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PubMed1999

An analysis of male and female breast cancer treatment and survival among demographically identical pairs of patients.

BACKGROUND: Male breast cancer is rare, and there are no large comparative studies to guide treatment. We used National Cancer Data Base data on 4755 men and 624,174 women who had breast cancer (1985-1994) to identify equivalent groups of male and female breast cancer patients. METHODS: For each man with breast cancer, the next woman treated at the same hospital was sought who matched the man's age (within 5 years), ethnicity, income category, and stage. We identified 3627 closely matched pairs of male and female patients with breast cancer. RESULTS: Men were more likely to be treated with mastectomy (modified radical, 65% of men versus 55.1% of women; radical, 2.5% of men versus 0.9% of women; simple, 7.6% of men versus 3.4% of women; P <.001), and more likely to receive radiation therapy after mastectomy (men, 29%; women, 11%; P <.001). Men treated with lumpectomy were less likely to receive radiation therapy (men, 54%; women, 68%; P <. 001). Men were also less likely to receive chemotherapy (26.7% of men versus 40.6% of women; P <. 001) after any surgical treatment. CONCLUSIONS: This large comparative study is the first to detail stage-specific differences in contemporary treatment strategies for highly comparable groups of men and women treated for breast cancer. Further studies of male breast cancer should focus on identifying prognostic factors and defining optimal therapy.

Adult↗

PubMed1977

Method to produce better areolae and nipples on reconstructed breasts.

A method to reconstruct the breast, nipple, and areola after mastectomy is described. The importance of symmetry is emphasized. A split-skin graft is used to reconstruct both (not one) areolae; this provides almost complete symmetry in terms of size, texture, and color. Ultraviolet light is used postoperatively to hyperpigment the skin-graft areolae, and the long-term appearance has been excellent. The method is quite simple, technically.

Breast↗

PubMed1993

Effect of cortisone on capsular contracture in double-lumen breast implants: ten years' experience.

Two groups of patients are compared with respect to capsular contracture after insertion of silicone breast prostheses. Six hundred seventy four women received single-lumen gel prostheses and 700 received double-lumen prostheses with cortisone. The addition of 12.5 mg of prednisolone to double-lumen prostheses diminished capsular contracture (Baker II to IV) dramatically; in patients with simple augmentation from 19% to 4.9%, in patients with subcutaneous mastectomy from 54% to 14.9%, and in patients with breast reconstruction from 64% to 24.4%. The use of double-lumen implants has three distinct advantages: (1) There is no bleeding and therefore no contact of the body with the silicone gel. (2) There is no danger of ruptured implants, even if the outer shell shows leakage. (3) If prednisolone is administered, capsular contracture is prevented to a significant degree.

Contracture↗

PubMed2001

Basal cell carcinoma of the nipple: a case report and review of the literature.

BACKGROUND: The nipple is an extremely unusual location for basal cell carcinoma (BCC). OBJECTIVE: To report a case of BCC originating on the areola and nipple region in a 47-year-old Dominican woman treated with Mohs micrographic surgery (MMS). METHODS: We discuss a case of BCC originating on the areola and nipple region treated with MMS and review the literature regarding treatment of BCC of the nipple. RESULTS: BCCs of the nipple occur rarely, with a total of 19 cases reported in the literature, 6 of which occurred in females. While many of the reported cases were treated with simple excision, several of these required postoperative radiation therapy and/or mastectomy due to their large size and aggressive nature. CONCLUSION: MMS should be considered for treating BCCs at this site as a tissue-sparing measure to minimize deformity of this important anatomic area and to minimize the risk of recurrence.

Breast Neoplasms↗

PubMed1982

Well-differentiated (tubular) carcinoma of the breast. A clinicopathologic study of 145 pure and mixed cases.

In this study, 145 well-differentiated (tubular) carcinomas were divided into two groups: 90 pure tubular carcinomas and 55 which were mixtures in that they contained a component of infiltrating duct carcinoma occupying less than half the tumor. Axillary lymph node metastases developed in 29% of women in the mixed group, but occurred in only 6% of the pure group. The prognosis was good in both groups, with five-year-actuarial survival rates in the pure and mixed groups of 100% and 93%, respectively. Residual carcinoma was present in the mastectomy specimen in 28% of the pure group, and in 40% of the mixed carcinomas. In addition, there was a recurrence rate of 50% in patients with pure tubular carcinoma treated by excisional biopsy. These features indicate simple excision of tubular carcinoma is likely to be inadequate therapy and that a mastectomy is warranted. Axillary node dissections should be done when there is a component of infiltrating duct carcinoma because of the increased risk of axillary lymph node metastasis.

Actuarial Analysis↗

PubMed1988

Eliminating the dog-ear in modified radical mastectomy.

Inadequate attention has been paid to optimal closure of the postmastectomy incision in patients not desirous of breast reconstruction. Herein, we describe the use of a basic plastic surgical technique at the time of mastectomy to eliminate the dog-ear deformity at the axillary end of the incision. The technique is conceptually simple and expedient, and gives an excellent cosmetic result.

Humans↗

PubMed1983

Internal mammary implantation: the need for revival of a simple technique.

Available statistics on breast cancer indicate a high frequency of positive internal mammary nodes, which is associated with decreased five-year survival rates. The close proximity of the majority of internal mammary nodes (87 percent within 1 cm) to the internal mammary vessels makes them easily accessible to high-dose intravascular continuous irradiation by afterloading radioactive ribbons (iridium 192) in the internal mammary vessels that are surgically exposed. This is a simple technique that can be carried out at the time of mastectomy or as a separate procedure, either as a primary radiation modality, for post-XRT recurrence, or as a boost in combination with conventional parasternal radiation therapy. The step-by-step technique, indications, need for revival, and future implications are presented.

Brachytherapy↗

PubMed2004

Mastectomy and reconstruction--an unusual solution to intractable breast pain.

Breast pain is a common complaint which usually subsides with simple reassurance or sometimes medication. This paper describes the case of a 41-year-old woman suffering from severe non-cyclical breast pain that had proved resistant to a battery of medical treatments. The pain was so disabling that it drove the patient to contemplate suicide. At the patient's request, a bilateral subcutaneous mastectomy with immediate implant reconstruction was performed, resulting in a complete resolution of the pain. Non-cyclical breast pain is less common than cyclical breast pain and tends to be more difficult to treat. This case suggests that mastectomy may be an appropriate option of last resort in the treatment of severe intractable breast pain.

Adult↗

PubMedDate not supplied

[Immediate use of an expander during mastectomy. Analysis of 120 cases].

This study analyses a series of 116 patients, in whom mastectomy was followed by immediate insertion of temporary tissue expander. The technique is safe, simple and quick. It carries an acceptably low complication rate. Moreover, it does not interfere with any other local or general adjuvant therapy, if needed. The advantages are rapid post operative healing and psychological recovery, creation of a favorable site for a better quality breast reconstruction. Later on, any procedure for the breast reconstruction can be used. We concluded, that this procedure may be recommended more often; 62% of cases of mastectomies in this series.

Adult↗

PubMed2000

[Infraclinical breast lesions: apropos of a retrospective study of 261 cases].

OBJECTIVE: To determinate the rate of malignant lesions discovered after surgery for nonpalpable breast lesions diagnosed by radiology. TOOLS AND METHODS: We performed a retrospective study of 261 patients who underwent surgery for nonpalpable breast lesions at the Saint-Etienne University Hospital between 1991 and 1998. We included women who did not have any palpable breast lesion. We excluded bilateral lesions and nonpalpable lesions associated with a palpable lesion in the same breast. We grouped outcome by alarming signs, those of complementary exams such as mammography, ultrasound, fine-needle aspiration biopsy and setreotaxis core needle breast biopsy in their sensitivity, specificity and predictive values, and classed results by pathology and type of surgery performed. All nonpalpable lesions were localized by stereotaxis maneuvers. RESULTS: In our series, 61.7% of the patients were seen for individual detection, 3% had participated in mass screening programs and 35.3% were referred for suspected conditions. The predictive value of malignant lesions on mammography, analyzed in all cases and interpreted in 275, was 42.2%. The sensitivity and specificity of ultrasound exams performed in 50.2% of the cases were 85% and 91% respectively. Fine-needle aspiration biopsy and core needle biopsy were performed in 45 (18%) and 23 (9%) cases respectively. Twelve patients underwent total mastectomy with axillary dissections, 58 had tumorectomy with axillary dissections, and 191 had simple tumorectomy. Benign lesions were found in 128 (49.1%) cases, atypical hyperplasia in 10.7%, carcinoma in situ in 57 (cases 21.8%). The rate of malignant lesions was 38.6%. I was 50.9% when borderline lesions (atypical hyperplasia and in situ lobular carcinoma) were included. CONCLUSION: In our series, 38.6% of all nonpalpable operated breast lesions were cancers. Ultrasound, fine-needle aspiration and needle core biopsy showed high sensitivity and specificity allowing good biopsy outcome.

Axilla↗

PubMed1986

A mastectomy--how so? An etymologic plea.

The word mastectomy and its modifiers are used so loosely and have so many meanings in the literature that it is often difficult to determine precisely what procedure the authors are discussing. Simple descriptive terms should be used that would standardize the terminology with respect to operative techniques. The classical term radical mastectomy should be reserved to refer to a complete en bloc resection of the breast with the pectoralis major and minor muscles and the entire axillary contents, with or without a skin graft for wound closure. A total mastectomy should indicate a complete resection of the breast, including the fascia of the pectoralis major muscle. A local excision should be defined as a resection of the primary tumor with margins that are free of disease, with specific margins stated if desired. The axillary lymph node dissection should be defined according to the extent of the axillary contents excised.

Breast Neoplasms↗

PubMedDate not supplied

[Role of conservative treatment of ductal carcinoma in situ of the breast].

In 1994, the treatment of ductal carcinoma in situ of the breast remains a controversial subject. There are two reasons for this: first, there are many possible treatments and secondly, there is still much discussion on choice criteria. Possible options are: Total mastectomy which or without axillary dissection. Tumorectomy followed by locoregional radiation therapy. Simple tumorectomy. Tamoxifen can be added to each of these options. The choice criteria are based on our knowledge of the complex natural history of these cancers. In this area some of the current concepts must be seriously revised. All of the former concepts were based on lesions observed at the time of their elaboration. These were voluminous tumours, diagnosed late with no prior conservative treatment. However, today, the lesions observed are quite different. We see "young" lesions which are naturally much smaller. It would appear that the natural history of small sized in situ ductal carcinoma of the breast is quite different from that of large sized tumours. The lesions seen today are less multifocal and less multicentric in nature than is generally thought. The progression of a small tumour is essentially segmentary. Likewise, the risk of occult micro-invasion is certainly less than previously thought. Even if the risk of micro-invasion still does exist, the risk of axillary lymph node invasion (resulting from an unknown infiltrating zone of tumoural tissue) is much lower. Finally the dogma of radioresistance, which was not based on any carefully conducted radiobiological study, has lost its substance since recent results on radiosurgery combinations have been published.(ABSTRACT TRUNCATED AT 250 WORDS)

Breast Neoplasms↗

PubMed1990

Survival following locoregional recurrence after breast conservation therapy for cancer.

We postulated that locoregional recurrence after limited surgery and radiotherapy for breast cancer might be associated with an additional survival hazard, similar to that of a second primary tumor with the same extent of local and regional disease. Using this hypothesis we examined the likely resultant effect on survival. Our calculations indicated that no statistically significant survival deficit due to such recurrence would be detectable until a randomized controlled trial comparing breast conservation with mastectomy had monitored more than 10,000 patients for more than 10 years. A simple mathematical model predicted 5-year survival rates in a cohort of patients treated with breast conservation of 75%, compared to 83% in those without locoregional recurrence. From the date of locoregional recurrence, a 61% 5-year survival rate was predicted, compared to 83% if no hazard was associated with locoregional recurrence. These predictions were compared with the actuarial survival rates of 499 patients with unilateral breast cancer, 49 of whom had developed locoregional recurrence. From the date of initial treatment, the 5-year survival rate of those whose disease recurred was 79%, compared to 88% for those without locoregional recurrence (p = 0.19). The actuarial 5-year survival rate from the date of locoregional recurrence was 63%. The similarity between the patient data and the predictions of the mathematical model indicates that locoregional failure after breast conservation therapy may result in reduced survival. The lack of a significant survival deficit in our cohort or in controlled trials comparing breast conservation therapy with mastectomy is compatible to the small size of the overall effect.

Actuarial Analysis↗

PubMedDate not supplied

[Breast reconstruction following mastectomy].

In our country reconstructive breast surgery developed approximatively 20 years ago. In the early 70s breast reconstruction was only performed by simple implantation of a prosthesis. Other surgical techniques were quickly introduced, such as the transfer of the musculocutaneous flap of the latissimus dorsi and the autogenous reconstruction with the rectus abdominis musculocutaneous island flap, better known as TRAM. Since the beginning, breast reconstruction was recommended after a minimal delay of one year. More recently reconstruction was proposed to start earlier and immediate breast reconstruction became indicated in certain specific instances.

Breast↗

PubMedDate not supplied

Delayed nipple-sparing modified subcutaneous mastectomy: rationale and technique.

The problem of nipple-areola complex (NAC) preservation during mastectomy is a very intriguing and stimulating issue. In fact, in order to perform an oncologically safe operation, no mammary tissue (enclosed in the main galactophoric ducts) should remain; on the other hand, without the blood supply coming from the breast gland, NAC viability is greatly impaired because the surrounding vascular dermal network is not developed enough to support its metabolic requirements. We suggest therefore a two-step surgical procedure. The first step, on an outpatient basis with local tumescent anesthesia, is a mini-invasive cutting and coagulating procedure. It addresses the autonomization of the vascular supply to the NAC by detaching the galactophore stalk from the nipple and coagulating the deep vascular plexus. The second step, under general anesthesia and again with tumescent technique, removes the breast within its capsule, with careful checks of any remnant and adequate approach to the axilla. A subpectoralis prosthesis completes the procedure. In our view, this technique is electively suitable for prophylactic mastectomy, but also for stage I breast cancer, 2.5 cm from the NAC and 1.5 cm from the skin and pectoralis fascia, and it is very safe, simple, and effective.

Adult↗

PubMed1989

The S nipple-areola reconstruction.

Nipple reconstruction is performed as a last stage in breast reconstruction following mastectomy. Various methods of nipple reconstruction have been described, most of them utilizing either free composite grafts or local flaps. The main problem encountered using either method is the gradual absorption and flattening of the nipple. The technique we used in reconstructing 22 nipples, in preference over the various methods accepted in breast reconstruction, achieves a long-standing, protruding nipple constructed from two large local flaps raised from an S-shape design. The technique is simple and permits freedom in choosing the height of the nipple, even in the presence of a mastectomy scar. The size of the nipple thereby constructed is in excess of what was expected. Shrinkage occurs during the first 2 months, and the resulting size is more than adequate. The areola is reconstructed by a full-thickness skin graft harvested from a nonhairy area of the upper inner thigh. The local flaps lack the necessary color, which is achieved by tattooing.

Breast↗

PubMed1989

The reverse hockey stick technique: postmastectomy radiation therapy for breast cancer patients with locally advanced tumor presentation or extensive loco-regional recurrence.

A combination of photon and electron radiation therapy (RT) fields was devised to treat patients with initial or recurrent breast cancer presentations which extensively involved the chest wall (CW) and/or the axilla. The ipsilateral supraclavicular, infraclavicular, axillary, and lateral CW regions are treated in continuity by anterior and posterior opposed photon beam "reverse hockey stick" fields. The internal mammary and medial chest wall regions are treated by an anterior electron beam field which is tightly junctioned to the photon beam fields. Electron beam energy and thickness of applied bolus are selected so that the electron beam 80% depth isodose curve matches the anterior pleural surface and/or deepest extent of tumor. The goal of treatment is to deliver 4400-5000 cGy to regions at risk of microscopic tumor with local boosts to 6000-7500 cGy to sites of gross disease. Between January 1977, and June 1985, this technique was selectively used in 46 patients, 31 patients with loco-regional tumor recurrence and 15 post-mastectomy patients who initially presented with locally advanced disease. A minimum tumor dose of 4400 cGy was delivered in all except five patients. A diffuse moist skin reaction developed in 31 of the 44 (70%) patients who received at least 3800 cGy. This healed in less than 1 month in all except seven. Frequency of CW diffuse moist skin reaction within the electron beam field was related to the daily applied RT dose. Diffuse moist skin reactions were also noted to be more frequent among patients who had received prior or concurrent Adriamycin. Significant complications included symptomatic arm lymphedema in seven; CW ulcer in two; and acute radiation pneumonitis; steroid-withdrawal radiation pneumonitis, pleuritis, and marked thrombocytopenia in one patient each. With a follow-up of 36-100 months, there was no evidence of loco-regional tumor relapse in 55% of patients treated for recurrent disease and in 73% treated following mastectomy for locally advanced presentations. In summary, we find the reverse hockey stick technique to be a simple, highly reproducible and effective RT approach for postmastectomy breast cancer patients with extensive initial presentation or recurrent disease.

Adult↗

PubMed1979

The fate of breast implants with infections around them.

In a retrospective study of 41 infected breasts following the insertion of implants, a high incidence of postoperative hematoma was noted. When infection occurred, cultures usually demonstrated the causative organism to be Staphylococcus aureus. Treatment by conservative drainage and vigorous antibiotics was generally successful in salvaging those implants which had been inserted through an areolar incision for simple augmentation, or under the pectoralis muscle (or a dermal pedicle) after a subcutaneous mastectomy. Those patients whose augmentations had been done through an inframammary incision, or whose implant after a subcutaneous mastectomy was under the skin flap, had a statistically higher incidence of implant loss. Most breasts will salvaged implants became firm.

Breast↗