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PubMed1999

Ductal carcinoma in situ recurrent on the chest wall after mastectomy.

Two patients with local recurrence on the chest wall subsequent to mastectomy for ductal carcinoma in situ (DCIS) are presented. One recurrence was invasive carcinoma and the second was DCIS. Excision and chest wall irradiation, together with chemotherapy in the first patient, have provided subsequent disease-free survivals of 6 and 12 years respectively. Although mastectomy for DCIS is almost always curative, the possibility of local recurrence requires careful surveillance.

Adult↗
PubMed2000

Subcutaneous mastectomy with implant reconstruction: cosmetic outcome and patient satisfaction.

AIMS: To assess the cosmetic outcome and satisfaction of patients who have undergone subcutaneous mastectomy (SCM) with silicon implant reconstruction and to investigate the factors influencing cosmesis. METHODS: A total of 101 patients who had had SCM implant reconstruction for treatment of primary breast cancer were assessed for cosmesis by a panel using photographic assessment. Satisfaction and sexuality were studied by a self-evaluation questionnaire. RESULTS: A good to excellent cosmetic result was achieved in 71 (70. 3%) patients (and in 85% of the group who had immediate insertion of the implant). Eighty-one patients (81%) were moderately or very satisfied (96% of the immediate reconstruction group were so). Factors found to influence cosmesis positively were submuscular insertion of the implant (P<0.001), the lateral incision approach (P<0.001) and immediate reconstruction (P<0.001). CONCLUSION: The findings of this study support the use of SCM with implant reconstruction as the simplest option in those advised to undergo mastectomy and who wish for reconstruction.

Adult↗
PubMed1999

The influence of radiotherapy on skin circulation of the breast after subcutaneous mastectomy and immediate reconstruction.

The skin circulation was measured in 43 breast cancer patients following subcutaneous mastectomy and immediate reconstruction with a prosthesis, at least 1 year after radiotherapy (46 Gy) following surgery (19 patients) or if no radiotherapy was given, at least 1 year postoperatively (24 patients). The skin circulation was measured by laser Doppler fluxmetry (LDF) and fluorescein flowmetry within three areas: 2 cm above the border of the areola, within the nipple-areola complex, and 2 cm below the border of the areola. The results show that there was no reduction in skin circulation. On the contrary LDF and fluorescein flowmetry showed in the operated breast an increased circulation in the nipple-areola complex in the irradiated breast compared with the non-irradiated by 26% and 30%, respectively (P < 0.05). The results indicate that radiotherapy following subcutaneous mastectomy and immediate reconstruction with a prosthesis does not lead to long-term reduction in basal skin circulation in the breast.

Adult↗
PubMed2001

Breast reconstruction with TRAM flap after subcutaneous mastectomy for injected material (siliconoma).

Many patients throughout the world have had breast augmentation using injectable materials. In the Far East, an adulterated impure silicone has been used by non-medical persons and unlicensed 'cosmetic surgeons' as well as by licensed physicians. The injected material usually causes a granulomatous reaction, tenderness, erythema, pain or discomfort and even skin necrosis. Eventually, the injected breast becomes very hard and develops a distorted contour. Previous treatment was by subcutaneous mastectomy with immediate or delayed reconstruction using a silicone prosthesis. The results of this were often unsatisfactory. We obtained more satisfactory results in 11 patients who had the siliconoma removed by subcutaneous mastectomy and the breast reconstructed with a de-epithelialised TRAM flap.

Adult↗
PubMed2003

Reduction or elimination of postoperative pain medication after mastectomy through use of a temporarily placed local anesthetic pump vs. control group.

OBJECTIVE: We evaluated the efficacy of a temporarily placed porous catheter with continuous application of a local anaesthetic(ON-Q( by l-Flow-Corp., Lake Forest, CA, USA) post mastectomy vs. patients without this device regarding postoperative need for opioid medication. MATERIAL AND METHODS: At Fayette Medical Center, Alabama, a retrospective evaluation of all consecutive mastectomies (n = 49) within a five-year-period from 1/1997-12/2001 and statistical analysis regarding postoperative need for opioids was performed. The ON-Q pain management pump with continuous 0.25% Sensorcaine (Bupivacaine and Epinephrine) application for about 72 h (n- 22) was compared vs. a control group without pain management pump (n- 27). RESULTS: There were no statistical significant differences regarding patient demographics in both groups. Patients in the ON-Q group with no need of postoperative opioid pain medication were: 18.2 vs. 3.7 % (P - 0.1), no need for opioids after postoperative day 1: 68.2% vs. 11.1 % (P 0.001), total opioids usage in dose equivalents (DE): 1.25 vs. 3.36 DE (-62.8%) (P-0.016), opioids usage postoperative day 1: 0.65 vs. 1.82 DE (-64.6%) (P - 0.016),opioids usage postoperative day 2: 0.24 vs. 0.75 DE (-68.4%)(P - 0.011). The length of stay in hospital was 2.35 vs. 2.93 days(n.s.), and postoperative stay in PACU: 384 vs. 43.3 min (n. s.).OR time for placement of catheter and pump is only slightly increased. No complications occurred. CONCLUSION: Use of an ON-Q pain management pump could significantly reduce or even eliminate postoperative need for opioids analgesics.

Aged↗
PubMed1988

[Breast reconstruction using a skin expander prostheses following modified radical mastectomy].

In the period from September 1983 to May 1986, 116 breast reconstructions were performed at Heidelberg University Gynecological Clinic with the aid of skin expander prostheses, following modified radical mastectomy (89 primary and 27 secondary reconstructions). In 18% of all cases, complications occurred due to the expanders, the most common being loss of prosthesis material. A total of 82 women have meanwhile had the expander prosthesis replaced by a definitive gel prosthesis in a "second reconstruction phase". Reconstruction of the nipple and areola has been performed in six cases in a third phase. Today, breast reconstruction in one or two stages following modified radical mastectomy represents an integral part of surgical rehabilitation of primarily operable breast cancer in cases, where a primary conservative procedure is out of the question.

Adult↗
PubMed1988

[Rate of local recurrence and survival in patients with breast reconstruction following mastectomy].

A retrospective study was conducted covering 100 patients who underwent breast reconstruction with plastic prostheses following mastectomy during the period from 1975 to May 1986. They were compared with 100 patients (matched pairs) who had not undergone breast reconstruction. No significant difference between the two groups could be found as regards locoregional recurrences or the overall survival rate. The mean observation period was 86.5 months. Surgical removal of local recurrences did not necessarily involve removal of the prosthesis. Therefore, given adequate operability, and experience on the part of the surgeon, a breast reconstruction following mastectomy can now be performed on any patient desiring it to alleviate mental suffering.

Adult↗
PubMed1985

[Objective measurement of lymphedema after mastectomy].

A new optic-electronic method for measuring arm volume was used on 275 women before and after mastectomy for carcinoma of the breast. Two weeks after modified radical mastectomy, an increase of over 150 ml in arm volume over the preoperative value was recorded in 12% of patients. Lymphoedema was demonstrated on average 19.3 months after the operation and telecobalt treatment in 42% of 200 women so treated; in 17% it was of moderately severe to severe degree (over 400 ml). In patients with severe lymphoedema a 15-day period of treatment reduced the oedema volume on average by 383 ml (62.1%). The described optic-electronic volumetric method makes it possible to obtain an objective comparison of swelling of the arm and thus early recognition and treatment of lymphoedema, as well as providing a means of assessing the effectiveness of any treatment.

Adult↗
PubMed1984

[Subcutaneous mastectomy: the importance of the histopathological assessment technic].

Subcutaneous mastectomy was performed in 300 patients between 1974 and 1981 for various indications. Precancerosis or non-invasive carcinomas were established by previous biopsy in 106 patients. The comparison of pathologic anatomy data of conventional and serial assessment of specimens showed an increase of clinically occult non-invasive carcinomas from 5.4 to 18.3% and of preoperatively undiagnosed invasive carcinomas from 2.3 to 7.7% in serial assessment and unchanged indication. Whereas the therapeutic value of subcutaneous mastectomy cannot be judged with certainty due to the relatively short observation period, the diagnostic value seems, according to these findings, to be ascertained. However, a much more complex histologic assessment technique beyond the usual is required.

Adult↗
PubMed2003

Peri-areolar skin-sparing mastectomy and immediate tram flap reconstruction.

The association of peri-areolar skin-sparing mastectomy with immediate autologous tissue breast reconstruction could be proposed to selected patients necessitating mastectomy to control their breast cancer. A prospective series of 14 consecutive patients were operated using this association and evaluated. Mean age at time of surgery was 52 years. Mean operating time for reconstruction was 163 minutes. There were two minor local complications, one needing secondary adaptation under local anaesthesia. Cosmetic result was judged good to excellent by all the patients with a mean follow-up of 13.2 months.

Adult↗
PubMed1978

Psychosexual counseling of the mastectomy patient.

A pilot research study is described, aimed at investigating the hypotheses that psychosexual factors are of central importance in the psychological recovery of the mastectomy patient and that counseling would prove beneficial. Forty-one women were interviewed. Results indicated (1) that sexual self-concept superseded mortality as the primary concern of most recovery mastectomy patients, (2) that the attitude of the partner--husband or lover--was crucial to that self-concept, (3) that most partners were eager to help, and (4) that psychosexual counseling was welcomed and found to be appropriate. Resistances to the execution of the study are also described.

Adult↗
PubMedDate not supplied

Breast cancer pathology practices among Medicare patients undergoing unilateral extended simple mastectomy.

OBJECTIVE: Information in pathology reports of breast cancer specimens is of critical importance to treating physicians for selection of local regional treatment and adjuvant therapy, evaluation of therapy, estimation of prognosis, and analysis of outcomes. This information is also of great importance to patients and their families. The Cancer Committee of the College of American Pathologists (CAP) and the Association of Directors of Anatomic and Surgical Pathology (ADASP) have published protocols for reporting the findings on breast cancer specimens to encourage adequate specimen examination and promote the reporting of findings in standardized formats and to provide treating physicians and their patients with vital information. METHODS: To assess the quality of breast cancer pathology practices and the degree to which they agree with published guidelines, we undertook a retrospective analysis among Medicare patients in New York State. Our random sample consisted of 748 (43.5%) of the 1718 cases of unilateral extended simple mastectomy, also referred to as total mastectomy with lymph node dissection (ICD-9-CM procedure code 85.43), for calendar year 1999. Of these, 555 (74.2%) were available for study, whereas the rest did not satisfy inclusion criteria. Among the 555 cases, 545 (98.2%) were women, and 10 (1.8%) were men. The gender distribution was proportionately the same at 98.2% and 1.8% for all 1718 cases. RESULTS: We examined the 555 hospital records for 16 elements (quality indicators). Aggregate performance on 7 of these was > or =83.7%, and performance was < or = 69.4% on 9 others. There were significant interhospital disparities in performance levels for a number of quality indicators. Although some hospitals always recorded certain indicators, others never did. CONCLUSIONS: The issues with breast cancer pathology reports identified in this study are amenable to improvement to better serve patients, especially women, and their treating physicians in making adjuvant decisions, estimating prognosis, and evaluating outcomes.

Aged↗
PubMed1987

Angiosarcoma of the breast following segmental mastectomy complicated by lymphedema.

A patient is discussed who had angiosarcoma of her lymphedematous right breast develop four years after segmental mastectomy for infiltrating ductal carcinoma. The lymphedema developed and persisted after an indolent and recurrent postoperative infection. The possibility that the second malignancy is a consequence of the chronic lymphedema, similar to the angiosarcomas of lymphedematous extremities after radical mastectomy, is cautiously entertained. This hypothesis is worthy of consideration as more breast conservation surgery is being done, with or without adjuvant radiation therapy, and accumulating evidence suggests that lymphedema of the breast is a common complication of surgery followed by radiation.

Aged↗
PubMed1990

Steroid receptors in benign mastectomy tissue.

Estrogen and progesterone receptors (ERs and PRs, respectively) were measured in both cancerous and noncancerous components of 104 modified radical mastectomy specimens. In addition, ER and PR levels were determined for 14 benign breast specimens obtained by reduction mammoplasty. The receptor levels were measured by scatchard method. Each of these groups--cancerous, corresponding noncancerous, and mammoplasty specimens--were divided into subgroups according to their receptor levels. Fourteen of the 104 noncancerous specimens were found to be ER positive (ER+). Most cases of ER+ noncancerous tissue (13 of 14 cases) were associated with ER+ tumors. The reverse was not true because only 13 of 64 cases of the ER+ tumors were associated with positive ER in their noncancerous counterparts. Comparable results were obtained for PR. The average ER-PR level of the noncancerous mastectomy tissue was significantly higher than that of the mammoplasty specimens despite the similar histologic findings in both groups.

Breast Diseases↗
PubMedDate not supplied

Antibiotic prophylaxis in clean surgery: peripheral vascular surgery, noncardiovascular thoracic surgery, herniorrhaphy, and mastectomy.

Studies published in the English-language literature on the use of prophylactic systemic antibiotics in vascular surgery, noncardiovascular thoracic surgery, mastectomy, and herniorrhaphy were reviewed. The effectiveness of antibiotic prophylaxis in preventing deep and superficial wound infections in peripheral vascular surgery appears to be well documented, especially if prophylaxis is directed against Staphylococcus aureus. In clean thoracic surgery the evidence is equivocal, and no studies have sufficient statistical power to eliminate the possibility even of a 50% reduction in incidence. In herniorrhaphy and mastectomy some evidence from a much more powerful study suggests that antibiotic prophylaxis may result in a decrease of up to 50% in wound infections, but whether these data can be generalized uncritically to all clean wounds is still a matter of debate. Accordingly, only guarded recommendations can be made regarding the use of prophylactic antibiotics in procedures associated with a very low risk of serious infection.

Anti-Bacterial Agents↗
PubMed2003

The sequencing of radiation therapy and chemotherapy after mastectomy in premenopausal women with breast cancer.

OBJECTIVE: The purpose of this study was to evaluate the prognostic importance of the sequencing of radiation therapy and chemotherapy after mastectomy in high-risk premenopausal women with breast cancer in addition to other known prognostic factors in the literature. METHODS: In this retrospective study, 176 premenopausal women with breast cancer were evaluated. The median age at referral was 39 years (range, 28-59 years); 106 patients had stage II and 70 had stage III disease. All were subjected to mastectomy. The median number of lymph nodes removed was 19. The influence of age, histological grade, number of nodes removed, number of positive nodes, tumor size, estrogen receptor status, lymphovascular invasion and sequencing of radiotherapy and chemotherapy on 5-year locoregional disease-free survival, 5-year systemic disease-free survival, 5-year disease-free survival and 5-year cancer-specific survival were studied. RESULTS: The 5-year locoregional disease-free survival was 94% for the entire patient population. Because of the small number of locoregional recurrences, none of the evaluated factors was prognostically significant for locoregional recurrence. The 5-year systemic disease-free, disease-free and cancer-specific survival rates were 72, 70 and 77%, respectively. On multivariate analysis of host, tumor and treatment-related factors, the number of positive nodes [RR 1.9 (95% CI: 1.36-2.63), RR 2 (1.46-2.84 ) and RR 1.8 (1.3-2.71), respectively], histopathological grade [RR 1.8 (95% CI: 1.24-2.65), RR 1.9 (1.34-2.88), RR 2.5 (1.65-4.07), respectively], estrogen receptor status [RR 3.5 (95% CI: 1.5-8.6), RR 3.9 (1.64-9.41), RR 2.5 (1.05-6.24), respectively] and the sequencing of radiotherapy and chemotherapy [RR 1.6 (95% CI: 1.17-2.39), RR 1.7 (1.25-2.54), RR 1.6 (1.14-2.43), respectively] were all significant independent predictors of outcome. CONCLUSIONS: Our results show that in addition to traditional prognostic factors, the sequencing of radiation therapy and chemotherapy also predict for increased risk of any type of recurrence or further tumor death.

Adult↗
PubMed1999

Preoperative small-dose ketamine has no preemptive analgesic effect in patients undergoing total mastectomy.

UNLABELLED: We evaluated the preemptive analgesic effect of a small dose of ketamine given before or immediately after surgery in a randomized, double-blinded study performed in 128 women undergoing total mastectomy. Group 1 patients received ketamine 0.15 mg/kg as a 5-mL i.v. injection 5 min before surgery and isotonic saline 5 mL i.v. at the time of skin closure. Group 2 received 5 mL i.v. of isotonic saline, then 0.15 mg/kg i.v. ketamine. A standard general anesthesia procedure including sufentanil was used. In the recovery room, patient-controlled analgesia i.v. morphine was used for postoperative analgesia. Postoperative pain was assessed by measuring morphine consumption and visual analog scale pain scores. No significant intergroup differences were seen in the pain scores. Patient-controlled analgesia morphine consumption was lower during the first 2 h after surgery in patients given ketamine at the time of skin closure. No patient complained of hallucinations or nightmares. The incidence of adverse effects was not different between the two groups. In conclusion, administering ketamine at the end of surgery is more effective in reducing morphine consumption than it is when given before surgery. IMPLICATIONS: We administered the same small dose of ketamine before or after surgery. The preoperative administration of 0.15 mg/kg ketamine in patients undergoing total mastectomy did not elicit a preemptive analgesic effect. Ketamine given at closure reduced the patient-controlled analgesia morphine requirement in the first 2 h after surgery.

Analgesia, Patient-Controlled↗
PubMed2001

Continuous thoracic epidural anesthesia with 0.2% ropivacaine versus general anesthesia for perioperative management of modified radical mastectomy.

We evaluated in this prospective study the effectiveness of continuous thoracic epidural anesthesia (TEA) and postoperative analgesia with ropivacaine and compared it with general anesthesia (GA) and opioids for pain relief, side effects, postanesthesia recovery, and hospital discharge after modified radical mastectomy. Sixty ASA physical status II and III patients undergoing mastectomy were randomly assigned to two study groups of 30 patients each. In the TEA group, an epidural catheter was inserted at T6-7, and 5--10 mL of 0.2% ropivacaine was injected to maintain anesthesia and to continuously administer adequate analgesia for 48 h. GA was induced with IV 1--2 mg of midazolam or 50--100 microg/mL of fentanyl followed by 50--150 mg of propofol and was maintained with sevoflurane and 50% N(2)O in oxygen. The Aldrete score system was used to evaluate postanesthesia recovery, a verbal rating scale was used for assessment of pain intensity, and a postanesthesia discharge scoring system was used for discharge home. The demographic data and side effects (except for nausea and vomiting) (GA 43%, TEA 10%, P = 0.0074) and discharge home were similar in both groups. However, the number of patients ready for discharge from the recovery room during the first postanesthesia hour (Aldrete score of 10) was significantly larger after TEA (80%) than after GA (33%) (P = 0.0006). GA patients experienced significantly more (P < 0.001) substantial pain than TEA patients on Day 0 (70%), Day 1 (53%), and Day 2 (27%) after the surgery. Patient satisfaction was greater with TEA (70%) than with GA (30%) (P < 0.001). We conclude that TEA with ropivacaine provides better postoperative pain relief and less nausea and vomiting, facilitates postanesthesia recovery, and gives greater patient satisfaction than GA.

Adult↗