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PubMed2004

[A clinical study of 214 cases of modified radical mastectomy with preservation of major and minor pectoral muscles].

OBJECTIVE: To study clinical effects of modified radical mastectomy with preservation of major and minor pectoral muscles. METHODS: A retrospective analysis was carried out in 214 cases of breast cancer patients (including stage I 66 cases, stage II 141 cases and stage III 7 cases). Modified radical mastectomy with preservation of major and minor pectoral muscles was performed on all the patients. RESULTS: Out of 214 cases, 12 (5.6%) had subcutaneous fluid, 16 (7.4%) had skin flap margin necrosis. Upper limb lymphatic edema was found in 8 (3.7%) patients, and pectoral muscle contracture with dyspraxia of upper arm occurred in 11 (5.1%) cases. Three year survival rate was 82.3% and five year survival rate was 63.4%. For stage I patients, the five year survival rate attained to 79.6%, and stage II 56.3%. CONCLUSIONS: Preservation of lateral branch of pectoral nerve can avoid complication of pectoral muscle contracture with dyspraxia of upper arm. Early chemotherapy of postoperation prevents breast cancer occurrence and metastasis. Comprehensive treat approaches for operative wound avert subcutaneous fluid, and complex therapy improves long-term effect of breast cancer patients.

Adult↗
PubMed2004

Skin-sparing and nipple-sparing mastectomy: preoperative, intraoperative, and postoperative considerations.

The last several decades have witnessed significant advances in the surgical management of breast cancer. Although many have embraced breast conservation as the procedure of choice, some patients will still opt for mastectomy for a variety of reasons. Recently, the concept of skin sparing mastectomy and immediate breast reconstruction has emerged as an option that provides excellent cosmetic results while being oncologically safe. However, this surgical approach must be considered within a multidisciplinary context, and there are a number of perioperative issues that need to be considered. In addition, newer techniques, which spare the nipple and/or areola, warrant further examination.

Breast Implants↗
PubMed2004

[Breast reconstruction following mastectomy].

BACKGROUND: Breast cancer is the most common cancer in women, many of whom feel less feminine after the loss of a breast. Breast reconstruction can strengthen their self image, hence it is an excellent treatment option for those who have had a mastectomy. MATERIAL AND METHODS: This review is based on information retrieved from Medline and on clinical experience. We have also asked all departments of plastic surgery in Norway which methods of breast reconstruction they are using. RESULTS AND INTERPRETATION: Breast reconstruction following mastectomy is performed by plastic surgeons and if necessary in cooperation with breast surgeons. The missing breast can be reconstructed with an implant, autologous tissue or by combining the two methods. Many years of experience have resulted in high standards within reconstructive breast surgery. In Norway breast reconstruction is performed in every department of plastic surgery.

Breast Implants↗
PubMedDate not supplied

[Effectiveness of a modified Madde-type mastectomy in patients with breast cancer of I-II stage].

Effectiveness of mastectomy with two breast muscles preserved and total lymphdissection (Malden surgical operation) in I-II stage breast cancer patients has been studied. The control group has been operated using classical mastectomy after Golsted and its modified variant named after Peity. The degree of the disease dissemination was confirmed pathohistologicaly based on the 5-th edition of TNM system. It was established that the 5 year survival period among patients with primary tumor size getting pT1-2 doesn't depend on a volume of a surgical operation but correlates with the number of regional lymph nodes metastasis (pN1). It has totaled 85.3-87.2 % among pT1 pNO MO breast cancer patients, 73.5%--pT2 pNo MO, 63.7-69.3%--pT1-2pN1Mo. 81% of patients who had 1-3 regional lymph nodes metastasis is still alive after the 5 year survival period--57.2%, of those who had 4-9 regional metastasis overpassed this 5 year survival period and 10 or over regional metastasis survive only about 19%.

Axilla↗
PubMed1992

The impact of adjuvant radiotherapy and cytotoxic chemotherapy on the outcome of immediate breast reconstruction by tissue expansion after mastectomy for breast cancer.

In an attempt to evaluate the impact of radiation therapy and cytotoxic chemotherapy on the outcome of immediate breast reconstruction by tissue expansion after mastectomy a prospective study on 32 patients was performed. The radiation therapy significantly worsened the surgical outcome, because the irradiated patients more often had pectoral muscle stiffness making the expansion more painful and the reconstructed breast too small, hard and with insufficient ptosis to obtain a natural breast mould. These results indicate that this technique should be avoided in patients likely to receive postoperative adjuvant cytotoxic chemotherapy and radiation therapy, thus reducing the indication to a small group of patients undergoing mastectomy for widespread ductal carcinoma in situ.

Adult↗
PubMed2005

[Treatment of upper limb lymphedema after radical mastectomy with liposuction technique and pressure therapy].

OBJECTIVE: To study a new method of treatment for upper limb lymphedema after radical mastectomy. METHODS: From Jun. 2001 to Sep. 2003, 11 cases (2 with complication of erysipelas) of upper limb lymphedema being treated with radical mastectomy for more than 2 years were used as model. All the edema of limbs was sucked from hypodermis with liposuction technique and compressed with compression garment. Three months after operation, elasticity stress was conducted every night. RESULTS: The reduction of the edema of upper limbs was remarkable. The average decrease of circumference was 4 cm. No erysipelas was observed. CONCLUSION: The liposuction technique and elasticity stress is a new and effective approach to the treatment of upper limb lymphedema.

Adult↗
PubMed2006

Intercostal nerves block for mastectomy in two patients with advanced breast malignancy.

Regional anesthesia is recognized as an alternative to general anesthesia for modern breast cancer surgery. Various techniques of block have been described. Each has its unique problems. Regional anesthesia was chosen for simple mastectomy in two patients with advanced breast malignancy, due to compromised pulmonary status resulting from widespread malignant infiltration of both lungs. We used intercostal nerves block. The block was supplemented with an infraclavicular infiltration to interrupt the branches of the superficial cervical plexus that provide sensation to the upper chest wall and subcutaneous infiltration in the midline to block the nerve supply from the contralateral side. Anesthesia was generally effective and the operations were uneventful. Both patients and surgeons expressed satisfaction. We conclude that where patients have significant comorbidities that make general anesthesia undesirable, the use of intercostal nerves block remains a safe and reliable anesthetic option that allows the patient access to surgery for simple mastectomy.

Breast Neoplasms↗
PubMed2006

[Bilateral breast reconstruction with deep inferior epigastric perforator flap following modified radical mastectomy].

OBJECTIVE: To present a method for bilateral breast reconstruction with deep inferior epigastric perforator (DIEP) flap following modified radical mastectomy. METHODS: From 2004 to 2005, three patients with bilateral modified radical mastectomy have undergone delayed bilateral breast reconstruction with deep inferior epigastric perforator flap. RESULT: The flaps in all the cases survived. Follow-up more than 3 months, postoperative abdominal wall examination didn't reveal hernia and bulging. The bilateral reconstructed breast achieved good results in shape and symmetry. Bilateral reconstructed breasts are symmetry. CONCLUSION: The procedure introduced is a reliable method for bilateral breast reconstruction.

Adult↗
PubMed2005

Quadrantectomy and nipple saving mastectomy in treatment of early breast cancer: feasibility and aesthetic results of adjunctive latissmus dorsi breast reconstruction.

BACKGROUND AND PURPOSE: Breast conserving surgery has been a recognised method of treatment of early breast cancer. The treatment methods include quadrantectomy or skin sparing mastectomy combined with ipsilateral axillary nodal dissection followed by radiotherapy. In the current study we evaluate the feasibility and oncologic safety of the quadrantectomy and SSM operations with preservation of the nipple and areola, and the cosmetic results of immediate reconstruction by using the latissmus dorsi flap. MATERIALS AND METHODS: A breast conservative surgery (quadrantectomy or nipple sparing mastectomy) was carried out in a group of 55 patients with invasive breast cancer treated at the Department of Surgical Oncology, NCI, between January 2001 and April 2004. The selection criteria included those patients who presented with T1 or T2 breast cancer and were located at least 2 cm from the nipple as the centre for the nipple areola complex. RESULTS: The age of the patients ranged from 32 years to 65 years. The follow up period ranged from 2 to 33 months with an average of 21 months. Pathological assessment of the specimens showed a negative safety margin in all cases. Most of our cases were invasive duct carcinoma grade 1-2 (42) (75%). The complications of the flap reconstruction included one major sloughing of the latissmus dorsi flap, 4 partial flap sloughing, 4 sloughing of the nipple and fat necrosis in 6 patients. The donor site healed normally in all of our cases except for one patient who suffered from a hypertrophic scar which settled down during the follow up period. The aesthetic assessment of the patients, showed an excellent to good results in the majority of cases (42) (75%) while in 6 (12%) results were fair and in 7 (13%) results were poor. CONCLUSION: Breast conservative surgery with quadrantectomy or skin sparing technique with preservation of the nipple and areola combined with immediate LD flap reconstruction is a valid procedure for treatment of early breast cancer. Immediate reconstruction by using the extended latissmus dorsi is as safe, relatively easy procedure which can provide an adequate volume replacement for small to moderate sized breasts.

Adult↗
PubMed2006

[Massive breast angiomatosis with dramatic course leading to acute total mastectomy--a case report].

OBJECTIVE: On the background of clinical, radiological and morphologic settings presented is unusual case of the rare angiomatosis of the female breast. Discussed are both clinicopathological aspects and differential diagnosis from the morphological point of view. DESIGN: Case report. SETTING: Biopsy Lab s.r.o. and Sikl's Department of Pathology, Charles University and Faculty Hospital, Pilsen. METHODS: As a case report described is a rare case of the angiomatosis of the female breast. Implemented illustrations consist of local findings, CT scan, specimen gross appearance and histological pictures including immunohistochemistry. Applied antibodies and detection system LSAB+ were provided by Dako, visualization was performed by chromogen DAB (diaminobenzidin tetrahydrochlorid). RESULTS: 30-year-old woman suffering of painful, enormous breast asymmetry underwent core needle biopsy of the right breast. The mastogram showed diffuse process of ambiguous significance. During the next few days her condition dramatically changed and under the circumstances of florid apoplexy and suspicion of tumor of her right breast, total mastectomy was carried out. Histological picture revealed widespread, unlimited vascular lesion dissecting throughout the stroma of the entire gland. Bland morphology and the nature of tissue involvement eventually led to diagnosis of benign angiomatosis. The woman underwent several local plastic operations but is out of final reconstruction of her breast so far. Thirteen months after mastectomy there are no signs of recurrence.

Adult↗
PubMed1975

Subcutaneous mastectomy in 80 patients with breast tumours. Indications, surgical results and pathological findings.

Eighty patients were operated upon with subcutaneous mastectomy and reconstruction with prosthesis. Seventy operations were performed on both breasts. The indications used were carcinoma in situ in a previous biopsy, pronounced epithelial proliferations on at least two previous occasions or recurring fibrocystic disease after at least two previous biopsies. Since the autumn of 1971, the operation has been performed as a one-stage procedure and we have had few complications. The appearance of the breasts was evaluated at review 3-60 months after operation. Most patients found the results acceptable or good. The mamilla always lost its sensibility, but the sensibility of the remaining skin of the breast sometimes returned with time. Most of the patients were well satisfied with the procedure and thought it better than any other sort of treatment. The tissues removed were thoroughly studied. Changes in the breasts were often bilateral and pronounced epithelial proliferation and carcinoma in situ were fairly common. Invasive carcinoma was found in 2 instances. The importance of the histologic examination of removed tissues is stressed. A regular follow-up of these patients is important for assessing the value and the risks of subcutaneous mastectomy.

Adult↗
PubMed1991

[Angiosarcoma in a mastectomy scar following irradiation].

A 74-year-old patient who had undergone radical mastectomy and postoperative radiotherapy for invasive ductal mammary carcinoma developed an angiosarcoma in the radiotherapy field without associated lymphedema. The latency time was 178 months after the first and 82 months after the second radiotherapy. The total radiation-dose was 54 Gy. Only a few such cases have so far been described. These tumors are often multifocal and their prognosis is poor. Better known are angiosarcomas appearing after radical mastectomy as a consequence of chronic lymphedema, which are known as Stewart-Treves-syndrome.

Aged↗
PubMed1990

[Modified radical mastectomy--an analysis of 217 cases].

Modified radical mastectomy (MRM) was performed in two hundred and seventeen patients with operable breast cancer during 1972-1982. Having been followed for 5 to 10 years, the results were compared with those of radical mastectomy (RM) during the same period. There was no significant difference in 5 and 10 year survival rates between the two groups. MRM had the advantages of insignificant deformity, better function and easy breast reconstruction in comparison with RM. The authors believe that MRM should be recommended as the treatment of choice for breast cancer.

Adenocarcinoma↗
PubMed1990

[Radical mastectomy technics].

The authors elaborated a new approach to radical mastectomy which, combined with nonoperative measures makes it possible to prevent the development of postmastectomy-induced edema by means of a lympho-venous anastomosis (LVA). The choice of the level of LVA formation and their number is substantiated. With due regard for the conditions named, the cubital fossa and the lower third of the upper arm on the anterointernal surface is the most rational zone. To accelerate lymph drainage through the collaterals and reduce lymph loss, goal-oriented ligation of the lymph vessels which are divided during mastectomy is additionally carried out; this is successfully done when they have been stained. As a result, wound lymphorrhea ceases practically at days 4 to 5.

Arm↗
PubMed1990

[Extended radical mastectomy using preoperative local injection of activated carbon particle adsorbing aclarubicin (ACR-CH)].

ACR-CH was injected prior to surgery of breast cancer. Incidence of black staining of regional lymph nodes and concentration of ACR in the nodes were examined in order to evaluate the usefulness of preoperative local injection of ACR-CH. 1) In 13 cases of extended radical mastectomy, black staining was seen in nodes of all the regions. Especially, in parasternal, retromanubrial, anterior mediastinal and supraclavicular nodes, 46% or more of the nodes were stained and ACR concentration of 6-7 micrograms/g was obtained. 2) When incidence of black staining of the metastasis-free nodes was compared with that of the nodes with metastasis, it was 79% in the metastasis free nodes and 42% in the nodes with metastasis. The average ACR concentration was 54.16 +/- 123.16 in the stained nodes and 2.58 +/- 3.59 in unstained nodes, the former being significantly higher than the latter. 3) Majority of the stained nodes with metastasis had only very small metastatic foci and nodes with significant metastasis were only very rarely stained. 4) In conclusion, we believe that anticancer effect of ACR-CH can be expected to small metastatic foci in the parasternal lymph nodes and more distal nodes, dissection of which tends to be incomplete at extended radical mastectomy, as well as to free cancer cells in the lymph vessels.

Aclarubicin↗
PubMed1990

[Seroma formation and drainage technic following mastectomy].

Although seromas represent the most frequent postoperative complication of mastectomy, little attention has been paid in the literature to etiologic factors or therapy. In the present paper, a modified drainage technique is described which reduced the incidence of seroma formation after total mastectomy with removal of the axillary lymph nodes from 50% to 20.2%. Seroma formation was associated with drainage of significantly higher amounts of fluid. Seroma formation generally began on the 7th day after operation, reached a peak rate of growth on the 8th day, and subsequently slowed continuously up to the 16th day after operations. Age was revealed to be a very important etiologic factor: the frequency of seroma formation increasing with age.

Adult↗
PubMed1989

[A carcinoma of the right breast arising after a mastectomy in primary malignant lymphoma of the left breast].

In 1987, a 51-year-old woman visited our hospital, having noticed a painless 1.5 x 1.5 cm tumor of the left breast. On biopsy, it was pathologically diagnosed as being a primary malignant lymphoma of the breast. Thus we performed a modified radical mastectomy (Patey's method), in combination with chemotherapy (Cyclophosphamide, Vincristine, Prednisolone). Two years after the operation, a tumor of the right breast, 1.0 x 1.0 cm in size, was noticed. At this time, since an excised specimen was pathologically determined as being a scirrhous carcinoma, we performed a modified radical mastectomy (Auchincloss' method), followed by chemotherapy (Tegafur).

Adenocarcinoma, Scirrhous↗
PubMed1989

Locoregional recurrences after 649 modified radical mastectomies: incidence and significance.

A continuous series of 649 patients, treated by modified radical mastectomy for primary breast carcinoma, is analyzed after a median follow-up of 92 months. 'True isolated' locoregional recurrences (LR), defined as LR not preceded or followed by distant metastases within 6 weeks, appeared with a cumulative actuarial incidence rate of 6%, 14% and 19% after 1, 5 and 7 years respectively, whereas the respective figures for distant metastases (M1) were 10%, 37% and 48%. The main initial parameters, predicting both the LR-free and the M1-free interval, are presented by statistical analyses in the following order of importance: number of invaded lymph nodes in the axilla, tumor size (T) and histological grading of differentiation. The same factors also predicted the imminence of M1 once LR had occurred, as well as survival after LR. A higher incidence of M1 after LR was also correlated with estrogen-receptor negative tumors and with those LR occurring within one year after mastectomy. LR occurred at the chest wall (65%), in the sub-clavicular fossa (16%) and the axilla (6%); the remaining 13% occurred in two of the sites. There was a trend towards longer survival after chest wall recurrence than after LR recurrence at another site. Axillothoracic irradiations postmastectomy gave a lower rate of LR in 227 patients than did a regimen of 12 months adjuvant chemotherapy with irradiation restricted to the internal mammary lymph nodes in 120 subsequent patients: 17 vs 25% at 5 years (P = 0.03 when adjusted by initial nodal involvement and T-size). Total excision of LR (repeated if new LR occurred) gave better rates of local ultimate control and survival than other kinds of treatments, with or without adjuvant local or systemic therapy. LR is not always a sign of imminent generalized disease. Actuarial 5-year survival after LR is 26.2% overall whereas, if only 'true isolated' LR are considered, the survival is 37%.

Breast Neoplasms↗