critical structure dose coverage. Passing criteria for target was 95% of target receiving 95% of dose using a standard dose of 50 Gy/25 fractions, for heart </=10% volume receiving 50% dose (i.e. 25 Gy) and for lung </=25% volume ipsilateral lung receiving 50% dose (i.e. 25 Gy). RESULTS: The number of patients optimally treated by each technique were as follows: wide tangential photon beams 23/32 (72%), direct appositional electron field 1/32 (3%), electron arc 4/32 (12.5%) and in 4/32 (12.5%) no technique was optimal. Geometric predictors for technique suitability include CW thickness, medial to lateral CW curvature, uniformity of superior to inferior CW curvature and length of mastectomy scar. CONCLUSIONS: This study confirms the utility of CT planning and DVH analysis for treatment planning of breast cancer. Patient factors that predict for treatment technique suitability and aid in technique selection can be identified. In a small subset of patients, none of the currently studied techniques were optimal and more novel methods of chest wall irradiation are required.

Adult↗
PubMed2000

The influence of young age and positive family history of breast cancer on the prognosis of ductal carcinoma in situ treated by excision with or without radiation therapy or by mastectomy.

BACKGROUND: Several recent studies have investigated the influence of family history on the progression of DCIS patients treated by tylectomy and radiation therapy. Since three treatment strategies have been used for DCIS at our institution, we evaluated the influence of family history and young age on outcome by treatment method. METHODS: Between 1/1/82 and 12/31/92, 128 patients were treated for DCIS by mastectomy (n = 50, 39%), tylectomy alone (n = 43, 34%), and tylectomy with radiation therapy (n = 35, 27%). Median follow-up is 8.7 years. Thirty-nine patients had a positive family history of breast cancer; 26 in a mother, sister, or daughter (first-degree relative); and 26 in a grandmother, aunt, or cousin (second-degree relative). Thirteen patients had a positive family history in both first- and second-degree relatives. RESULTS: Six women developed a recurrence in the treated breast; all of these were initially treated with tylectomy alone. There were no recurrences in the mastectomy group or the tylectomy patients treated with postoperative radiation therapy. Patients with a positive family history had a 10.3% local recurrence rate (LRR), vs. a 2.3% LRR in patients with a negative family history (p = 0.05). Four of 44 patients (9.1%) 50 years of age or younger recurred, compared to two of 84 patients (2.4%) over the age of 50 (p = 0.10). Fifteen patients had both a positive family history and were 50 years of age or younger. Among these women, the recurrence rate was 20%. Women in this group treated by lesionectomy alone had a LRR of 38% (3 of 8). CONCLUSION: The most important determinant of outcome was the selection of treatment modality, with all of the recurrences occurring in the tylectomy alone group. In addition to treatment method, a positive family history significantly influenced LRR in patients treated by tylectomy, especially in women 50 years of age or younger. These results suggest that DCIS patients, particularly premenopausal women with a positive family history, benefit from treatment of the entire breast, and raise concerns about treating patients with a possible genetic susceptibility to breast cancer with tylectomy alone.

Adult↗
PubMed2001

The influence of pathologic tumor characteristics on locoregional recurrence rates following mastectomy.

PURPOSE: The objective of this study was to evaluate the influence of pathologic factors other than tumor size and number of involved axillary nodes on the risk of locoregional recurrence (LRR) following mastectomy. PATIENTS AND METHODS: We reviewed the medical records of 1031 patients treated with mastectomy and doxorubicin-based chemotherapy without radiation on 5 prospective clinical trials. Median follow-up was 116 months (range, 6-262 months). RESULTS: Patients with gross multicentric disease were at increased risk of LRR (37% at 10 years). However, patients with multifocal disease and those with microscopic multicentric disease did not experience higher rates of LRR than those with single lesions (17% at 10 years). Patients with lymph-vascular space invasion (LVSI) or involvement of the skin or nipple also experienced high rates of LRR (25%, 32%, and 50%, respectively). The presence of close (<5 mm) or positive margins was associated with an increased risk of LRR (45%). The increased risk of LRR observed for patients with pectoral fascial invasion (33%) was not reduced when negative deep margins were obtained. On multivariate analysis, the presence of 4 or more involved axillary nodes, tumor size of greater than 5 cm, close or positive surgical margins, and gross multicentric disease were found to be independent predictors of LRR (all, p < 0.01). In a separate analysis including only patients with 1-3 involved axillary nodes, microscopic invasion of the skin or nipple, pectoral fascial invasion, and the presence of close or positive margins were significant predictors of LRR. CONCLUSION: In addition to the extent of primary and nodal disease, other factors that predict for high rates of LRR include the presence of LVSI, involvement of the skin, nipple or pectoral fascia, close or positive margins, or gross multicentric disease. These factors predict for high LRR rates regardless of the number of involved axillary nodes.

Adult↗
PubMed2000

Locoregional first recurrence after mastectomy: prospective cohort studies with and without immediate chemotherapy.

PURPOSE: To evaluate prospectively the impact of combination chemotherapy in the combined modality treatment of isolated first locoregional recurrence (LRR) following mastectomy for breast cancer. METHODS AND MATERIALS: Between 1979 and 1989, 120 chemotherapy-naive women with isolated LRR as first failure after mastectomy were prospectively identified, uniformly staged, and systematically followed. Treatment consisted of excision if feasible, radical locoregional radiotherapy, and a hormonal maneuver (unless estrogen receptor negative). The initial chemotherapy cohort also received 8 cycles of doxorubicin and cyclophosphamide. This was compared to a subsequent control cohort. RESULTS: For all patients, the 10-year actuarial relapse-free survival +/- 95% confidence interval was 42.1+/-9.2%, and overall survival was 56.8+/-9.1%. No difference was seen in locoregional control between cohorts. At 5 years, distant recurrence-free survival for chemotherapy and control cohort respectively was 75.4+/-10.8% and 60.7+/-12.5% (p = 0.33) and overall survival was 81.9%+/-9.6 and 74.3%+/-11.2 (p = 0.24). Univariate analysis showed no prognostic importance for any imbalance between cohorts. Cox modeling confirmed that complete resection was strongly associated with fewer LRR (hazard ratio [HR] 0.32, p = 0.001) and also with better overall survival (HR 1.82, p = 0.019). Chemotherapy produced a substantial reduction in risk of death (HR 0.72 CI 0.421-1.235, p = 0.23). CONCLUSIONS: In this prospective but nonrandomized study of treatment for first LRR, the risk of death in the later control cohort was 1.39 times the risk in the chemotherapy cohort but failed to reach statistical significance. The results justify further study.

Adult↗
PubMed1996

A prospective audit of simple mastectomy under local anaesthesia.

The treatment options for breast cancer in elderly or unfit patients can be complicated by their coexistent medical problems. This study assesses the feasibility of simple mastectomy under local anaesthesia by means of a prospective audit on 36 patients with breast carcinoma and an ASA grade of 3 or worse. In 27 patients the tumour had escaped from tamoxifen control, no patients having had previous radiotherapy. Operation time ranged from 40 to 70 min, average blood loss was 200 ml and an average inpatient stay of 5 days. Only two patients had a resection margin less than 1 cm and in none was there significant morbidity or mortality despite the patients' poor pre-operative medical condition. This confirms the potential of using local anaesthetic for simple mastectomy. Eliminating the morbidity/mortality due to general anaesthesia widens the range of treatment available (especially to medically unfit patients) giving them the option of a rapid resolution to what could be a distressing protracted condition.

Adult↗
PubMed1991

Use of an electron beam for post-mastectomy radiotherapy: 5-year follow-up of 500 cases.

Since 1982, the standard method of postmastectomy regional radiotherapy at the Christie Hospital has been to use a single electron field of fixed energy (8 MeV) to irradiate the chest wall, matched to a single megavoltage field (4 or 8 MV) irradiating the nodal areas in the axilla and supraclavicular fossa. (A separate parasternal field was not used.) All 500 cases treated in 1982 and 1983 with this method were reviewed (median follow-up 59 months). Four hundred and twenty-two were referred directly post-mastectomy and 78 for local recurrence after previous mastectomy. Of these, 42 were treated palliatively, and 458 with radical intent. In radical cases the given dose in both fields was 40 Gy in 15 fractions in 3 weeks. The overall survival (n = 458) was 51% (actuarial) at 5 years. At 5 years the local recurrence rate by site and UICC stage were as follows: chest wall - all Stages 17%, Stage I 4%, Stage II 13%, Stage III 26%, recurrent cases 21%; axillary recurrence - all Stages 20%, Stage I 4%, Stage II 10%, Stage III 22%, recurrent cases 39%; supraclavicular recurrences - all Stages 9%. Only one patient of the 500 treated had a parasternal recurrence. Late effects included mild telangiectasia in the electron field and asymptomatic apical lung fibrosis in the photon field. There was no match line fibrosis.

Adolescent↗
PubMed2003

Mastectomy using ultrasonic dissection: effect on seroma formation.

Seroma formation is the most common complication after mastectomy. Among the several known etiological factors the surgical procedure used may be of importance for seroma formation. This prospective study was carried out to evaluate the ultrasonic energy dissection technique and its effect on seroma formation and other complications: 59 patients with operable breast cancer underwent modified radical mastectomy, performed in 30 of them with an Ultracision Harmonic scalpel and in 29 with scissors and electrocautery. In all cases a standard level II axillary dissection was performed with scissors. We found no differences in the outcome of surgery. Peroperative bleeding (median 300 ml, range 100-790 vs 300 ml, range 40-1400), drain volume (585 ml, range 130-1455) vs 645 ml, range 95-1570), seroma formation 50 (0-580) ml vs 105 (0-3775) ml and wound complications were about the same in both groups. In conclusion, neither clinical advantages or disadvantages of the ultrasound dissection technique were found.

Adult↗
PubMed2003

Prophylactic mastectomy: the Rotterdam experience.

The efficacy of prophylactic mastectomy (PM) depends on the ability to remove all breast tissue and a regular mastectomy is recommended. In our study population (n=112), 103 women (94%) have chosen for immediate breast reconstruction (IBR) with a silicone prosthesis placed in a subpectoral pocket. The median follow-up after IBR was 3.5 (range 1-7) years. These 103 patients underwent 193 PM with IBR: 90 bilateral and 13 unilateral. The median follow-up after IBR was 3.5 (range 1-7) years. In 163 IBRs (82%) no complications were observed. The most common late complication was capsular contracture, significantly more around prostheses placed in a previously irradiated area. No cases of breast cancer were found after PM at a mean follow-up of 2.9 years. After breast cancer a delayed ipsilateral PM and/or contralateral PM can be considered after a disease-free interval of 2 years, also taking into account the age of onset of the first breast cancer. The prognosis of breast cancer in BRCA2 mutation patients seems to be similar to that in sporadic cancer. The most striking result of PM is the decrease of anxiety of developing breast cancer and a negative impact on their sexual life. Therefore a time delay is necessary to allow women to fully address the issues involved in PM and IBR.

Body Image↗
PubMed2005

Time to reconsider subcutaneous mastectomy for breast-cancer prevention?

Genetic testing for women at increased risk of developing breast cancer has moved from the research setting to become part of established clinical practice. By testing for inherited mutations in BRCA1 and BRCA2, we are identifying more and more women who have an 80% or more lifetime risk of developing breast cancer. Since the discovery of BRCA1 in 1994, several clinical studies have led to strategies for reducing the risk of developing breast cancer, including prophylactic mastectomy, prophylactic oophorectomy, and preventive tamoxifen. We believe that in 2005, all prophylactic options, including subcutaneous and total mastectomy should be discussed and made available to women who find themselves unfortunate enough to have inherited a BRCA mutation.

Breast Neoplasms↗
PubMed1998

A reduction in the requirements for mastectomy in a randomized trial of neoadjuvant chemoendocrine therapy in primary breast cancer.

BACKGROUND: A prospective randomised trial was undertaken to evaluate the role of neoadjuvant chemoendocrine therapy prior to surgery in primary operable breast cancer. PATIENTS AND METHODS: Three hundred nine women (median age 56 years, range 27-70) with primary operable breast cancer confirmed on fine needle aspiration (FNA) cytology were recruited to this study. They were treated with a combination of mitozantrone and methotrexate (+/- mitomycin-C) combined with tamoxifen (2MT). Patients received eight cycles of 2MT (four prior to surgery in the neoadjuvant group) and tamoxifen for five years with appropriate surgery and radiotherapy. The two groups were comparable for age, menopausal status, stage and surgical requirements. RESULTS: The clinical response rates to neoadjuvant therapy were as follows: 22% complete response (CR), 29% minimal residual disease (MRD), 33% partial response (PR), 15% no change (NC) and only two patients had clinical evidence of progressive disease. Surgical requirements were reduced from 31 patients (22%) of the adjuvant group having mastectomy to 14 (10%) in the neoadjuvant group (P < 0.003). At a median follow-up of 48 months (range 10-70 months) there is no statistically significant difference between the two groups in terms of local relapse, metastatic relapse or overall survival. Symptomatic and haematologic acute toxicity was low and similar for adjuvant and neoadjuvant therapy. CONCLUSION: This randomised trial has shown a significant reduction in the surgical requirements for mastectomy, after treatment with neoadjuvant chemoendocrine therapy, with no deterioration in local or distal relapse.

Adult↗
PubMed2003

Simple anesthesia for simple mastectomies.

We describe our technique for simple mastectomy under local anesthesia for patients with high anesthetic risk factors, particularly the elderly. Seven patients with a mean age of 88 years (range 80-94 years) with American Society of Anesthesiologists (ASA) classes of three or four were given a simple mastectomy using local anesthesia and an intravenous sedative. Blood loss was minimal (mean = 95.7 cm3), as was operating room time (mean = 62 min). Most patients were returned to nursing homes on post-operative day 2. There were no complications related to the procedure.

Aged↗
PubMed2002

[Breast carcinoma: value of adjuvant therapy after mastectomy? Overview of personal results over > or = 20 years].

Analysis of 626 consecutive locoregional postoperative irradiated patients after mastectomy. 49.5% (310/626) were without further therapies, 32.8% (205/626) received TAM and 17.7% (111/626) an adjuvant chemotherapy +/- TAM. All tumours were classified on the basis of the pathologic-anatomical spreading. Median age 59 (25-91) years, follow-up 180 (60-265) months. Local relapses 7.1%, distant metastases 40.4%, death as consequence of breast cancer 35.6%, in 20.3% death of other causes. Cause specific survival (CSS) by negative axilla in 76%, by 1 to 3 LN+ metastases in 55% and by > or = LN+ in 30%. On the basis of the final results, lymphnode status, vascular invasion and initial tumor size have been the most important risk factors of prognostic relevance. Their rate of local relapses have been twice to six times as high, the distant metastasis 1.5 to 2 times more frequent. Immense differences too in comparing the CSS after 20 years: high risk collective 26 to 47%, low risk 65 to 72%. No statistical difference has shown in the low risk collective between the therapy groups. As referred back to the initial axillary status, 39.6% (248/626) have been without positive LN at the time of mastectomy. 76.2% (189/248) have remaind without distant metastases (DM), in 78.4% (149/190) without adjuvant therapy after locoregional irradiation. In 60.4% (378/626) the axilla was attacked. 48.7% (184/378) remained without distant metastases. 19.6% (36/184) with chemotherapy, 49.4% (91/184) with TAM and 31% (57/184) without supplemented systemic therapies. With 1 to 3 LN+ 58.4% (108/185) neither clinical nor radiological dissemination proven. It may be due to the efficiency of chemotherapy and TAM that only in 38.2% (13/34) respectively in 34.3% (23/67) distant metastases have been proven. In contrary after > or = 4 LN+ the chemotherapy-group has had 76.2% (48/63) and by combination with vascular invasion 85.2% (23/27) distant metastases. An opposite effect cannot be excluded. A positive axilla may but doesn't have to be a harbinger of tumor generalisation, since on third has remained without distant metastases despite of the lack of adjuvant therapies after locoregional irradiation. Is it possible a consequence of the irradiation too? No side effects of importance: Absence of plexopathies, no cardiotoxicity, 0.8% rib-necrosis after high dose irradiation as a consequence of R1-resections. There are no reasons for a renunciation of postmastectomy irradiation because of its secondary effects.

Adult↗
PubMed2003

Clinical, pathological and genetic features of women at high familial risk of breast cancer undergoing prophylactic mastectomy.

Prophylactic mastectomy (PM) is a risk-management option for women at high familial risk of breast cancer (BC). This study describes the PM experience of women enrolled in a large observational cohort study involving families with a history of hereditary breast cancer. Within 357 multiple-case BC families [119 (33%) BRCA1 or BRCA2 mutation positive], identified via family cancer clinics, 49 cases of PM [21 (43%) BRCA1 or BRCA2 mutation positive] were identified and their clinical, pathological and genetic features reviewed. Families with at least one incidence of PM displayed stronger breast/ovarian cancer histories than did families without PM. Median age at time of PM was 45 years (range 28-58). Ten cases (21%) were bilateral PMs in unaffected women and 39 cases were contralateral PMs in women with prior invasive BC (71%) or ductal carcinoma in situ (DCIS) (8%). Most (88%) underwent total mastectomy. Unnecessary axillary surgery occurred in eight subjects (16%). Malignant histology was found in three PM specimens (6%). Prior to genetic testing, PM was performed in two women who were subsequently shown not to carry the mutation specific to their family. Optimal utilization of genetic testing to guide surgical decision making, appropriate surgical technique and careful pathology examination of PM specimens, are important issues to consider prior to PM in women at high familial risk of BC.

Australia↗
PubMed2005

Risk reduction of contralateral breast cancer and survival after contralateral prophylactic mastectomy in BRCA1 or BRCA2 mutation carriers.

The clinical outcome of contralateral prophylactic mastectomy (CPM) in women with a BRCA1 or BRCA2 mutation and a personal history of invasive breast cancer is unknown. We identified a cohort of 148 female BRCA1 or BRCA2 mutation carriers (115 and 33, respectively) who previously were treated for unilateral invasive breast cancer stages I-IIIa. In all, 79 women underwent a CPM, while the other women remained under intensive surveillance. The mean follow-up was 3.5 years and started at the time of CPM or at the date of mutation testing, whichever came last, that is, on average 5 years after diagnosis of the first breast cancer. One woman developed an invasive contralateral primary breast cancer after CPM, whereas six were observed in the surveillance group (P<0.001). Contralateral prophylactic mastectomy reduced the risk of contralateral breast cancer by 91%, independent of the effect of bilateral prophylactic oophorectomy (BPO). At 5 years follow-up, overall survival was 94% for the CPM group vs 77% for the surveillance group (P=0.03), but this was unexpectedly mostly due to higher mortality related with first breast cancer and ovarian cancer in the surveillance group. After adjustment for BPO in a multivariate Cox analysis, the CPM effect on overall survival was no longer significant. Our data show that CPM markedly reduces the risk of contralateral breast cancer among BRCA1 or BRCA2 mutation carriers with a history of breast cancer. Longer follow-up is needed to study the impact of CPM on contralateral breast cancer-specific survival. The choice for CPM is highly correlated with that for BPO, while only BPO leads to a significant improvement in overall survival so far.

BRCA1 Protein↗
PubMed2006

Mastectomy rates are decreasing in the era of service screening: a population-based study in Italy (1997-2001).

We enrolled all 2162 in situ and 21 148 invasive cases of breast cancer in 17 areas of Italy, diagnosed in 1997-2001. Rates of early cancer increased by 13.7% in the screening age group (50-69 years), and breast conserving surgery by 24.6%. Advanced cancer rates decreased by 19.4%, and mastectomy rates by 24.2%. Service screening did not increase mastectomy rates in the study population.

Aged↗
PubMed2003

Breast reconstruction following mastectomy: current status in Australia.

BACKGROUND: Although breast reconstruction provides some advantages for women following mastectomy, few Australian breast cancer patients currently receive reconstruction. In Australia, the routine provision of breast reconstruction will require the development of specific health service delivery models. The present paper reports an analysis of the provision of breast reconstruction in eight sites in Australia. METHODS: A semi-structured telephone interview was conducted with 10 surgeons offering breast reconstruction as part of their practice, including nine breast or general surgeons and one plastic surgeon. RESULTS: Surgeons reported offering breast reconstruction to all women facing mastectomy; the proportion of women deciding to have breast reconstruction varied between sites with up to 50% of women having a reconstruction at some sites. Most sites offered three types of reconstruction. Two pathways emerged: either the breast surgeon performed the breast surgery in a team with the plastic surgeon who undertook the breast reconstruction or the breast surgeon provided both the breast surgery and the reconstruction. Considerable waiting times for breast reconstruction were reported in the public sector particularly for delayed reconstruction. Surgeons reported receiving training in breast reconstruction from plastic surgeons or from a breast surgery team that performed reconstructions; a number had been trained overseas. No audits of breast reconstruction were being undertaken. CONCLUSIONS: Breast reconstruction can be offered on a routine basis in Australia in both the private and public sectors. Women may be more readily able to access breast reconstruction when it is provided by a breast surgeon alone, but the range of reconstruction options may be more limited. If access to breast reconstruction is to be increased, there will be a need to: (i) develop effective models for the rural sector taking account of the lack of plastic surgeons; (ii) address waiting times for reconstruction surgery in the public sector; (iii) review costs to women in the private sector; (iv) develop a better understanding of women's views and how best to communicate about breast reconstruction; and (v) improve training in breast reconstruction.

Australia↗