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PubMed1975

Subcutaneous mastectomy. The excess skin problem.

Subcantaneous mastectomy through a lateral approach, with preservation of the nipple and areola on a dermal pedicle, removing the excess skin at the time of aubautaneous mastectomy, is a safe procedure which results in esthetically acceptable breasts. The surgical approach greatly facilitates the removal of the entire glandular portion of the breast. The need for a second surgical procedure is eliminated. Lateral biopsy scars can be reinforced by the dermal sling support, thereby decreasing the chances of exposure of the implant. The implant is also successfully and easily held in position by the use of the dermal-fat sling support. The nipple and areola survive quite well on the dermal pedicle, with preservation of contractility and sensation, as well as of blood supply.

Dermatologic Surgical Procedures↗
PubMed1975

Breast restoration after mastectomy for cancer.

The clinical problems encountered in the reconstruction of breasts of patients who have undergone mastectomy for cancer are presented. The indications and contraindications for reconstruction of the breast are arbitrarily defined. Various methods are available to reconstruct the breast. We favor implantation of a preformed silicone prosthesis under the skin and subcutaneous tissue overlying either the pectoralis major muscle or the chest wall. The advantages of this procedure outweigh those of other methods. Seven cases are presented to illustrate our experience in this rehabilitative procedure. It is suggested that breast reconstruction should be offered to a much higher proportion of patients undergoing mastectomy for breast cancer.

Adult↗
PubMed2002

Immediate and delayed two-stage post-mastectomy breast reconstruction with implants. Our experience of general surgeons.

BACKGROUND: Breast reconstruction after a mastectomy, today is considered the best choice to improve the quality of life for the patient. The aim of the procedure is to consider the aesthetic results obtained and the various involvements, comparing them with those already reported in literature. METHODS. There is no certain data of the number of breast reconstructions performed in Italy in the few years. In 1999, in Veneto, reconstruction surgery after total breast removal, represented only 16% of the operations. In our surgery Division, from 1996 to 2000, there were breast reconstructions performed, either immediately or delayed on 87 patients out of 118 after mastectomy. 73.7% none over the age of 60 (range 27-60). The breast removal technique used is the Madden, while, for the reconstruction we have put into effect the submuscle prosthetic implant; 63 patients were subject to follow-up treatment during the period of 10 to 36 months. RESULTS: Seventy-eight percent of the women have judged the final aesthetic results the same or better than expected. Based on reconstruction with prosthesis, is the preferred procedure, even with serious complications which do not always influence the final results. This preference is because of the reduced operation time and the psychological and physical benefits due to immediate restoral of the mammary volume and shape. CONCLUSIONS: Some problems (Garavaglia Law) have slowed down the diffusion in Italy of this type of treatment which is now receiving more and more request and approval by the women affected with breast cancer.

Adult↗
PubMed2002

[External oblique muscle-cutaneous flap use of the in the reconstruction of large chest wall defects after mastectomy].

The use of an external oblique muscle-cutaneous flap in the reconstruction of large chest wall defects after mastectomy is described. The flap is drown as a V-Y advancement-rotation flap, laterally based, on the ipsilateral abdominal wall. The flap extends from the posterior axillary line to the linea alba, vascular supply is provided by the musculo-cutaneous perforating arteries of the intercostal vessels. Mobilization starts medially including the anterior rectus sheath, décollement continues between the external and the internal oblique muscles as far as the posterior axillary line. The abdominal wall, after flap mobilization, is reinforced by the plication of the internal oblique sheath. The flap was used in 13 patients with major anterior chest-wall defects after mastectomy. In one patient a marginal skin necrosis of about 2 cm was observed. The flap described differs from other external oblique flaps already described in several technical innovations that allow to obtain better functional and esthetic results.

Abdominal Muscles↗
PubMed2001

[Organizational aspects of the one-staged reconstruction of mammary glands after performance of mastectomy].

The femoral mammarial glands reconstruction after performance of mastectomy have become an ordinary procedure in USA and in countries of Europe. Primary reconstructions owes following advantages: high cosmetic effect, small psychological trauma of female patient, lesser cost of treatment of such patients in comparison with corresponding indices for postponed performance of reconstruction. In Ukraine such operations were not nearly performed yet. An organizational aspects of one-staged reconstruction of mammarial glands using auto tissues after performance of mastectomy for the mammarial glands cancer were presented, basing on literature data and the authors own experience.

Adult↗
PubMedDate not supplied

Deltopectoral flap for reconstruction of male breast after radical mastectomy for cancer in a patient on hemodialysis.

A rare case of advanced male breast cancer in a patient on hemodialysis was successfully treated with radical mastectomy and chemotherapy. Computed tomography of the chest revealed multiple pulmonary metastases. After administration of chemotherapy consisting of 5-fluorouracil (4000 mg) and epirubicin (280 mg), the pulmonary metastases disappeared and this was associated with a decrease of serum CEA levels and tumor size. Radical mastectomy and reconstruction for the chest wall defect using a deltopectoral flap (DP flap) were performed. Histopathological examination of the resected specimen showed intraductal adenocarcinoma with nodal metastases. The patient has remained well without clinical recurrence of distant metastasis for a follow-up period of two years. Our experience has demonstrated that the DP flap was a feasible approach in male breast reconstruction despite the debilitated condition of the patient.

Breast Neoplasms, Male↗
PubMed1976

[Bilateral radical mastectomy for carcinoma of the breast of the stages T0 and T1 (N0, M0) and mammoplasty of both breasts, areola and nipples in a single operation (author's transl)].

Bilateral radical mastectomy and concomitant mammoplasty is a new operative procedure for the treatment of carcinoma of the breast in the stages T0 and the small T1, N0, M0. The advantage of the procedure is the increased extent of the operation, the improved cosmetic result and the single stage of the procedure. Consequently the cure rate is improved and the psychic trauma to the patient is decreased. The operation is more radical since the so-called healthy breast is operated first, including axillary lymphadenectomy and subsequent mammoplasty followed by the same procedure on the so-called diseased breast. If the pectoral muscles are involved, a conventional radical mastectomy has to be done. The diagnosis is made by excisional biopsy and frozen section microscopy. The cosmetic result is improved because both breasts are subjected to the same operation, and lateral differences in shape, volume and consistency of the breasts are eliminated. Cylastic prostheses are inserted as new breasts usually sub-pectorally and rarely subcutaneously. The nipples are surgically reconstructed and pigmented by tattooing. The advantage of this single stage procedure is a single general anaesthesia and less psychic trauma since the patient goes to sleep with the knowledge of waking up with two breasts even though endoprothetic breasts. Post-operative radiotherapy can be applied with the prostheses in place. The principle of cure before cosmetics is preserved. Radical operation of the so-called healthy side is justified because of the above mentioned cosmetic advantages and the 25% incidence of primary or metastatic cancer of the so-called healthy side. The post-operative care of women with a bilateral operation is not a problem since no more breast tissue is left behind. Orthopedic complaints which can occur because of macromastia of the remaining breast are also eliminated.

Axilla↗
PubMedDate not supplied

[Complications and incidents associated with arm edema in the first 3 months after mastectomy].

This study aimed at identifying complications, intercurrences and the appearance of edema following breast cancer surgery as well as factors that could predispose to arm lymphedema on the operated side. It is a descriptive and prospective study based on a quantitative approach. The subjects consisted of 17 women submitted to unilateral mastectomy in a University Hospital. Data were collected by means of a weekly post-operative follow-up of each patient for a period of three months. Edema was detected in 11 women, nine of which were in mild level and two in moderate level. It must be emphasized that even mild-level edema could become severe if not treated appropriately. Among the women with edema, complications, intercurrences and other variables were observed. The results revealed the importance of nurse follow up during the mastectomy post-operative period as well as the need for better staff training for patient guidance aiming at edema prevention.

Adult↗
PubMed1976

Restorative prosthetic mammaplasty in mastectomy for carcinoma and benign lesions.

It is possible to reconstruct the normal shape of the female breasts at the time of operation for carcinoma of the breast or benign lesions where the whole breast tissue is removed. This is done by the insertion of an inert silicone plastic prosthesis. This procedure avoids the mutilating effect normally associated with mastectomy. The criteria for this operation must be strictly applied if it is to be successful and if cure of the disease is not to be prejudiced. These principally involve local characteristics of the tumour and the nutrition of the skin flaps which will remain after the ablation procedure has been completed. The importance of strict adherence to the minutiae of the surgical technique is to be stressed. Failure to observe these will result in failure of the operation. It is also possible in cases with adequate skin to perform the operation as a secondary procedure where there has been an earlier mastectomy.

Aged↗
PubMedDate not supplied

[Post-mastectomy lymphedema: surgical therapy].

After some preliminary remarks concerning epidemiological data about post-mastectomy lymphedema, on the basis of specific etiologic and pathophysiologic aspects, authors report a modern clinical and instrumental staging of lymphedema and an accurate diagnostic protocol, which allows not only to study lymphedema at late stages, but also to individuate the disease at earliest stages. Protocols of medical, physical and rehabilitative treatment mostly used today are schematically described, and they include proper igienic measures for the prevention bacterial and micotic infections, manual lymph drainage, sequential compression therapy, exercises, thermotherapy, bandages and elastic garments. Authors underline above all the importance of Microsurgery in treating post-mastectomy lymphedema, by means of modern methods of lymphatic microsurgery, derivative or reconstructive (multiple lymphatic-venous anastomoses, lymphatic-venous-lymphatic plasty). The operation of multiple lymphatic-venous anastomoses represent the mostly used technique. The registry consists of 194 microsurgical operations, performed in patients treated and followed-up statistically in the last 15 years, with positive result in over 80% of cases.

Arm↗
PubMed2003

[Lymphoscintigraphy in the diagnosis and prognosis of post-mastectomy edema of the extremities].

Dynamic lymphoscintigraphy provides adequate means for in vivo contrast-enhanced examination of functional lymph collectors in the extremeties which in turn offers best advantage in diagnosing post-mastectomy edema of the arms. A comparative study was concerned with lymph flow in healthy subjects, breast cancer patients and those with post-mastectomy edema and without it after complete course of treatment. A group of risk for edema was formed.

Arm↗
PubMed2003

[Post-mastectomy radiotherapy with different fractionated dose schemes in early breast cancer].

OBJECTIVE: To study the effect of post-mastectomy radiotherapy with different fractionated dose schemes for early breast cancer. METHODS: From January 1987 to January 1993, 367 patients with early breast cancer were given post-mastectomy radiotherapy with three different fractionated dose schemes. 149 patients received conventional radiotherapy with 50 Gy/25 fractions/5 weeks (Group A). 177 patients received 45 Gy/15 fractions/5 weeks (Group B). Forty-one patients were treated with 23 Gy/4 fractions/17 days (Group C). 257 patients received systemic therapy (chemotherapy and/or endocrine therapy). RESULTS: The overall 5-year survival and 5-year disease-free survival rates were 87.4% and 89.6%. The 5-year disease-free survival rate were 90.8%, 86.5% and 84.6% for A, B and C groups (P = 0.16). The corresponding loco-regional failure rates were 2.7%, 2.8% and 2.4%, respectively. There was no statistically significant difference in the local control and efficacy of the three groups. CONCLUSION: With similar 5-year tumor-free survival rates by the conventional fractionation and hypofractionation, the scheme with 45 Gy/15 fractions/5 weeks has the advantage of giving less factions, which is suitable for a unit with limited radiation resources. The course of hypofractionation with 23 Gy/4 fractions/17 days is much shorter than conventional radiotherapy, which may benefit patients with higher risk of metastasis who need to undergo chemotherapy earlier. This study warrants further investigations.

Adult↗
PubMed1992

Unnecessary mastectomy for gynecomastia in testicular cancer patient.

A young man presented with a 4-month history of progressive, bilateral tender gynecomastia and underwent a bilateral subcutaneous mastectomy without regard for a possible occult testicular tumor. Following the mastectomy, metastatic testicular cancer was discovered; the patient had an overlooked scrotal mass and a very elevated serum human chorionic gonadotropin tumor marker. The possibility of testicular tumor must be considered in any male, especially those in the younger age group, who present with gynecomastia.

Adult↗
PubMed1992

Non-tumour morbidity and mortality after modified radical mastectomy.

From 1985 to 1987 148 patients underwent mastectomy for breast cancer, of whom 91 underwent modified radical mastectomy. Of these patients (median age 60 years (range 31-86 years)), 89 have been assessed for early (< 30 days) and late (> 30 days) non-tumour morbidity and mortality. A total of 41 patients had nodal metastases. Adjunctive therapy used was tamoxifen in 70 patients and radiotherapy in 20. Overall, 47 patients (53%) developed a total of 75 complications, and there was one 30-day mortality. Of the patients, 26 developed one complication, 14 had two complications and 7 three complications. Early complications were lymphocoele/seroma (n = 22), wound infection (n = 9) and cardiopulmonary problems (five deep vein thrombosis, two pulmonary embolus (1 death), one myocardial infarct). Late complications were lymphoedema (n = 10), pectoralis major wasting (n = 6), frozen shoulder (n = 7), intercostobrachial neuralgia (n = 4), and a small number of self-limiting wound problems (n = 9). There were two late deaths (myocardial infarcts). Early complications were not related to nodal status, and late complications were related to neither nodal status nor radiotherapy. Significant morbidity is attached to radical surgery for breast cancer. Most complications are minor and self-limiting, but there are a small number of late complications which may affect quality of life.

Adult↗
PubMed1992

Fibrin glue reduces seroma formation in the rat after mastectomy.

Fibrin glue is a biologic tissue adhesive that has been found to be useful in several areas of surgical treatment. Little has been written in the English literature, however, on its use in preventing postoperative fluid collections. We performed a prospective randomized trial to determine if fibrin glue could reduce postoperative fluid collections after mastectomy in a rat. Bilateral mastectomies and axillary lymph node dissections were performed upon 42 rats, one-half of which were treated with fibrin glue and one-half of which served as controls. The rats were sacrificed after seven days and inspected for quantity of fluid and adhesion formation. The mean plus or minus standard error of the mean fluid collections were 0.71 +/- 0.26 milliliter and 3.75 +/- 0.65 milliliter for the rats treated with fibrin glue and control rats, respectively. This was statistically significant (p < 0.0001). Seventeen of 21 rats treated with fibrin glue and four of 21 control rats were found to have fluid collections of less than 1 milliliter, again statistically significant (p = 0.00006). Furthermore, greater adhesion formation between the skin flap and chest wall was noted in the rats treated with fibrin glue. The results support the use of fibrin glue in clinical investigations to reduce postoperative fluid collections and also support the need to develop a standard reproducible method of producing fibrin glue or a commercial product free of transmissible disease.

Animals↗
PubMed2003

A 40-year delayed locoregional recurrence of breast carcinoma following mastectomy.

A 90-year-old woman who underwent a left modified radical mastectomy 40 years ago with no further adjuvant treatment presented with a left chest wall mass at the suture line. A biopsy of the mass confirmed that it was invasive ductal carcinoma of the breast. After a negative metastatic work-up, the patient underwent a local resection of the chest wall mass with clear margins. We present here the longest documented delayed recurrence after modified radical mastectomy reported in the literature.

Aged↗
PubMed1992

[Attempt for modified radical mastectomy in the treatment of early breast cancer].

Until five years ago the Aichi Cancer Center had adopted the standard radical mastectomy where breast, major and minor pectoral muscles, and axillary adipose tissues were resected en bloc. In case tumor was found at the inner half or the center of the breast, parasternal lymph node dissection was concomitantly carried out. Recently, however, we begin to perform Auchincloss by which major and minor pectoral muscles can be conserved, as an attempt for modified radical mastectomy. In some cases, furthermore, breast conserving operation is made. The reasons why we changed the operation methods are: 1) Due to the advancement of diagnostic imaging and widespread self examination, percentage of early breast cancer has considerably increased. 2) Postoperative adjuvant therapy, especially adjuvant endocrine therapy, has remarkably progressed.

Breast Neoplasms↗
PubMed2004

Two doses of oral sustained-release tramadol do not reduce pain or morphine consumption after modified radical mastectomy: a randomized, double blind, placebo-controlled trial.

BACKGROUND: Tramadol is a weak opioid agonist with antinociceptive effects through its action on the mu-receptor and by inhibiting the neuronal re-uptake of both noradrenaline and serotonin. Tramadol is commonly used for treatment of mild to moderate post-operative pain. An oral form of sustained-release tramadol (SR) was recently formulated for reducing the administration frequency from qid to bid. OBJECTIVE: To evaluate the analgesic efficacy and safety of two doses of oral tramadol SR for the treatment of pain after modified radical mastectomy. STUDY DESIGN: Randomized, double blind, placebo-controlled trial. METHOD: Fifty women were randomly allocated to receive either tramadol SR 100 mg (group T), or placebo tablet (group P) orally approximately 1 hour before surgery with a repeat dose administered 12 hours later by nurses not apprised of the patient groupings. All patients received the standard general anesthesia. Post-operatively, nurses in the research team assessed pain using a visual analog scale 0-100 mm at rest (rVAS) and during arm movements (mVAS) at admission to postanesthesia care unit (PACU) (T0) and 2 (T2), 6 (T6), 12 (T12) and 24 (T24) hours after surgery. Rescue analgesia was provided for 24 hours via a morphine-loaded patient-controlled analgesia (PCA) device at 1 mg bolus with a 5-minute lockout interval. Cumulative morphine consumption and adverse events were recorded. RESULTS: Twenty-five patients with comparable baseline characteristics from each group were studied. The proportions of patients with VAS > 30 (both rVAS and mVAS) at each measurement period were not significantly different between the groups except for the mVAS at T24, where the proportion in group T was higher than group P (48% vs 20%, 95% CI of difference: -53%, -3%, p = 0.04). The median morphine consumption in both groups at T2, T6, T12 and T24 were comparable. No serious adverse effects were observed; however, patients in group T reported nausea and vomiting more than group P (56% vs 24%, p = 0.02). CONCLUSION: Two doses of oral tramadol SR 100 mg had no effect on post-operative pain scores and morphine consumption in patients who underwent modified radical mastectomy. In fact, more patients in the tramadol group reported nausea and vomiting than the placebo group.

Administration, Oral↗