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PubMedDate not supplied

[Lymphedema after modified radical mastectomy as performed at the Bordet Institute. A report of 60 cases (author's transl)].

Three hundred and fifteen patients who underwent a radical mastectomy between 1969 and 1976 were studied. Nineteen percent developed lymphedema of the upper limb. Ten percent were resistant to all forms of therapy while the pathology gradually subsided in 9%. The causes of lymphedema as well as the preventive and curative methods were statistically studied and compared with those in the literature. Several preventive measures are proposed, in particular, the modified radical mastectomy.

Female↗
PubMed1979

[Subcutaneous mastectomy (author's transl)].

Subcutaneous mastectomy is a real precaution to third-order mastopathy, and it is urgently indicated for therapeutic action on carcinoma in situ, since the incidence of invasive carcinomas to accompany such diseases is between ten and 25 per cent. Proliferative forms of mastopathies were recorded from 768 in 2,563 surgically treated women, with atpical tissue being found in 164 cases. Carcinoma in situ was established from 28 women. Indications, limitations of the method, surgical technique, and complications are discussed against the background of results obtained from 31 subcutaneous mastectomies.

Adult↗
PubMed1977

Angiosarcoma in post-mastectomy lymphoedema. A report of one case of Stewart-Treves syndrome.

A 67 year old woman developed lymphoedema in the ipsilateral arm about 1/2 year after radical mastectomy for carcinoma of the breast with no metastases. 11 years later she developed an angiosarcoma in the same upper arm and this spread rapidly to the forearm and chest wall. She had considerable bleeding from the lesions and had to be given repeated blood transfusions. Radiotherapy was without effect and she died of pulmonary emboli 3 months after the diagnosis of angiosarcoma was made. No sign of distant metastases, 0ut a small carcinoma was found in the right breast. On going through the literature, the author has found 206 cases of Stewart-Treves Syndrome (development of angiosarcoma in post-mastectomy lymphoedema), 7 of which were from Scandinavia.

Aged↗
PubMed1977

[Is curative treatment of breast cancer necessarily connected with radical mastectomy after Rotter-Halsted? (author's transl)].

Lokal recidivation rate in carcinoma of the female breast represents besides the 5- to 10-years survival rate an important parameter for primary surgical treatment. At the Chirurgische Universitätsklinik Tübingen radical mastectomy in the Rotter-Halsted technique as well as extended radical mastectomy were abandoned because they did not improve the survival rate. Surgery of the female breast is now performed according to different stages of the carcinoma. A comparative study in non-selected patients of our hospital showed that local relapse of the breast cancer did not depend on surgical technique, if the tumour was removed with a sufficient safety distance and postoperative megavolt radiation was performed.

Breast Neoplasms↗
PubMed1978

[Indication for subcutaneous mastectomy as carcinoma prevention].

The indication for subcutaneous mastectomy is analyzed. Prospective investigations seem to confirm that different morphological forms of breast dysplasia (grade I, II, III, PRECHTEL [10]) do not implicate differences in risk for development of invasive breast cancer. Only if these forms of breast dysplasia are associated to high risk factors such as family history of breast cancer, should subcutaneous mastectomy be considered as a cancer prophylaxis.

Breast↗
PubMedDate not supplied

[Analysis of loco-regional control rate, metastatic remission and survival in 178 breast cancer patients treated by radical modified mastectomy and post-operative irradiation (author's transl)].

178 cases of post-operative irradiation for breast cancer (145 T1, T2, T3 and 33 T4) are analyzed. According to the surgical procedure there are 146 cases of radical modified mastectomy (Patey) and 32 cases of radical mastectomy (Halsted). The axillary status reveals 50% of involved nodes, but radiotherapy has been systematic on chest wall and supra-clavicular, parasternal, axillary lymph nodes areas. Loco-regional failures are only situated on chest wall (3,9%) and in the supraclavicular area (1,7%). The five year actuarial rate of locoregional control is 93% and 98% if we exclude 7 locoregional failures contemporaneous or consecutive to a metastatic evolution. The five year actuarial rate of metastatic remission for patients with negative axillary nodes (N-) is 83% against 55% for N+ (p < 0,001). The five year actuarial survival rate is 92% (N-) and 64% (N+) (p < 0,001). We discuss about indications of selective irradiation of chest wall and parasternal area for patients with negative axillary nodes and also about post-operative immuno-suppression, and chronology of chemotherapy.

Adult↗
PubMed1983

[The range of removing fatty tissue and lymph nodes by a modified radical mastectomy with preservation of the major and minor pectoral muscles].

Thirty five patients with mammary carcinoma were selected and completeness of lymph node dissection in modified radical mastectomy (MRM) was evaluated by two step procedures, i.e., MRM was performed at the first step and then standard radical mastectomy was added immediately following the first step. Complete axillary dissection was possible in all the cases with MRM, however, in some cases, excision of the other areas was insufficient, especially in an obese patient. There were number of cases in which the number of subclavicular lymph nodes and Halsted lymph nodes felt by palpation during the MRM operation did not correspond to the actual number of excised lymph nodes. MRM may be indicated in those cases where no metastasis is observed in the histological examination of the frozen section of axillary lymph nodes during operation and/or where there is no recognizable swelling of axillary lymph nodes under palpation when the size of breast lump is less than 2 cm in diameter.

Adipose Tissue↗
PubMed1983

Breast reconstruction following mastectomy.

Breast reconstruction now is an integral and valuable part of the management of patients with breast cancer. It offers hope and restitution for the patient while lessening the ablation and psychologic trauma of mastectomy. Continued close cooperation between the general surgeon and the plastic surgeon will assist the patient in her return as a functioning member of society and not mere survival as a mastectomy cripple.

Adult↗
PubMed1983

The effect of counselling on physical disability and social recovery after mastectomy.

A controlled trial was conducted to determine if a specialist nurse improved the physical and social recovery of patients after mastectomy and helped them adapt to the breast loss. Seventy five patients were counselled by the nurse who also monitored their progress after discharge while 77 patients received the care normally given by the surgical unit. Twelve to eighteen months after surgery those helped by the nurse showed a greater social recovery, return to work, adaptation to breast loss and satisfaction with their breast prostheses. Eleven percent remained distressed by the mastectomy but most responded well to breast reconstruction. The nurse had little impact on physical disability. The morbidity found in the control group highlights the need to find ways of reducing it. While the appointment of a specialist nurse can achieve this the morbidity would probably also be much reduced if the breast was conserved when possible, reliable staging methods other than axillary clearance were developed and the adverse effects of cytotoxic drugs and radiotherapy were reduced.

Adult↗
PubMed1984

Breast reconstruction after mastectomy. What the family physician should know.

The most common female malignancy, cancer of the breast, affects one in 15 women in Australia. A significant number of those who have had a mastectomy seek the advice of their general practitioner about breast reconstruction. The counsel of the past--that they should think themselves fortunate to have survived the mastectomy and 'leave well enough alone'--is no longer valid. This article discusses the need for reconstruction, its worth and the procedures available.

Adult↗
PubMed1981

[Preservation of the pectoral nerves in modified radical mastectomy].

Modified radical mastectomy with preservation of one or both pectoral muscles is the surgical treatment of choice in stage I and II breast cancer. A surgical anatomic study has been performed, based on post-mortem and intraoperative findings, to investigate origin and course of lateral and medial pectoral nerves and their relations to pectoral muscles and axillary lymphonodes. The results suggest that Patey-Meier operation can produce, in 80 per cent of cases, atrophy and fibrosis of the costoabdominal portion of the pectoralis major muscle as lateral pectoral nerve is generally dissected. On the contrary, radical mastectomy with both pectoral muscles preservation permit also to preserve the nerves during lymphadenectomy if they are recognized.

Atrophy↗
PubMed1984

Breast carcinoma: pattern of recurrence and metastasis after mastectomy.

This is a retrospective review of 556 patients who had carcinoma of the breast (1971-1980). Among the 476 patients who had mastectomy, 38% have died and the median follow-up time of those who were alive was 53 months. When the axillary nodes were free of metastasis initially, 18% of the patients had relapse. Among the patients who had axillary nodal metastasis, 24% of those with 1-3 positive nodes, and 69% of those with greater than or equal to 4 positive nodes relapsed. Regarding specific type of first recurrence, about 10-30% had loco-regional relapse, 60-70% had distant metastasis and 10-30% had both (patients with greater than or equal to 4 lymph nodes involved are less likely to have only loco-regional relapse). Postoperative radiotherapy decreased the frequency of isolated loco-regional relapse, but did not decrease the overall failure rate nor influence the chance of dissemination. Among patients who had one or more positive axillary nodes, adjuvant chemotherapy (melphalan or CMF) did not significantly decrease relapse rates nor change types of relapse. Thus, distant dissemination is the major problem for those who developed recurrence after mastectomy. The relative distribution of the initial spread is similar to that seen among the 80 patients who had Stage IV disease at diagnosis. The most common five sites are bone (which accounted for 40-60% of the distant metastasis), lung (15-22%), pleura (10-14%), soft tissue (7-15%), and liver (5-15%).

Breast Neoplasms↗
PubMed1984

Wound healing following mastectomy.

Local complications following mastectomy are of considerable importance if peri-operative chemotherapy is to be used. A retrospective survey of 100 patients following Patey mastectomy was therefore undertaken to investigate problems associated with wound healing in the absence of such therapy. The survey showed that 18% of patients developed postoperative wound infection, this being severe in 50% of cases. Varying degrees of total wound breakdown occurred in 9% of patients while delayed healing occurred in a further 5%. The incidence of seroma was 25%, and the majority of these patients required further drainage. There was a significant association between seroma formation and wound infection (P less than 0.05). The mean length of hospital stay in patients without wound infection was 11.7 days, but was increased to 27.3 days when infection occurred (P less than 0.001).

Female↗
PubMed1983

[Immediate breast reconstruction following mastectomy for carcinoma].

Analysis of the psychic situation of the women after mastectomy. Most surgeons are against an immediate reconstruction of the breast, because the comparison to conditions before the amputation is usually too negative. The main argument against immediate reconstruction is the local recurrence which occurs in the first 6 postoperative months in 75% of the cases. In stage 0, no local recurrences were observed. If a mastectomy is performed in this stage, immediate reconstruction can be done. In stage 1 the number of local recurrences is 5% in the first postoperative months. In elected cases, if it is the expressed wish of the patient immediate reconstruction can be discussed. In stage 2 the local recurrence rate is already 13,8%. In this stage, an immediate reconstruction is out of the question.

Breast↗
PubMed1983

[Role of plastic reconstructive operations in the rehabilitative treatment of women following mastectomy for breast cancer].

In 1980--1983, 15 plastic reconstruction surgeries were performed at the Center's clinics. In 11 cases, one-stage reconstruction of the breast was carried out after mastectomy for cancer. 13 females were mastectomized after Halsted and 2--after Patey (radical mastectomy). Good results were obtained in 11 cases. The paper contains a description of a procedure for one-stage mammoplasty for cancer which produces a good uniform bed for silicone prosthesis fixation as well as the breast contour. A musculocutaneous flap from musculus vastus dorsi and a silicone prosthesis were used in all cases of primary reconstruction. Emphasis is placed on the role of plastic reconstruction surgery as a factor of medical and social rehabilitation of females operated on for breast cancer.

Breast↗
PubMed1984

Subcutaneous mastectomy: acute complications and long-term follow-up.

Subcutaneous mastectomy as performed at our institution from 1965 to 1979 was an operation with high morbidity. The risk of complication appears to have been decreased with a two-stage approach. Long-term results were disappointing, with a high incidence of capsular contracture. The incidence of capsular contracture appears to have been reduced by subpectoral placement of the implants. One breast carcinoma occurred 10 years after subcutaneous mastectomy.

Acute Disease↗
PubMed1984

Prophylactic mastectomy with immediate reconstruction for the high-risk woman.

Prophylactic mastectomy should provide the woman at high risk for breast cancer with some degree of assurance that the surgical procedure is of benefit in preventing the occurrence of cancer. The so-called subcutaneous mastectomy fails because too much breast parenchyma is left to preserve the blood supply to the undisturbed nipple-areola complex. The procedure of choice described here removes the nipple-areola complex, thins and cores it, and replaces it as a free graft when the breast parenchyma is removed. A high-profile silicone breast implant is inserted into a pocket made of pectoralis major muscle, serratus anterior muscle, and a deepithelialized skin flap.

Adult↗
PubMed1983

Modified subtotal mastectomy and free nipple graft in the treatment of severe mammary hypertrophy and ptosis.

Subtotal mastectomy using a modified Strömbeck formula for planning of the incisions, and occasionally from one to three dermofat flaps, combined with free nipple transplantation, has been applied to seven patients with severe mammary hypertrophy and ptosis. There have been no major complications, the aesthetic result is satisfactory, and the risk for later mammary cancer is minimized. The technique is recommended in severe hypertrophy and/or ptosis to overcome the increased risk of nipple necrosis of the classical reduction plasties. It may also be combined with prosthetic augmentation to substitute a subcutaneous mastectomy in only ptotic breasts.

Adult↗