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PubMed2005

Evaluation of residual glandular tissue after skin-sparing mastectomies.

BACKGROUND: The oncological safety of skin-sparing mastectomy (SSM) has been the object of several studies. METHODS: From June 2003 to January 2004, 42 breast cancer patients, stage 0 to IIIA, underwent SSM. Before surgery, two lines were drawn on the breast skin, representing SSM and conventional mastectomy incisions. After surgery, the skin flap that would remain after SSM was removed, and immediate breast reconstruction was begun. The presence and amount of remaining glandular breast tissues were histologically evaluated in the skin flap. Terminal ductal lobular units (TDLUs) and residual disease were identified. These data were correlated with other clinical and pathologic parameters by using Fisher's exact test (P value) and receiver operating characteristic curves. RESULTS: The prevalence of residual breast tissue in the sample was 59.5%, and the presence of TDLUs was significantly associated with skin flaps thicker than 5 mm. Residual disease was found in 9.5% of the women and was associated with skin flaps >5 mm thick and the presence of TDLUs. There was no significant association between the presence of TDLUs and residual disease with age, body mass index, menopausal status, clinical and pathologic staging, breast volume, mammographic density, neoadjuvant chemotherapy, type of surgery, and presence of an extensive in situ component. The receiver operating characteristic curve showed that as skin flaps decrease in thickness, TDLUs also decrease. CONCLUSIONS: A high prevalence of glandular breast tissue and residual disease in the skin flap was associated with a skin flap thickness >5 mm.

Adult↗
PubMed1994

Quantitative magnetic resonance for assessment of radiation fibrosis after post-mastectomy radiotherapy.

Subcutaneous fibrosis is a serious complication of post-mastectomy radiotherapy with a pronounced influence on skin conditions, shoulder movement and arm oedema. To establish safer radiotherapy schedules, precise evaluation of the tissue damage is required. A feasibility study was performed to assess the value of calculated relaxation times from magnetic resonance (MR) images for quantitative characterization of different degrees of subcutaneous fibrosis after post-mastectomy radiotherapy. A surface coil was applied to the irradiated area, as well as to unirradiated skin, to obtain appropriate MR coronal slices for acquisition of calculated values using a mixed imaging sequence technique. 14 patients with clinically diagnosed subcutaneous fibrosis were examined, 10 of whom had severe fibrosis. The mean T2 values of the treated and untreated side were 53.0 and 56.7, respectively. A statistically significant decrease of the calculated T2 values on the treated side was observed. No correlation was found between the clinically assessed fibrosis and the calculated relaxation times. The findings indicate that despite a general decrease of T2 calculated values, the large variation in the relaxation times restricts the value of MR, as applied in this study, in differentiating between different degrees of fibrosis in normal tissues after radiotherapy.

Aged↗
PubMed2002

Predictive factors for skin telangiectasia following post-mastectomy electron beam irradiation.

This study evaluated the predictive factors associated with skin telangiectasia following post-mastectomy electron beam irradiation of the chest wall and regional lymph nodes in patients with breast cancer. From July 1987 to December 1994, 120 women with stages II and III breast cancer received electron beam irradiation following modified radical mastectomy. Doses of 50-50.4 Gy per 25-28 fractions were given to the chest wall (with bolus), the internal mammary nodes, the supraclavicular nodes and the axillary lymph nodes using a 12 MeV or 15 MeV single portal electron beam. 19 patients received an additional 10-16 Gy boost to the surgical scar using a 9 MeV electron beam. Univariate and multivariate analyses for the development of skin telangiectasia showed 5- and 7-year actuarial rates of telangiectasia to be 59% and 72%, respectively. In univariate analysis, an additional surgical scar boost (p=0.023) as well as no treatment interruption (p=0.028) were associated with a significantly increased risk of skin telangiectasia. In multivariate analysis, the only significant independent factor for the development of skin telangiectasia was surgical scar boost (p=0.026); no treatment interruption showed a trend but did not achieve significance (p=0.051). Thus, patients given an additional boost to the surgical scar are more likely to develop skin telangiectasia. Shorter treatment courses may result in a higher probability of skin telangiectasia following electron beam irradiation.

Adult↗
PubMed2002

Controversies regarding the use of radiation after mastectomy in breast cancer.

Despite years of clinical study, there are still many unanswered questions regarding postmastectomy radiation. It is clear that radiation therapy plays a critical role in the multidisciplinary management of patients with locally advanced or inflammatory breast cancer. It is also accepted that postmastectomy radiation is not required for most women with noninvasive disease or stage I disease. Randomized clinical trials studying radiation treatments for women with stage II or III breast cancer have shown that the addition of radiation after mastectomy can reduce local-regional recurrence rates, which then improves survival. However, other data have indicated that the risk of local-regional recurrence after mastectomy and chemotherapy is low for patients with small tumors and one to three positive lymph nodes, leading some to question whether postmastectomy radiation is useful for this group. A second controversy regards the sequencing of postmastectomy radiation and breast reconstruction. In this article we discuss these controversies, review the data that are relevant, and provide our institutional approaches to these issues.

Breast Neoplasms↗
PubMed1993

Inappropriate Halsted mastectomy and patient volume in Italian hospitals.

To study whether Halsted mastectomy was used only when properly indicated, a prospective survey was undertaken on the process of care of 985 breast cancer patients seen consecutively at 62 general hospitals in Northern and Central Italy. Overall, 79% of Halsted mastectomies were performed inappropriately. The procedure was less likely to be performed on more educated patients and, other factors considered, on those seen at hospitals with larger volume. We conclude that the measurement of utilization of a surgical procedure for which only a few appropriate indications exist may help identify important relationships between hospital characteristics and quality of surgical care.

Adult↗
PubMed2001

Breast cancer presenting with the syndrome of inappropriate secretion of antidiuretic hormone after simple mastectomy.

A 71-year-old woman showed disorientation 7 days after simple mastectomy for right breast cancer. Computed tomography of the brain was normal. The level of serum sodium was very low (110 mEq/l), while the urine sodium level was normal. The osmolality of urine was higher (342 mosmol/kg) than that of serum (220 mosmol/kg). These data suggested a syndrome of inappropriate secretion of antidiuretic hormone. A fluid restriction, infusion of hypertonic saline and administration of diuretics gradually increased the level of serum sodium. Subsequently, disorientation disappeared. This is a rare case of the syndrome of inappropriate secretion of antidiuretic hormone caused by simple mastectomy, a relatively minor surgical procedure.

Aged↗
PubMedDate not supplied

Psychiatrict themes in the rehabilitation of mastectomy patients.

The author discussed the psychological variables involved in the rehabilitation of patients who have undergone a mastectomy. The scope of the problem, the psychological meaning and fears suffered by mastectomy patients, and importance of body image is discussed along with the psychological treatment.

Adult↗
PubMed1983

Influence of adjuvant irradiation on shoulder joint function after mastectomy for breast carcinoma.

The influence of postoperative radiation therapy on ipsilateral shoulder function following mastectomy was evaluated from a series of 52 women with primarily operable carcinoma of the breast. Mastectomy and partial axillary dissection were carried out in all patients. In addition, 29 of the patients received postoperative irradiation with 36.6 Gy applied mid-axillarily in 12 fractions with irradiation twice a week. A significant impairment of the active shoulder mobility was found in the irradiated group (p less than 0.01). The passive mobility did not differ significantly between the two groups. The impairment of active shoulder mobility is suggested to be caused by radiation induced subcutaneous fibrosis.

Adult↗
PubMed1988

Total mastectomy with special reference to surgical technique, extent of axillary dissection and complications.

Total mastectomy and partial axillary dissection as advised in the DBCG (Danish Breast Cancer Cooperative Group) protocols was performed in 104 consecutive females with operable primary invasive breast cancer, aged 34-82 years, median 47 years. The glandular removal was complete as assessed by microscopic examination of side resection planes and deep fascia of the surgical specimen. The number of removed axillary lymph nodes ranged from 1 to 28, median 8. The mortality was zero. There were no general complications. Wound complications comprised seroma (47.1%), flap margin necrosis (5.8%) and infection (1.9%). The pitfalls in securing total mastectomy are discussed as is the extent of axillary dissection for staging purposes. Furthermore, the problem of axillary dissection and axillary irradiation in node positive patients is considered.

Adult↗
PubMed1988

A Danish randomized trial comparing breast-preserving therapy with mastectomy in mammary carcinoma. Preliminary results.

The present study comprises 847 women operated upon for invasive breast carcinoma at 19 surgical departments and enrolled in protocol DBCG-82TM from January 1983 to November 1987. Among them 662 (78%) were allocated for breast-preserving therapy or mastectomy by randomization, while 185 patients (22%) did not accept randomization. Within the randomized group 6% could not be entered into adjuvant protocols, i.e. subsequent programmes of postoperative therapy and follow-up. This left 619 evaluable patients. In the non-randomized series 26% did not fulfil the demands for entrance into the adjuvant protocols, leaving 136 evaluable patients, 60 of whom had chosen a breast-preserving operation and 76 mastectomy. In the randomized series the patients in the two treatment arms were comparable in age, menopausal status, site of tumour, pathoanatomical diameter of the tumour, number of removed axillary lymph nodes, number of metastatic axillary lymph nodes, and distribution on adjuvant regimens. Ninety per cent of the patients in the randomized group accepted the method offered, whereas 10% declined and wanted the alternate form of operation. The median follow-up period was approximately 1.75 years. The cumulative recurrence rate in the randomized group was 13% and in the non-randomized group 7%. These results are preliminary. Life-table analyses have not so far demonstrated differences in recurrence-free survival either in the randomized or the non-randomized series.

Adult↗
PubMed1989

Long-term psychological sequelae of mastectomy and breast conserving treatment for breast cancer.

Psychiatric and psychosocial adaptation to two types of treatment for primary breast cancer, modified radical mastectomy and partial mastectomy with radiotherapy, was studied five years after the primary treatment. 102 consecutive patients with pT1NOMO breast cancer were invited to follow-up which was done by standardized questionnaires. Nineteen women declined the invitation and 25 others were not included for various reasons, leaving 58 to complete the interviews. 30% of the women reported accentuated mental symptoms compared to the state before treatment, with no significant difference between the two treatment groups. Psychiatric state, marital adjustment and fear of cancer recurrence were also similar in the two groups. However, breast conserving treatment seems to preserve the woman's female identity and acceptance of body configuration. We conclude that breast conservation does not in itself prevent mental sequelae after treatment for primary breast cancer. Selective psychoprophylactic programs and reorganization of the postoperative follow-up should be tried to diminish unwanted psychological reactions.

Body Image↗
PubMed1985

Investigation of 72 patients following subcutaneous mastectomy. A clinical evaluation of current surgical techniques.

Different surgical techniques for subcutaneous mastectomy (SCM) have been evaluated and compared in this retrospective study of 72 patients. It has been clearly demonstrated that SCM followed by immediate reconstruction is a serious operation with a high frequency of both primary and late complications. It is important to have strong indications and a well informed and motivated patient before performing an SCM. A high frequency of postoperative tissue necroses was found for breasts of over 500 grams, when operated on using technique (VI) which entails skin reduction and transposition of the nipple-areola complex. In the very large breast a total mastectomy with skin reduction and transplantation of the nipple-areola complex is recommended. To obtain a good take of the graft it is advantageous to postpone the insertion of the prosthesis until a later occasion. For small breasts the lazy-S-shaped horizontal incision (technique V) is recommended. This technique gave perfect accessibility to the gland together with good cosmetic results and satisfied patients. At the follow-up examination it was found that the size and position of the implants were appropriate in about 80% of the breasts. Twenty-five per cent of the breasts were somewhat hard, although acceptable. The majority of the implants, however, were soft. The erotic sensibility of the breast is lost after an SCM.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Influence of the site of skin incision on the circulation in the nipple-areola complex after subcutaneous mastectomy in breast cancer.

Necrosis of the skin resulting from impaired perfusion is one possible complication of subcutaneous mastectomy. The aim of this study was to evaluate the influence of two differently sited skin incisions on the circulation in the nipple-areola complex and in the surrounding skin. Sixty-nine patients with invasive breast cancer underwent subcutaneous mastectomy and immediate reconstruction with a subcutaneously placed prosthesis. In 26 of them a "lazy-S"-shaped horizontal lateral incision was made, and in 43 patients a transverse incision 1.5 cm above and parallel to the submammary fold. The skin circulation was measured by two methods, laser Doppler flowmetry (LDF) and fluorescein flowmetry, two or three days postoperatively. The skin circulation in the nipple-areola complex and in the skin 2 cm above the complex was the same irrespective of which of the two incisions was used, both by LDF and fluorescein flowmetry, but 2 cm below the complex fluorescein flowmetry showed 36% lower circulation in the submammary incision group than in the group with a lazy-S incision (p < 0.01), in contrast to LDF, which did not show any differences between the incisions. The circulation measured by LDF was higher in all three areas both with the lazy-S incision and with the submammary incision than in the opposite untreated breast. With fluorescein flowmetry there was a corresponding increase by 36% (p < 0.01) below the complex in the lazy-S incision group. There was no skin necrosis. In conclusion, the site of the skin incision used in this study did not influence the circulation in the nipple-areola complex or in the skin 2 cm above the complex as measured by LDF and fluorescein flowmetry. However, there was a reduction of the superficial circulation as measured by fluorescein flowmetry 2 cm below the complex in the submammary incision group. The increased circulation in the breast operated on was probably the result of traumatic hyperaemia.

Adult↗
PubMed2002

Effect of mastectomy on milk fever, energy, and vitamins A, E, and beta-carotene status at parturition.

The objective of this study was to compare blood profiles of intact and mastectomized periparturient cows to discriminate those metabolic changes associated with the act of parturition from the metabolic changes caused by lactation. Mastectomized and intact cows had similar increases in plasma estrogens and cortisol concentrations around the time of calving. Mastectomy eliminated hypocalcemia and the rise in 9,13-di-cis retinoic acid observed in intact cows. Mastectomy reduced but did not eliminate decreases in plasma phosphorus, alpha-tocopherol, and beta-carotene associated with parturition in intact cows, suggesting the mammary gland is not the sole factor affecting plasma concentrations of these compounds. Dry matter intake was similar in both groups before calving. The day of calving, dry matter intake was lower in intact cows than in mastectomized cows, but after calving the mastectomized cows exhibited a pronounced decline in feed intake. Plasma nonesterified fatty acid (NEFA) concentrations rose rapidly in intact cows at calving and did not return to baseline level for > 10 d. In contrast, NEFA concentrations in mastectomized cow plasma rose moderately at calving and returned to baseline level 1 to 2 d after calving. This study provides evidence that hypocalcemia in the cow is solely a result of the calcium drain of lactation. The act of parturition affects blood phosphorus, dry matter intake, and NEFA concentration independent of the effect of lactation.

Animals↗
PubMedDate not supplied

Breast reconstruction following mastectomy.

Breast reconstruction after mastectomy can avoid a permanent deformity. As a member of the breast management team, the reconstructive surgeon can give advice on timing and techniques. Breast reconstruction can either be started at the time of the mastectomy or delayed for months or years. Newer techniques of tissue expansion permit breast reconstruction without additional scars or significant hospitalization. Autogenous tissue breast reconstruction techniques are available that provide natural, long-lasting breast reconstruction without the need for a silicone breast implant.

Adult↗
PubMed1992

Partial mastectomy with axillary lymph node dissection and radiotherapy as a new treatment modality of breast cancer (I).

This is the first preliminary report among two consecutive papers. Partial mastectomy(PM), axillary lymph node dissection(AD) and radiotherapy (RT) were performed on seventeen operable breast cancer patients who had been admitted from April 1991 to March 1992 to the department of surgery, Yongdong Severance Hospital for improved cosmetic appearance and better survival rate. Of seventeen patients, 47% were T1 lesion and 76% were stage I and II. Extensive intraductal component(EIC) within or around the tumor was also analyzed. Twenty nine per cent of the patients were EIC positive. The mean number of axillary lymph nodes was 21.5 after PM with AD and 20.5 after mastectomy. For radiotherapy, 4,500 rad was delivered to the breast parenchyma and 1,600 rad of boost to the primary tumor site using the electron beam method after surgery. All patients have since been living well without any local recurrence and were satisfied with breast preservation for the one-year follow-up period. We concluded that the PM, AD and RT can be another surgical treatment modality of breast cancer. A longer follow-up data will be followed on the second paper.

Breast Neoplasms↗
PubMedDate not supplied

Factors influencing local recurrence of cancer after partial mastectomy.

From 1957 to 1975, 291 patients underwent partial mastectomy for carcinoma of the breast. In a follow-up period of 6 to 25 years, 32 patients had local recurrences. These 32 were matched with 32 patients without local recurrence but who had had the same treatment during the same periods of time for the same clinical stage of disease. Comparisons were made for age of the patient, family history, size of tumor, proximity of tumor to line of resection, involvement of lymph nodes, and prophylactic radiation. The average age of the patients with recurrence was 7 years less than those without, and the incidence of nodal involvement was three times as high in those with local recurrence as in those without. These were the only factors that showed any significant difference between the two groups. When axillary dissection is done in patients treated by partial mastectomy, valuable information is obtained about the likelihood of local recurrence.

Age Factors↗
PubMed2004

[Effects of a comprehensive rehabilitation program for mastectomy patients].

PURPOSE: The purpose of this study was to investigate the effect of a comprehensive rehabilitation program on physical function, immune response, fatigue and quality of life in mastectomy patients. METHOD: The subjects included fifty-five patients with breast cancer (27 in the control group and 28 in the experimental group). The subjects in the experimental group participated in a comprehensive rehabilitation program for 10 weeks, which was composed of 1 session of education, 2 sessions of stress management, 2 sessions of exercise, and 1 session of peer support group activity per week. RESULT: The results revealed an increase in shoulder extension, abduction, external rotation, and internal rotation of the affected upper extremity, and in shoulder extension and abduction of the healthy upper extremity. Also an increase in quality of life and a decrease in fatigue were significantly higher in the experimental group than the control group. However, the results revealed that the natural killer cell ratio of the experimental group increased but there was no significant difference from that of the control group. CONCLUSION: The 10-week comprehensive rehabilitation program showed a large affirmative effect on physical function, fatigue and quality of life of breast cancer patients after a mastectomy.

Exercise Therapy↗