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PubMed2004

Wise pattern mastectomy with immediate breast reconstruction.

A new technique of immediate breast reconstruction is presented. This technique uses a silicone implant placed in a subpectoral pocket, using de-epithelialised skin from the lower breast to augment the submuscular pocket, thus producing a compound myodermal flap. The technique is simple, and the resulting scar is cosmetically satisfactory; when combined with reduction mammoplasty on the opposite breast, this technique produces satisfactory breast symmetry.

Breast Neoplasms↗
PubMed2004

Breast cancer: improving outcome following adjuvant radiotherapy.

In the treatment of early breast cancer adjuvant irradiation improves local control following both mastectomy and breast-conserving surgery. For women at high risk of relapse it also increases survival. Breast radiotherapy is usually given using simple planning techniques and serious morbidity is unusual. The greatest concern following adjuvant breast irradiation is of an increase in cardiovascular mortality after 15-20 years. New techniques of breast irradiation including conformal radiotherapy and intensity-modulated radiotherapy (IMRT) have been shown to reduce cardiac and lung irradiation. In addition, improved dosimetry within the breast may improve both local control and cosmesis. To replace current radiotherapy techniques with those requiring more complex planning would demand an increase in resources including both machinery and staff. In this review we outline the indications and benefits of breast radiotherapy along with the planning process. Technical advances are discussed within the context of improving outcome at a time of limited national resources.

Breast Neoplasms↗
PubMed1994

[Immediate breast reconstruction following mastectomy for recurrence after conservative treatment].

The authors report their experience with immediate breast reconstruction following salvage mastectomy for local recurrence of invasive breast cancer after conservative treatment. From January 1987 to December 1992, among 91 immediate breast reconstructions, 41 were performed for this indication. The results and complications were analyzed for each of the three techniques used: simple prosthesis (n = 5), latissimus dorsi flap with prosthesis (n = 26), trans abdominalis musculocutaneous flap--TRAM flap (n = 10). Immediate flap reconstruction appears to be required in cases of either early or late local relapse since the skin has been irradiated and the mastectomy must be extensive. The transrectus abdominalis flap allows more extensive resection and gives better cosmetic results without the need for a prosthesis.

Adult↗
PubMedDate not supplied

Cystosarcoma phylloides of the breast: a review of clinical, pathological and therapeutic option in 18 cases.

The clinical and pathological findings and therapeutic options in 18 patients with cystosarcoma phylloides were retrospectively studied and analysed. Painless breast lump was the most common clinical penetration. An accurate pre-operative diagnosis was obtained in only six patients (33.3%). Intraoperative frozen section examination was performed in nine patients and the diagnosis was cystosarcoma phylloides in five patients, benign breast tumor in four patients with a 55.5% yield. The final pathological results revealed benign form cystosarcoma phylloides in 17 patients and malignant form in one patient. Seven patients, including the one with malignant form tumor, underwent wide excision with an adequate margin of normal breast tissue. One patient underwent subcutaneous mastectomy due to the huge size of tumor. The remaining 11 patients with presumed diagnosis of fibroadenoma or breast cancer underwent simple excision. There was no local recurrence or distant metastasis in any of the 18 patients, with a mean follow-up time of 31.5 months. On the basis of this data, wide excision with an adequate margin of normal breast tissue may be the preferred initial therapy for cystosarcoma phylloides. For those patients undergoing simple excision, the follow-up option may be acceptable if microscopic examination reveals no unrecognised amputation of tumor.

Adolescent↗
PubMed1999

Role of high speed biopsy gun in breast cancer diagnosis.

Preoperative diagnosis of histology and receptor status is important in management of breast cancer. Percutaneous automated core biopsy with biopsy gun (Gun biopsy) was done in fifty patients with palpable breast lump in whom fine needle aspiration cytology (FNAC) was either negative or not done In all patients adequate tissue for histology and receptor status studies was obtained forty-two patients had infiltrating duct carcinoma and eight patients had benign lesions on gun biopsy. There were no complications in this procedure. Twenty of the forty-two patients underwent mastectomy either per primum or after chemotherapy, had the diagnosis substantiated on histopathological examination Thirty-four samples were examined for receptor status and the specimen was found to be adequate and of good quality. We conclude that gun biopsy is a simple and safe procedure which is more sensitive and specific than FNAC.

Biopsy, Needle↗
PubMed1989

Reconstructive options after cancer surgery of the breast.

Breast cancer is now treated either by conservative therapy or by mastectomy. In the first case, no reconstruction is usually necessary, although some patients require additional surgery for asymmetry, distortion or even severe damage, by surgery or radiotherapy, of the treated breast. In these cases, reconstructive surgery should be performed very carefully, taking full account of the risk of operating in irradiated tissues. Minor procedures are usually adequate, but major surgery, reconstruction with abdominal flap, is sometimes the only solution to solve difficult postradiotherapy disasters. When a mastectomy is the choice of the patient and the surgeon, immediate reconstruction is now performed more often than before, as expansive prostheses are now available, allowing immediate implantation without endangering the skin flaps. In most cases of mastectomy, however, reconstruction is performed as a secondary procedure, in two stages if possible (volume and symmetry after the first, areola after the second). Most of the reconstructions are done by simple implantation of a prosthesis. When local conditions require a flap, the latissimus dorsi musculocutaneous has been the best choice for years, but the lower rectus flap is now taking over, as it gives the advantage of reconstructing a breast with autologous tissue.

Breast Neoplasms↗
PubMed1998

MRI of the breast: state of the art.

Contrast-enhanced MRI of the breast is probably the most sensitive method to detect breast pathology. It is best used to improve the sensitivity of mammography and sonography in selected patient groups with high breast cancer prevalence, where conventional methods are known to be less sensitive. Despite the high sensitivity of MRI, 5-12 % of invasive carcinomas are not recognized during MRI, because of lack of the typical criteria of carcinoma. MRI is probably inferior to mammography in detecting ductal in-situ carcinoma or very small carcinomas (< 3 mm), because the neo-angiogenesis induced by these small carcinomas is too faint to be detected by contrast-enhanced MRI. These tumours cannot be excluded by a normal MRI examination. MRI is non-specific as the distinction of benign and malignant breast lesions is unreliable. Only in selected cases (fat- or blood-containing lesions) may it improve the specificity of mammography and sonography. Mostly image-guided core biopsy is by far the most specific and least expensive method to establish a definitive diagnosis. For lesions exclusively detected by contrast-enhanced MRI, simple and reliable localisation devices are urgently needed. Presently accepted indications for MRI of the breast are: patients with silicone implants after mastectomy or augmentation mammoplasty (detection of recurrence/prosthesis rupture/silicon leakage); patients whose breasts are difficult to evaluate by combined mammography and sonography, who have had breast conservation therapy (local recurrence), or who have proven carcinoma in one breast (multifocality/-centricity or contralateral breast carcinoma) or proven axillary lymph node metastases from an unknown primary tumor, especially when these are hormone receptor positive; patients with extensive postoperative scarring. In the future, genetically defined high breast cancer risk may become an indication.

Adult↗
PubMed1987

Thermography after subcutaneous mastectomy and reconstruction with silicone gel prosthesis: a pilot study.

Patients with subcutaneously placed silicone gel prostheses, for reconstruction after subcutaneous mastectomies, often complain of cold breasts as well as of slow regaining of warmth after cooling. We have used thermography in 7 such women and in 7 healthy women of the same age group as controls. Thermography has also been used in 3 women after repositioning of the subcutaneously placed prostheses to a submuscular position in order to study any possible changes in temperature. In 2 cases thermography also was found to aid in the diagnosis of a suspected subcutaneous displacement of a submuscular prosthesis; the technique has an advantage over mammographic examination, since thermography is a simple, less expensive, and safer method.

Bioprosthesis↗
PubMed1981

Hormone dependency of breast cancer.

Quantitative determination of the estrogen receptor (estrophilin) content of an excised tumor specimen provides information useful in selecting the type of systemic therapy best suited to the individual patient with advanced breast cancer. Women whose tumors contain low or negligible amounts of estrophilin rarely respond to endocrine ablation or other hormone therapy, whereas most but not all patients with receptor-rich cancers receive benefit from endocrine treatment. Properly interpreted, estrophilin assay predicts hormone dependency correctly in 85 to 90 percent of the cases. Analysis of the primary tumor at the time of mastectomy not only serves as a guide to subsequent therapy if metastases should appear but it also provides a clue to the probability and rapidity of recurrence. Because present methods for receptor determination have certain limitations, we are developing an immunoassay, based on monoclonal antibodies to human estrophilin, that promises to provide a simple, inexpensive procedure for the routine analysis of breast cancer specimens.

Adrenalectomy↗
PubMed1988

The effect of tamoxifen and medroxyprogesterone on giant cell formation by monocytes from patients with breast cancer.

Incubation of peripheral blood monocytes from patients with breast cancer under agarose for 6 days at 37 degrees C in a 5% CO2 atmosphere resulted in giant cell formation. This phenomenon appeared to be mediated by retroviruses present in these cells. In this study giant cell formation was investigated in patients with primary stage I and II breast cancer before and 3 months after mastectomy with axillary lymph node clearance. Mastectomy had no significant inhibitory effect on giant cell formation. In vitro incubation of monocytes from patients with breast cancer in the presence of tamoxifen (Nolvadex) resulted in significant inhibition of giant cell formation (P less than 0.000003; paired Student's t-test). In vitro addition of medroxyprogesterone (Farlutal) to monocytes from patients with breast cancer also resulted in significant inhibition of giant cell formation (P less than 0.003: paired Student's t-test). Furthermore, incubation of monocytes from patients treated by mastectomy followed by 3 months treatment with adjuvant tamoxifen, resulted in a significant reduction (P less than 0.00007; paired Student's t-test) in the number of giant cells compared to the same samples tested before the commencement of the treatment. Giant cell formation may be used as a simple test to predicte the response of patients with breast cancer to either tamoxifen or medroxyprogesterone.

Adult↗
PubMed1991

Achieving symmetry in the tissue-expanded breast reconstruction.

Breast reconstruction has become such a commonplace procedure over the last ten years that we as plastic surgeons are no longer content to simply create a mound. Today's goal is to create a mound that not only looks like a breast, but also matches the opposite breast. The most commonly used procedures today include simple augmentation if adequate tissue exists, flap reconstruction with either the latissimus dorsi or the tram, and, finally, tissue expansion. Each technique has its own highlights and pitfalls. It is the purpose of this article to deal only with tissue expansion and to present a simple technique to produce symmetry with the opposite breast.

Adult↗
PubMed1995

[Therapeutic strategy in breast cancer].

The authors present the actual concepts of the therapeutic strategy for the breast cancer. The choice of the optimal protocol treatment is based on a complete and correct pretherapeutic evaluation. This implies the staging using TNM/ UICC/ 1987 system (explained in the text) and the definition of the prognostic factors: axillary lymph node involvement, other pathological patterns, the situation of the hormonal receptors and the cell proliferation index. For the stages I-II the strategy of the treatment include: modified radical mastectomy, postoperative irradiation in well defined cases and the adjuvant systemic treatment using chemotherapy and hormonal therapy. The laparoscopic ovariectomy is a safe and simple technique. For the local advanced cancer (IIIA and IIIB) the treatment begins with a systemic aggressive approach, the surgery being applied following the tumoral regression. In the stage IV the complex palliative treatment is indicated.

Breast Neoplasms↗