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PubMed1985

Male breast carcinoma.

Fifty men with primary breast carcinoma were seen between the years 1938 and 1983 at the University of Iowa Hospitals and Clinics. In most patients, there was a significant delay between the onset of symptoms and seeking medical advice (mean, 21 months; range, 1-156). The vast majority of patients were treated by simple, modified radical, or radical mastectomy. Ten patients underwent incisional or excisional biopsy with or without radiation because of locally advanced disease or distant metastases. Survival was comparable in the groups of patients treated with simple mastectomy (mean, 70 months), modified radical mastectomy (mean, 61 months), and radical mastectomy (mean, 78 months). Local recurrence occurred in 25 per cent of all patients, and this rate was not dependent on the operation performed. The data suggest that modified radical mastectomy is adequate therapy for local control and staging of the disease without reducing survival from that observed after radical mastectomy.

Adult↗
PubMed1992

Racial differences in cancer of the male breast--15 year experience in the Detroit metropolitan area.

Characteristics of cancer of the male breast were evaluated in a population based review of 244 cases identified retrospectively through the Metropolitan Detroit Cancer Surveillance System (MDCSS) between 1973 and 1987. The mean age at diagnosis was 65 years and median survival time, 44 months. There were no apparent time trends in incidence for either white or black men from 1973 through 1987. Modified radical mastectomy was the most common surgical procedure, while simple and radical mastectomy declined in popularity over time. Cox's proportional hazards regression model was used to test the simultaneous effects of age, race, stage, and treatment on survival. Men older than 65 at diagnosis had a greater risk of dying than men under 65 (RR 1.52, 95% confidence interval, 1.01-2.28). Survival was significantly worse for men who presented at a more advanced stage; regional versus localized (RR 2.19, 95% confidence interval, 1.39-3.45) and remote versus localized (RR 4.31, 95% confidence interval 2.26-8.23). Race had no significant effect on survival in men with breast cancer in the Detroit Metropolitan Area.

Adult↗
PubMed1981

[Are there still indications for subcutaneous mastectomy?].

There are many indications for subcutaneous mastectomy with immediate reconstruction using silicone implants because of the relatively simple technique. The risk of malignant change in simple mastopathy is minimal. However, the inadequacy of an operative technique that leaves behind unknown quantities of breast tissue and the frequently bad cosmetic results make all indications appear doubtful. For these reasons subcutaneous mastectomy should be abandoned and simple mastectomy with immediate reconstruction is to be preferred for the following conditions: (1) Diffuse, painful, simple mastopathy that has been repeatedly biopsied; (2) Non-invasive carcinoma, either intra-duct or in situ.

Breast Neoplasms↗
PubMed1990

Breast cancer in situ: a retrospective review of 23 cases with a minimum of 10-year followup.

Twenty-three cases of breast carcinoma in situ (12 with intraductal carcinoma and 11 with lobular carcinoma in situ) seen at Charleston Area Medical Center between 1957 and 1977 were reviewed. The mean age diagnosis was 50 years (age range: 30-86 years). An asymptomatic breast mass was the initial symptom in 19 patients (82 per cent). Mammography, performed in seven patients, was abnormal in five. A simple or modified radical mastectomy was performed in 20 women and wedge resection in three. Twenty-two women underwent ipsilateral axillary nodal dissection, and all but one had histologically-negative nodes. Only one patient in this series died with metastatic breast cancer. Six other patients died from non-malignant causes. Sixteen patients are still alive with no evidence of disease from 11.5 to 26.5 years after the initial diagnosis. The role of simple excision with or without radiotherapy in breast carcinoma in situ remains to be determined.

Adult↗
PubMed1996

Quality of the capsule in reconstructions with textured or smooth silicone implants after mastectomy.

Many women desire some kind of reconstruction after mastectomy for breast cancer to improve the cosmetic result. Since the introduction of silicone breast implants, capsular contracture has been the most common complication of breast augmentation or reconstruction. The aim of the present study was to evaluate the capsule quality in patients with breast cancer who had undergone reconstructions with either textured (rough) or smooth silicone implants after simple or modified radical mastectomy. Forty-three consecutive patients had reconstructions with textured silicone implants (49 implants) and were evaluated 32 months post-operatively in a prospective clinical trial. The last 43 consecutive patients who had reconstructions with bilumen smooth silicone implants (49 implants) acted as controls. The results were graded by Baker's classification. Among the patients with textured implants only 9% (4/47) was graded as having moderate or severe capsular contracture in contrast to 24% (11/46) in patients with bilumen smooth-surface implants (p < 0.05). These results confirm previous reports that favour textured silicone implants in breast augmentation and reconstruction.

Breast Implants↗
PubMed1977

Reconstruction of the breast following radical mastectomy.

A method of reconstruction of the breast following radical mastectomy is presented. The technique involves the use of an individually made Silastic prosthesis inserted three to six months after the mastectomy. A new simple method of nipple reconstruction is described, and the total restoration can be achieved in one operation. It is suggested that reconstruction of the breast be considered more frequently in patients subjected to mastectomy.

Breast↗
PubMed1989

[Changing trends in the surgical management of breast carcinoma in Japan].

Modified mastectomy, which involved removal of the breast, overlying skin and axillary contents but spares the pectoralis muscle, has recently been established as an entirely satisfactory approach for Stage I and Stage II breast carcinoma. In a sequential series of patients, we noted that the traditional mastectomy followed by radiation to axilla and adjacent area failed to confirm the efficacy to support the prevention for local relapse in the past decade. The concepts of adjuvant chemotherapy evolved primarily from clinical trials: CMF and CAMF have been shown to influence favorably the therapy of premenopausal women with positive. nodes. Additional endocrine adjuvant treatment in postmenopausal women with positive nodes was significantly superior to that with CAMF. Immediate breast reconstruction following modified mastectomy or subcutaneous mastectomy was safe, simple, and possible to produce the patient's satisfaction. There was a positive effect on life style and on sexual, social or work relationships. Finally, in recent years, several studies have reported that more conservative treatment, such as partial mastectomy and nodes dissection with postsurgical radiotherapy are as effective as modified mastectomy. Present research will likely continue to modified current treatment as more data are gathered and analyzed clinically and histologically.

Adult↗
PubMed1987

Immediate breast reconstruction with tissue expansion.

Between October of 1983 and June of 1985, 31 patients underwent primary breast reconstruction with tissue expansion. Tissue expansion was utilized for breast reconstruction when the remaining muscle and skin following modified radical mastectomy was insufficient to accommodate a prosthesis that matched in size and shape the opposite breast. All expanders were placed beneath an investing muscular pocket created by elevating the pectoralis major and serratus anterior. Postoperative expansion began within 1 week, and the breast was expanded to double the volume of the opposite breast. Twenty-two patients have completed their reconstruction with a mean follow-up in 7 months. There were nine complications, including five deflations and four infections. All patients have remained Baker I or Baker II. Creating ptosis to match the breast was accomplished by placing the expander below the rectus fascia and superiorly advancing this expanded tissue at the time of prosthesis placement. Primary breast reconstruction with tissue expansion following modified radical mastectomy is safe, simple, and produces a breast with excellent shape, size, texture, and patient satisfaction.

Breast↗
PubMed1984

Diaphragm mobilization for closure of chest wall defects.

Locally disseminated breast carcinoma after a simple or radical mastectomy and radiotherapy causes serious surgical problems. Excision of the chest wall obliterates the negative intrapleural pressure, and wound healing within a previously irradiated area is notoriously poor. A new method is described in which the diaphragm is mobilized and reinserted into the defect to allow final resurfacing with a skin graft or locally rotated skin flap. This simple surgical method is advocated when the prognosis is poor and breast reconstruction is not being considered.

Adult↗
PubMed1994

Mastectomy from the perspective of a medical oncologist.

An increasing awareness of breast cancer and the increased use of mammography fortunately is resulting in a marked increase in the diagnosis of early breast cancer. Many of these lesions are characterized by intraductal breast cancer (ductal carcinoma in situ) and/or lesions smaller than 1 cm. Before the era of mammography, approximately 3-5% of new breast cancer cases involved ductal carcinomas in situ. More recent series suggest that such lesions can account for up to 25% of all new breast cancer cases. Breast conservation therapy is of particular importance to this population of patients with breast cancer. Breast conservation therapy is defined as excision of the primary breast tumor and adjacent breast tissue followed by radiation. This is referred to as lumpectomy, tumorectomy, segmental mastectomy, and quadrantectomy. Surgeons have participated in a series of clinical studies which that provided us with the progressive concept that breast cancer is not only a local but a systemic disease. These studies have shown that a modified radical mastectomy is as effective as a radical or extended radical mastectomy for the management of breast cancer. Subsequently, patients with Stage I or II breast cancer, in which the tumor size was 4 cm or smaller, appeared to do equally well when treated with either total mastectomy or lumpectomy with radiation therapy. Lumpectomy followed by radiation therapy resulted in a 5-year survival rate of 85%, compared with 76% for total mastectomy. The probability of a radiated breast remaining free of tumor at 8 years after the operation was 90%, compared to 61% for those who did not receive radiation therapy after lumpectomy. Subsequent observations indicate that lumpectomy followed by breast radiation and adjuvant chemotherapy in women with positive nodes was appropriate treatment for Stages I and II breast cancer. This manuscript describes the contraindications and indications for conservative surgery for breast cancer and the role or perioperative chemotherapy. Improved imaging techniques will allow clinicians to diagnose breast cancer at an earlier stage of its evolution and demand even more stringent conservation approaches to its management. Simple or total mastectomy and lumpectomy with radiation therapy remain viable options for the management of patients with early stage breast cancer.

Breast Neoplasms↗
PubMed1988

Pleomorphic adenoma of the human breast with local recurrence.

Pleomorphic adenoma of the human breast is a rare, benign tumor for which the literature is sparse. A local recurrence has been reported only once before. The diagnostic challenge of this cancer-imitating lesion is emphasized in this report. Although local excision of the tumor is the treatment of choice, almost 50% of the patients reported have undergone fairly extensive surgery, i.e., simple or radical mastectomy. A paraffin secretion of the excised tumor is mandatory to confirm the benign nature of the lesion to avoid an unnecessary mastectomy for a benign condition.

Breast Neoplasms↗
PubMed2003

VEGF and endostatin levels in wound fluid and plasma after breast surgery.

Angiogenesis is essential for wound repair after surgical trauma. Vascular endothelial growth factor (VEGF) and endostatin are endogenous angiogenic factors involved in the initiation and completion of angiogenesis. The aim of this study was to examine the local and systemic VEGF and endostatin profiles in patients undergoing surgery for benign and malignant breast processes. A total of 16 patients with or without cancer underwent breast surgery. Group I: eight patients with primary breast cancer underwent a simple or radical mastectomy according to Madden including dissection of axillary lymph nodes. Group II: eight healthy female-to-male transsexuals underwent subcutaneous mastectomy. VEGF and endostatin levels in plasma and wound fluid were determined. In both groups VEGF levels in wound fluid were significantly higher compared to postoperative plasma levels, whereas wound fluid endostatin levels were lower than plasma levels and decreased progressively after surgery. In both groups plasma VEGF and endostatin levels did not change significantly before and after surgery. The local VEGF increase and endostatin decrease observed immediately after surgery appears to be a physiological response to operative trauma, which can be studied more profoundly in locally generated fluid than in blood. This process did not seem to be influenced by the type of process (cancerous or non-cancerous) involved in the surgical intervention.

Breast Neoplasms↗
PubMed2001

Extent of ductal carcinoma in situ within and surrounding invasive primary breast carcinoma.

BACKGROUND: The aim of this study was to evaluate the pathological and morphological features of ductal carcinoma in situ (DCIS) within and surrounding invasive ductal carcinoma, and to investigate its relationship with clinical outcome and established prognostic variables. METHODS: One hundred and seven patients with primary operable invasive breast carcinoma and associated DCIS treated by simple or subcutaneous mastectomy or wide local excision with radiotherapy were assessed. Those with pure DCIS and insufficient tumour available for examination were excluded. The most representative haematoxylin and eosin-stained sections from the remaining 91 samples were selected and examined at x 100 magnification using a 45-point, 2-mm grid graticule. The entire section was assessed and the cell under each point of the graticule was classed as either normal (a), DCIS surrounded by normal tissue (b), invasive tumour (c) or DCIS surrounded by invasive malignancy (d). The volume ratio of DCIS in the normal (b/(a + b)) and invasive (d/(c + d)) tissue was then calculated. RESULTS: The DCIS volume within invasive tumour was not associated with outcome. The DCIS volume within adjacent normal tissue, however, was associated with local recurrence (P = 0.025), disease-free interval (P = 0.048), the occurrence of distant metastases (P = 0.019), death (P = 0.049) and disease-free survival (P = 0.048). Volume ratios of DCIS in normal and invasive tissue were not related to known prognostic factors including lymph node stage, grade, tumour size, vascular invasion or patient age. CONCLUSION: There is a significant prognostic effect relating to the extent of DCIS associated with an invasive cancer, particularly with respect to local recurrence of tumour. This effect is restricted to the volume of DCIS in the tissue surrounding the invasive lesion rather than the intratumoral component.

Adult↗
PubMed1980

Body contouring.

The prospect of surgical body contouring is a rather recent innovation for the surgeon. For underdeveloped or atrophic breasts, augmentation mammaplasty is reasonably successful. For ptosis and/or hypertrophy of the breast, reduction and elevation on the chest wall by making the breasts more conical and more projecting is a common procedure for the plastic surgeon. Breast reconstruction is now done after either simple or radical mastectomy, and subcutaneous mastectomy procedures, preserving the nipple and areola, are also commonly done for disease of the breast which is not yet malignant. The abdomen which has been stretched and distorted with scars and striae can be reconstructed by resecting excess skin and fat and tightening up the underlying musculature and fascia. Excess fullness in the lateral aspect of the hips or relaxation, wrinkling, and sagging of the skin of the thighs can be corrected by a thigh lift and surgery for lipodystrophy, keeping most of the scars high in the inguinal area and in the inferior gluteal crease. The buttocks themselves can be corrected if sagging or hypertrophic and, in the exceptional case, even an augmentation to the buttocks similar to that of the breasts can be done.

Abdomen↗
PubMed1990

Highlights from the history of mammography.

The evolution of mammography from simple radiography of mastectomy specimens to the foremost method of breast cancer screening has been dependent on its creators and nurturers, people with intense vision, idealism, and scientific skill. Society owes these investigators a debt of gratitude that can never be adequately repaid.

History, 20th Century↗
PubMed2001

Weight gain and quality of life in women treated with adjuvant chemotherapy for early-stage breast cancer.

PURPOSE/OBJECTIVES: To document weight gain in women treated with adjuvant chemotherapy for early-stage breast cancer and to examine the relationship of weight gain and perceived quality of life (QOL). DESIGN: Descriptive, correlational study. SETTING: Data collected in three settings: an ambulatory oncology service of a university teaching hospital, a private oncology office, and a university-affiliated health clinic, all located in southern New England. SAMPLE: Women with stage I or II breast cancer with primary treatment of simple or modified mastectomy or breast-conserving surgery with radiotherapy scheduled to receive adjuvant chemotherapy. METHODS: Weight data collected through retrospective chart review. QOL data collected prospectively using the Linear Analog Self Assessment Symptom Distress Scale for Breast Cancer and the Functional Assessment of Cancer Therapy for Breast Cancer Scale. MAIN RESEARCH VARIABLES: QOL and weight gain of five pounds or more. FINDINGS: One year after treatment began, 62.5% of the study participants experienced weight gain (X = 10.44 lb), with a range of 5-27 pounds. After two and three years, 68% and 40%, respectively, maintained a clinically significant weight gain. A greater weight gain occurred over time in premenopausal women. No correlation between overall QOL and weight gain existed, but selected items were significantly positively correlated with weight gain. CONCLUSIONS: This study documented a significant weight gain in women treated with adjuvant chemotherapy for early-stage breast cancer. A large percentage of those women maintained this weight gain. Women premenopausal at diagnosis had a greater tendency to gain weight. Although weight gain was not correlated with overall QOL it was distressing for these women. IMPLICATIONS FOR NURSING PRACTICE: Nurses can incorporate the possibility of weight gain into the plan of care for women with breast cancer. Nurses should include this information in education about side effects of treatment and in the ongoing nursing assessment of patients with breast cancer.

Adult↗
PubMed1976

[Pathogenesis, morphology, prognosis, clinical course and therapy of cystosarcoma phyllodes mammae (author's transl)].

Our investigation of 20 cases of C. ph. of the breast in women aged between 12 and 70 years yielded the following results: 1. In all cases a fibroadenoma or remnants of such a tumor were seen alongside with C. ph. A C. ph. therefore always develops on the base of a benign fibroadenoma of the breast. 2. The mitotic proliferation of the epithelium induces a proliferation of the myoepithelial cells which form the stromal portion of the tumor and can differentiate in to fibroblasts, lipoblasts, smooth muscle cells, reticulum cells, cartilage cells, osteoid cells or bone cells. The C. ph. of the female breast should thus be seen as an adenomyothelioma. Malignant degeneration of stromal cells possibly with haematogenous metastasis is observed in some cases. Concurrent malignant change of the epithelium (carcinosarcoma) is extremely rare and leads to lymph node metastases. 3. At the time being, there is no standardized and/or schematic treatment available. The therapy should be performed according to the size and growth of the tumor into the surrounding tissue, from simple excision to mastectomy. Radiation therapy ist not effective.

Adenofibroma↗
PubMed1988

Polyurethane implants: a 6-year review of 416 patients.

The author reviews 6 years of experience and 416 patients in whom polyurethane implants were used for augmentation and reconstruction of the breast. As with many other plastic surgeons, early use was confined to "salvage cases." Owing to the impressive results, use was extended to routine augmentation. Polyurethane implants are now used exclusively for aesthetic breast surgery. Results are evaluated for replacement of gel capsules and simple and radical mastectomy reconstruction. Gel capsules (Baker stages III to IV), in which prostheses were removed and replaced with polyurethane-covered implants, improved in 29 of 32 patients (87 percent). For reconstruction, placement of polyurethane implants in unscarred situations gives far superior results than following repeated procedures. The incidence of infection is no higher than with gel implants. Removal without capsulectomy was not a problem in most instances. However, on two recent occasions capsulectomy was extremely difficult.

Breast↗