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PubMed1989

[Mastectomy and primary breast reconstruction].

Primary breast reconstruction after mastectomy may be proposed individually after careful consultation of the patient. Whereas postoperative chemotherapy or hormone therapy are not contraindications, radiotherapy is a relative contraindication. Methods include the submuscular silicone implant (+/- expansion), mobilisation of the abdominal skin or flap reconstruction (thoracoepigastric or latissimus flap). The indications, pros and cons, are discussed. Mastectomy and primary reconstruction are good alternatives to the so-called conservative treatment with irradiation.

Adult↗
PubMedDate not supplied

Multicentricity of breast carcinoma: a case against partial mastectomy.

One hundred and seventy-three mastectomies for carcinoma of the breast during a two-year period were reviewed for multicentric foci in the pathologic specimen. There was a total of 38 cases of multicentric carcinoma, comprising 22%. Sixty-two percent of all carcinomas presented as clinical Stage A and B, of these, 21% were multicentric. It is our opinion that except for certain extenuating circumstances, the procedure of choice for carcinoma of the breast is either a modified or standard radical mastectomy.

Breast Neoplasms↗
PubMedDate not supplied

[Lymphangiosarcoma following mastectomy: review of the literature apropos of 2 recent cases of Stewart-Treves syndrome].

Two cases of lymphangiosarcomas which arose 4 and 14 years after a mastectomy are reported (Stewart-Treves syndrome). One of the patients was treated by shoulder disarticulation and the other by chemotherapy (using Melphalan, Cyclophosphamide and 5-fluorouracil). Disseminated metastases and deaths occurred 6 and 18 months after the onset of the lesion. Stewart-Treves syndrome occurs in approximately 0.07 to 0.45% of mastectomy. Prognosis is worse: survival at five year is fewer than 10%. Early diagnosis is mandatory. Surgical resection of the lesions and adjunctive chemotherapy seem the best treatment.

Aged↗
PubMed1989

[A retrospective study of recurrent breast cancer following radical mastectomy].

During 10 years from 1974 to 1986, 390 patients with breast cancer underwent radical mastectomy in our consisting of 12 local lymph node, 26 bone metastasis and 20 lung metastasis. A total of 63 (69%) were found within 3 years. The time internal between radical mastectomy and cancer recurrence was significantly correlated with three year and five year survival rates. Radiation therapy was a adequate chemo-endocrine therapy was required in the control of bone metastasis.

Bone Neoplasms↗
PubMed1987

[Mastectomy with immediate reconstruction by transposition of a transverse abdominal skin flap attached to the rectus abdominis muscle].

The technique of mastectomy with immediate reconstruction, using a skin flap attached to the rectus abdominis muscle, is described. Its drawbacks and advantages are analyzed from a series of 27 cases. The principal complication is necrosis of the flap; it occurred in 6 cases of our series but always remained partial. On the other hand, the flap has the advantage of providing a substantial amount of material, so that prosthesis is unnecessary, and it can be installed immediately after the mastectomy without repositioning the patient.

Female↗
PubMed1986

Cowden's disease: a further indication for prophylactic mastectomy.

Cowden's disease (multiple hamartoma syndrome) is a syndrome involving abnormalities of multiple organ systems. Transmitted in an autosomal dominant pattern, it carries a high frequency of mammary carcinoma in early middle age in affected women. The hyperkeratotic cutaneous and gingival markers of the disease are its principal overt manifestations. Prophylactic bilateral total mastectomy with optional immediate reconstruction is recommended for women Cowden's disease. An illustrative family with the disease is presented in which one affected young woman was found to have invasive mammary carcinoma with regional metastasis at the time of prophylactic mastectomy.

Adult↗
PubMedDate not supplied

Effect of perioperative blood transfusion on recurrence and death after mastectomy for breast cancer.

A recent report suggested that perioperative blood transfusion doubles the recurrence rate of breast cancer after mastectomy. In the present retrospective study the effect of transfusion on cancer recurrence and death after mastectomy was investigated in 96 women, 27 with and 69 without blood transfusion. The overall survival rates, the breast-cancer-specific survival and the recurrence-free survival rates were similar in the two groups. The study thus does not support the hypothesis that perioperative blood transfusion promotes recurrence of breast cancer.

Adult↗
PubMed1987

Primary radiation therapy as an alternative to mastectomy for early-stage breast cancer.

Breast conservation surgery followed by radiation therapy for definitive treatment of patients with early stage (limited extent) breast cancer (Stage I and Stage II) has been reported by several retrospective and prospective randomized trials to provide comparable local control, disease-free survival, and overall survival to patients treated with mastectomy. Excisional biopsy of the breast lump and associated axillary dissection are required prior to initiation of radiation therapy in order to remove all known tumor and to reduce the dose of radiation required for cure. The axillary dissection is therapeutic for extension into the axillary volume as well as a prognosticator that aids in the selection of patients for adjuvant systemic therapy. Although certain patients may be adequately served without radiation therapy by excisional removal of the tumor and a margin of surrounding normal breast tissue, this population still needs to be defined. Adequate patient selection and the use of good surgical and radiation therapy techniques results in good to excellent cosmesis in 80 to 90 per cent of treated patients. The treatment alternatives, if presented to patients deemed as appropriate candidates, will aid the patients in making an informed consent decision. Wider application and availability of this alternative to mastectomy may have a significant positive impact on our female population by encouraging women to seek detection of breast cancer through breast self-examination and mammography because the desirable alternative reduces the fear of loss of the breast and self image.

Axilla↗
PubMed1988

Scalpel versus electrocautery in modified radical mastectomy.

Forty nine consecutive mastectomy patients were randomized to one of two groups. Twenty four patients had skin flaps created with the cold scalpel and twenty five with the electrocautery. The two groups were similar with respect to age, stage of disease, size of tumor, and weight. Cautery patients had significantly less operative blood loss when compared with scalpel patients, 352 versus 507 milliliters, respectively, P less than 0.05. No cautery patient required transfusion compared with three transfused scalpel patients, P less than .005. Total postoperative hemovac drainage and hospital stay were not significantly different between the two groups. Although the number of fever days and wound complications were slightly higher in the cautery group, the difference was not statistically significant. The electrocautery may be superior to the scalpel for mastectomy.

Electrocoagulation↗
PubMedDate not supplied

Subcutaneous mastectomy. A review of 130 cases.

Subcutaneous mastectomy (SCM) is discussed in connection with 130 such procedures performed on 108 patients. Seventy-nine malignant breast lesions and 51 benign breast lesions were operated on by this technique, which lies midway between conservative therapy and classical ablation. Conservation of the nipple-areola complex depends on the results of intraoperative biopsy; flaps are reduced when necessary. Breast volume is usually reconstituted using a prosthesis. Eleven of the 79 malignant breast lesions recurred locally (13.6%): generalization of postoperative irradiation thus seems justified, as in conservative therapy protocols. The 5-year survival rate of 83% is comparable to that of other treatment techniques for T1-T2 cancers. Cosmetic results have been improved, and the fact that SCM may give a better result than reconstruction after mastectomy must be kept in mind. However, the technique is only indicated for those cases which would otherwise be suitable for conservative surgery, were it not for the need to resect the gland because of a diffuse pathology.

Adenocarcinoma↗
PubMed1986

Pharmacokinetics of cefotiam in the exudate from wounds of patients with breast cancer operated upon for radical mastectomy.

Cephalosporin antibiotics have been widely used to prevent infections during and after operation. To establish an efficient use of prophylactic antibiotics for patients undergoing surgery, it is important to investigate the drug levels in exudate from wounds of the patients and to elucidate the relation between drug concentration in the blood and that in the exudate. In a previous paper, the present authors (except E.M. and Y.K.) determined cefotiam (CTM) concentrations in serum and exudate from wounds of patients with breast cancer who underwent radical mastectomy and discussed an adequate regimen of CTM prophylaxis after the operation. However, CTM concentrations in serum and exudate from the wounds of the patients were not analyzed pharmacokinetically. In the present paper we report on the disposition kinetics of CTM in serum and exudate from wounds after the administration of CTM following bolus intravenous injection into patients with breast cancer operated upon for radical mastectomy.

Adult↗
PubMed1978

[Reconstruction of the breast after mastectomy].

A wider use of reconstructive surgery of the breast has become possible since Patey-modified mastectomy has been preferred to Halsted classic radical mastectomy for operable breast cancer and routine use of postoperative radiotherapy discontinued in patients eligible for adjuvant chemotherapy. Reconstructive techniques are reviewed and pitfalls subjected to careful scrutiny. It is thought that women might be encouraged to seek earlier medical advice after noticing a lump in the breast if they are alive to the prospect of possibile restoration of the contours of the breast after ablative surgery.

Breast Neoplasms↗
PubMed1987

Munchausen's syndrome and prophylactic mastectomy.

A patient sought bilateral prophylactic mastectomies because of a strongly positive family history of breast cancer. Fortunately, prior to operation, this family history was discovered to be a fabrication by the patient. Few ablative plastic surgical procedures are done without objective criteria. Plastic surgeons relying on a positive family history as sufficient indication for bilateral prophylactic mastectomy need to be aware that such a history may be the contrivance of a patient with Munchausen's syndrome. A high index of suspicion may enable the plastic surgeon to recognize Munchausen's syndrome and thus avoid both contributing to the patient's illness and performing an unwarranted operation.

Adult↗
PubMedDate not supplied

Mastectomy stimulates prolactin release in breast cancer patients.

Hyperprolactinaemia has been described to occur after mastectomy in breast cancer patients, but whether it may be the result of surgery or breast cancer is particularly unknown. Plasma prolactin levels were measured in 51 patients one day before, and 1, 7, 30, and 180 days after mastectomy (23 primary breast cancer patients), tumourectomy (10 patients with benign or malignant breast lesions), and cholecystectomy (18 patients with cholelithiasis). Elevated prolactin levels were found on the 7th and 30th postoperative day in mastectomized and laparotomized patients, but not in patients who underwent tumourectomy of benign or malignant breast lesions (p less than 0.01). The prolactin levels were in the normal range one day before and again 180 days after surgery in all patients. We conclude, therefore, that postoperative hyperprolactinaemia in breast cancer patients is a result of surgery rather than the disease.

Adult↗
PubMed1986

[Changes in the lymphatic vessels of the upper extremity following a radical mastectomy (based on lymphographic data)].

The study group included 171 patients suffering from postmastectomy syndrome which had developed either after combined treatment for breast cancer or after radical mastectomy alone. Lymphographic examination of 146 cases carried out long after treatment for primary treatment revealed frequent roentgenologic features characteristic of all patterns of secondary obstructive lymphatic edema. In 20 patients, lymphographically-detectable changes were followed at early stages (until day 40 after radical mastectomy) before edema became clinically apparent. Radiation therapy and erysipelatous inflammation were shown to have an effect on lymphatic lesions.

Arm↗
PubMed1985

The attitude of South African women to mastectomy for breast cancer.

No previous study has reported on the acceptance of and attitudes towards the treatment of breast cancer among white South African women. The influence of age, social, economic and marital status, occupation, and the effect of knowledge of the disease on the reaction to the possible diagnosis of breast cancer, the attitude to mastectomy, and physical and psychological readjustment after mastectomy were studied in 100 respondents to a questionnaire. The preliminary conclusions from this study are that South African women desire effective treatment of breast cancer, that physical and psychological readjustments are readily made by the majority without major problems, and that reconstructive surgery is not in high demand.

Adult↗
PubMed1985

Use of the Limberg flap to close breast wounds after partial mastectomy.

Early experience using a rhomboid flap to reconstruct the breast after partial mastectomy and axillary clearance of glands is encouraging. This operation has been used in 7 cases to reconstruct breasts after partial mastectomy and axillary clearance of glands and has given a good cosmetic result.

Adult↗