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PubMedDate not supplied

Three-dimensional shaded-surface rendering of MR images of the breast: technique, applications, and impact on surgical management of breast disease.

Contrast material-enhanced magnetic resonance (MR) imaging is reported to be the most accurate modality for determining the extent of breast cancer before surgery. Three-dimensionally rendered MR images can be used as an adjunct in planning breast surgery. Semiautomated methods are used to isolate the breast tissue within high-resolution MR images and to render the skin with a shaded-surface method. Cut-away views reveal lesions in the interior of the breast. Cut-plane shaded-surface display provides the surgeon with information on the size, extent, and spatial relationships of a breast lesion in a simple, intuitive format. This technique can help the surgeon plan a breast biopsy, lumpectomy, or mastectomy that will maximize local control of breast cancer while minimizing cosmetic damage to the unaffected portions of the breast. In a review of 15 clinical cases, cut-plane shaded-surface rendering aided surgical planning in 10 cases.

Adult↗
PubMed1978

[Epithelioma (lobular) developing in a fibroadenoma: study of a case report and review of the literature].

Carcinoma developing in a fibroadenoma correspond, according to current criteria, to neoplasms inclused in fibroadenomas. One personal case and 42 others from the literature fall within this definition. These neoplasms, small in size, are asymptomatic. The average age of the patients at the time of discovery of the lesion was 44 years. Two thirds of these carcinomas were lobular in type (29 cases), the others being invasive (7 cases) or non-invasive (7 cases) galactophoric carcinomas. Lobular carcinomas in situ (25 cases) involved, at the same time, one or more fibroadenomas and the remaining breast tissue in 60% of surgical specimens (15 cases). Independent of the operative technique used (local excision, wide excision or radical mastectomy), the course of a lobular carcinoma in situ in a fibroadenoma is, in general, simple.

Adenofibroma↗
PubMed1986

Breast reconstruction using modified tissue expansion.

Inadequate chest-wall skin following mastectomy for carcinoma continues to be a problem in many breast reconstructions. To avoid extensive surgery, serial tissue expansion has been advocated. Since 1977, one of the authors has used a simple method of tissue expansion that we have termed "modified tissue expansion", defined as the creation of an adequate breast mound in one or two stages using a permanent prosthesis. Ninety percent of patients undergoing breast reconstruction between 1978 and 1983 were reconstructed using this method. A retrospective analysis of these 208 patients is presented. There were no mortalities, and only a 6.3 percent complication rate. Skin necroses related directly to the prosthesis occurred once, and there were no prosthetic deflations. Eighteen percent had first-step reconstruction only. The initial prosthesis averaged 400 cc in size. Selected Halsted radical mastectomy and postradiotherapy patients were successfully reconstructed. Seventy-eight percent felt their results were excellent at 1 year. Two percent were dissatisfied. Multiple office visits and the potential problems of serial expansion were avoided. Modified tissue expansion is a simple and viable method and should be considered among the options for breast reconstruction following mastectomy.

Adult↗
PubMed2001

The prevention of breast cancer: an overview.

The role of lifestyle modifications, antioestrogens, cyclo-oxygenase-2 inhibitors and prophylactic mastectomy in reducing breast cancer is reviewed. It is concluded that avoiding postmenopausal obesity and regular physical activity are simple measures that seem to reduce breast cancer risk. There is no conclusive evidence that dietary modification and vitamin supplementation significantly reduce the risk of breast cancer. The evidence suggests that tamoxifen significantly reduces the risk of breast cancer in women at increased risk, but whether it reduces breast cancer mortality remains unknown. Ongoing clinical trials may prove that raloxifene is superior to tamoxifen in breast cancer prevention due to its anti-oestrogenic effects on the endometrium. Bilateral prophylactic mastectomy reduces the risk of breast cancer by 90% in high risk women.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2005

Histological grading and prognosis in dogs with mammary carcinomas: application of a human grading method.

The human "Elston and Ellis grading method" was used in dogs with mammary carcinoma to examine its relation to prognosis in this species, based on a 2-year follow-up period. Of the 85 cases examined, 27(31.8%) had well-differentiated (grade I), 28 (32.9%) had moderately differentiated (grade II) and 30 (35.3%) had poorly differentiated (grade III) carcinomas. Two years after mastectomy, significant differences in survival between cases with different tumour grade were found; thus, survival was worse in dogs with grade III carcinomas than in those with grade II (P<0.05) or grade I (P<0.001) tumours. However, in dogs with simple carcinomas which had a less favourable prognosis than that of other carcinomas (P<0.001), there was no significant difference in survival between grade II and grade III cases (P=0.878), both having a very poor prognosis. Undifferentiated (grade III) carcinoma cases had a 21-fold increased risk of death as compared with differentiated (grade I and II) carcinoma cases. An increased risk (about 10-fold) was also associated with undifferentiated simple carcinomas as compared with differentiated ones. The predictive value of histological grade was not influenced by tumour size or age of the dog at mastectomy; nodal metastasis, however, worsened the prognosis (P<0.001). Routine use of this human grading method would help the clinician to make a more accurate prognosis in the interests of post-surgical management in dogs with mammary carcinomas.

Animals↗
PubMed1989

Conservative management in full-thickness nipple-areolar necrosis after subcutaneous mastectomy.

Nipple-areolar necrosis is a known and expected complication in a small percentage of patients undergoing subcutaneous mastectomy, especially with concomitant mastopexy or in smokers. Impending ischemia or congestion of the areola can often be ameliorated by simple maneuvers such as suture release. When full-thickness necrosis occurs, conservative management with essential debridement, dressings, and careful wound hygiene alone will often yield a surprisingly good result, requiring little or no revisional surgery.

Adult↗
PubMed2005

Subincisional muscular coverage of expander implants in immediate breast reconstruction with pectoralis flaps.

Immediate breast reconstruction with expander implants is a safe, simple procedure that allows for a rapid physical and emotional postmastectomy recovery. When complications occur, the patient may be left with a prolonged reconstructive course. Such complications may result from thin mastectomy flaps and resulting marginal skin flap necrosis and implant exposure. Muscle coverage of the implant under the skin incision prevents such marginal necrosis of skin flap from becoming a factor in implant loss. This paper demonstrates a simple method for providing subincisional muscle coverage of expander implants with pectoralis muscle flaps. In this technique, a pocket is developed under the pectoralis muscle. The sternal origin of the pectoralis is released from the midsternal position to its inferior origin. The pectoralis muscle is then rotated inferior-laterally and sutured to the dermis of the underside of the inferior mastectomy skin flap, thereby providing subincisional muscle coverage of the expander implant. During a 5-year period, 42 patients between the ages of 36 and 61 underwent breast reconstruction utilizing this technique. In these patients, there were 4 instances of marginal necrosis. In each of these cases, the implants did not become exposed, and all patients completed the expansion process without significant delay and underwent subsequent implant exchange without incident. Five-year follow-up has shown good esthetic results in all patients.

Adult↗
PubMed1995

Pseudoangiomatous stromal hyperplasia (PASH). A mammary stromal tumor with myofibroblastic differentiation.

Pseudoangiomatous stromal hyperplasia (PASH) is frequently a microscopic incidental finding in breast biopsies performed for benign or malignant disease. However, it may also produce a mass lesion. We reviewed PASH seen first as a tumor in 40 women aged 14 to 67 years (mean, 37 years). All but one lesion were clinically palpable. The exceptional tumor was found by mammography. The mass, typically unilateral, was usually diagnosed clinically as a fibroadenoma. Most specimens contained a well-circumscribed tumor with a firm white-gray cut surface. In six cases, there was no discrete gross lesion in the surgical specimen. Microscopically, there was a spectrum of pathological stromal changes ranging from classical PASH with anastomosing slit-shaped spaces outlined by flat, bland spindle cells to more proliferative lesions composed of bundles of plump spindle cells that obscured the underlying pseudoangiomatous architecture in the most florid lesions. The spindle cells were vimentin and CD34 positive and factor VIII negative. In more cellular fascicular lesions, the stromal cells acquired desmin and actin positivity. These immunohistochemical features were consistent with myofibroblastic histogenesis of PASH. Reactivity for progesterone receptor (PR) typically exceeded estrogen receptor (ER) in the nuclei of stromal and glandular cells. In most lesions, the nuclei of stromal spindle cells were ER negative. The majority of the patients were treated by excisional biopsy. One lesion, incompletely excised, spontaneously regressed. One patient had bilateral mastectomies. Follow-up was 0.6-11 years (mean, 4.5 years). Five patients had ipsilateral recurrences, and two had subsequent contralateral PASH. The morphological spectrum of cellular proliferation and staining qualities indicates that the myofibroblast plays a major role in the histogenesis of PASH. The pathogenesis of PASH remains uncertain, but aberrant reactivity of myofibroblasts to endogenous or exogenous hormones is likely to be an important factor. Simple excision is adequate treatment initially and for infrequent recurrences, Diffuse PASH occasionally presents a difficult management problem that may necessitate mastectomy.

Adolescent↗
PubMed2000

Breast reconstruction by tissue expansion. A retrospective technical review of 197 two-stage delayed reconstructions following mastectomy for malignant breast disease in 189 patients.

Despite the advent of free tissue transfer, breast reconstruction by tissue expansion is an important technique in the armamentarium of the reconstructive breast surgeon. The concept is deceptively simple and yet in reality can produce difficult complications and poor results. A database was compiled of all the patients receiving tissue expanders and/or implants for cosmetic, congenital and reconstructive purposes between 1986 and 1998. 189 patients had 197 delayed two-stage tissue expansion breast reconstructions following mastectomies for malignant breast disease between 1986 and 1997. 103 breasts (52%) had two uncomplicated stages. The remainder had one or more complications, revisional procedures for complications or alterations to the reconstruction for size, position or shape. Overall each breast reconstruction required 2.9 procedures (range 2-9). The complications and additional procedures are discussed. In particular, capsular contracture of the definitive implant (12%) was related to implant type and not to the speed of tissue expansion or the degree or duration of over-expansion. Although 17% of patients received radiotherapy, none of those who developed contracture around the definitive implant had this adjuvant therapy, P< 0.05. Twelve reconstructions (6%) totally failed due to complications of which six underwent secondary flap reconstruction. Twenty-one patients have subsequently developed metastatic disease of which 15 have died to date. Breast reconstruction by tissue expansion is still an important technique. It should be used carefully and thoughtfully by surgeons trained to deal with any complications. Patients need to be carefully selected and counselled prior to undertaking this process.

Adult↗
PubMed1993

Complications of rectus abdominis myocutaneous flaps in breast surgery.

One-hundred-and-twenty-two rectus abdominis myocutaneous flaps used for reconstruction, post mastectomy (106) and after salvage surgery (16), were reviewed. The minimum period of follow up was 24 months. Simple vertical flaps were raised in 88 patients; in addition seven Drevers, four trans-umbilical, 19 lower transverse and four combined (vertical and transverse flaps) were raised. Early complications (within 2 weeks of surgery) were seen in 30% (37/122) patients. Late complications occurred in 5% of patients (6/122) and 8% had both early and late complications. Flap necrosis was seen in 25% (21/122) of patients. This comprised complete flap loss in two patients. Partial skin and fat necrosis was observed in 14 patients and partial skin loss only in 15. In the group with simple vertical flaps the incidence of partial flap necrosis was 12.5%. Late complications included incisional hernia in 5% of patients. Reoperation for complications were required in 18% of patients. We conclude that while minor morbidity is common with rectus flaps, major complications are few. The more important considerations relate to cigarette smoking and overuse of the peripheral segment of the transverse rectus abdominis flap. While the transverse flaps have now largely replaced other breast flaps, in our practice vertical and higher transverse flaps were useful alternatives. Lessons learned during the development of these flaps have led to greatly improved results in the latter part of the series and it is regarded as a versatile and useful flap in this situation.

Abdominal Muscles↗
PubMed1995

Hysteroscopic follow-up in tamoxifen treatment for breast cancer.

In the postmenopausal women endocrinotherapy proves to be as useful as the cytotoxic treatment in breast cancer therapy, regarding the percentage and duration of response, both in prophylactic and palliative therapy, with the advantage of milder side-effects and a better quality of life. This study was carried out in order to evaluate the Tamoxifen weak estrogenic activity, which could appear during long-term therapies, determining endometrial morphological modifications. Twenty-one postmenopausal women suffering from breast cancer underwent hysteroscopy with target biopsy or curettage at the same time with mastectomy and afterwards during additional Tamoxifen treatment at 12 and 24 months. Our results confirm that this simple, outpatient endoscopic investigation should be provided as a routine in the follow-up of oncologic patients during hormonotherapy.

Breast Neoplasms↗
PubMedDate not supplied

Modified lateral thoracodorsal flap: a way out of a difficult problem.

BACKGROUND: Breast deformities, often attributable to surgical mutilations as a result of mammary carcinoma treatment, still are a challenge to plastic surgeons. Interesting alternatives for the frequently used musculocutaneous flaps are local flaps such as the lateral thoracodorsal flap developed by Holmström in 1986. This flap is simple to raise and involves no sacrifice of important muscular structures. This report aims to demonstrate the use of the modified lateral thoracodorsal flap in an immediate mammary reconstruction for a patient who refused any other scar. METHODS: A case report describes a patient presenting with breast cancer after reduction mammaplasty who was treated with a skin-sparing mastectomy and immediate reconstruction. RESULTS: Satisfactory defect correction was accomplished with adequate silicone implant covering and a natural ptotic breast shape. CONCLUSIONS: The versatility of this flap and its simple execution make it an important option for diverse breast reconstruction situations. The lateral thoracodorsal flap provides aesthetic results similar to those with other reconstruction methods, but without major complexity. The authors believe that it could be an interesting tool for the treatment of a breast anomaly.

Breast Neoplasms↗
PubMed1993

Latissimus dorsi breast reconstruction. Long term results and return of sensibility.

The long-term results of 44 patients who underwent breast reconstruction after mastectomy with latissimus dorsi musculocutaneous flaps with endoprostheses were studied. Good symmetry without a brassiere was achieved in 15 patients, slight asymmetry in 24 and poor symmetry in five (11%). Symmetry when a brassiere was worn was acceptable in all but one of the patients (43/44). A third of the patients (n = 13) had developed unacceptable (grade III or IV) capsular contraction, but 39 (89%) of the patients studied were satisfied with the long-term reconstruction. Cutaneous sensibility, measured by von Frey's test, had returned to 28 (64%) of the cutaneous skin islands, to their medial parts in particular. The flaps in patients who had received concentrated radiation or who had large prostheses remained numb. Sensation was normal in the scars of the donor areas in all but three patients. Latissimus dorsi breast reconstruction with an endoprosthesis is safe and simple. It gives a subjectively satisfactory result in nine out of 10 patients and is therefore a valuable method of reconstruction after mastectomy.

Cicatrix↗
PubMed1988

Standardization of the surgical technique in breast-conserving treatment of mammary cancer.

A number of designations--for example excision, wide excision, lumpectomy, tylectomy, extended tylectomy, partial mastectomy, tumorectomy, segmental resection and quadrantectomy--have been applied to operative procedures aimed at treating mammary carcinoma with preservation of the breast. None of them, however, has been explicitly linked to a defined surgical technique and there is no consensus about the terminology. We propose a simple classification system for breast-conserving procedures, which can facilitate the communication between surgeons and the interpretation and exchange of scientific data. We also describe a strictly defined and locally radical partial mastectomy--a sector resection--which has been used at several centres in Sweden for more than 5 years with a favourable outcome so far in terms of local tumour control and the cosmetic result.

Breast↗
PubMed2004

The impact of intra-operative specimen radiographs on specimen weights for wide local excision of breast cancer.

The ultimate goal of breast conserving surgery (BCS) is to achieve survival and local control rates similar to those for mastectomy while providing improved cosmetic and functional results. The volume of breast tissue removed is the most significant determinant of the final cosmetic outcome of BCS. We hypothesised that intra-operative specimen radiograph (IOSR) during BCS may guide the surgeon to achieve clear radiographic and histological margins with minimum normal breast tissue excision, thus preserving cosmetic appearance. The aim of this study was to evaluate the effect of introducing the policy of IOSR on the weight of specimens of wide local excision of palpable invasive breast cancer. All consecutive patients who underwent therapeutic wide local excision for palpable invasive breast cancer from 01/01/02 to 31/03/03 were included in this study. A policy of IOSR was introduced in October 2002, thus all BCS done after 01/10/2002 underwent IOSR. The mean (S.D.) specimen weight for the no intra-operative specimen radiograph (NIOSR) group was 74 grams compared to 46 g in the IOSR group, (P = 0.0241, unpaired t-test with Welch's correction) and the mean tumour size for the NIOSR was 23(13)mm and for IOSR was 21(8)mm (P = ns, unpaired t-test with Welch's correction). A histologically clear circumferential margin rate in the IOSR group was 96% compared to 82% in the NIOSR group. Five patients in the IOSR group and 11 in NIOSR group had positive anterior or posterior margin. For these patients no further surgical excision was possible as BCS was performed from skin to pectoral fascia. Therefore a radiation boost was given to the site of excision. Only one patient in the IOSR group needed further breast surgery (mastectomy) for a positive inferior (toward nipple) margin for a mammographically occult tumour, while 11 patients in the NIOSR group required further breast surgery. In conclusion, IOSR is a simple, effective and economical way of assessing adequacy of margins while minimising the breast tissue excised during wide local excision of palpable breast cancers.

Adult↗
PubMed2002

Development and validation of a method for using breast core needle biopsies for gene expression microarray analyses.

PURPOSE: Gene expression microarray technologies have the potential to define molecular profiles that may identify specific phenotypes(diagnosis), establish a patient's expected clinical outcome (prognosis), and indicate the likelihood of a beneficial effect of a specific therapy (prediction). We wished to develop optimal tissue acquisition, processing, and analysis procedures for exploring the gene expression profiles of breast core needle biopsies representing cancer and noncancer tissues. EXPERIMENTAL DESIGN: Human breast cancer xenografts were used to evaluate several processing methods for prospectively collecting adequate amounts of high-quality RNA for gene expression microarray studies. Samples were assessed for the preservation of tissue architecture and the quality and quantity of RNA recovered. An optimized protocol was applied to a small study of core needle breast biopsies from patients, in which we compared the molecular profiles from cancer with those from noncancer biopsies. Gene expression data were obtained using Research Genetics, Inc. Named Genes cDNA microarrays. Data were visualized using simple hierarchical clustering and a novel principal component analysis-based multidimensional scaling. Data dimensionality was reduced by simple statistical approaches. Predictive neural networks were built using a multilayer perceptron and evaluated in an independent data set from snap-frozen mastectomy specimens. RESULTS: Processing tissue through RNALater preserves tissue architecture when biopsies are washed for 5 min on ice with ice-cold PBS before histopathological analysis. Cell margins are clear, tissue folding and fragmentation are not observed, and integrity of the cores is maintained, allowing optimal pathological interpretation and preservation of important diagnostic information. Adequate concentrations of high-quality RNA are recovered; 51 of 55 biopsies produced a median of 1.34 microg of total RNA (range, 100 ng to 12.60 microg). Snap-freezing or the use of RNALater does not affect RNA recovery or the molecular profiles obtained from biopsies. The neural network predictors accurately discriminate between predominantly cancer and noncancer breast biopsies. CONCLUSIONS: The approaches generated in these studies provide a simple, safe, and effective method for prospectively acquiring and processing breast core needle biopsies for gene expression studies. Gene expression data from these studies can be used to build accurate predictive models that separate different molecular profiles. The data establish the use and effectiveness of these approaches for future prospective studies.

Animals↗
PubMed1992

[Surgical treatment of local recurrence after mastectomy].

This paper deals only with local recurrence of a mammary carcinoma, not with all locoregional recurrences. The surgical treatment of a true local recurrence depends on the freedom from metastases, on the type of the primary operation, whereas the localisation and the size of the recurrence are of minor importance. If no metastases can be found, the operative treatment of the recurrence is the method of choice leading to cure of part of the patient. Simple excision of the tumor is insufficient; the second operation must be radical. When a segmentectomy or a lumpectomy was performed as primary operation, the recurrence must be treated with a modified mastectomy. The status after modified mastectomy with or without primary reconstruction must be converted into a radical mastectomy. A local recurrence after radical mastectomy must be removed by chest wall resection.

Breast Neoplasms↗