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PubMed2005

Uncovering homeless African-American women's knowledge of breast cancer and their use of breast cancer screening services.

This study explored the knowledge of breast cancer and the use of breast cancer screening services by homeless African-American women in an attempt to understand their use of cancer screening services and whether they understood the information about breast cancer and breast cancer screening. A qualitative study using a focus group format was employed to obtain a deeper understanding of the participants' experiences as they related to knowledge of breast cancer and their use of breast cancer screening services. The sample consisted of 25 (N = 25) African-American women who were currently living in a transient shelter for homeless women and children. Three, one-hour focus group sessions were conducted over a three-week period. Sessions were audio taped and transcribed for analysis. Content analysis was used to analyze the data. Findings from the study revealed categories that were associated with the women's personal experiences with cancer, their knowledge of breast cancer and experiences with the use of screening services, and their motivations as they related to breast cancer screenings. These categories can be useful in providing access to care and in addressing cancer education, screening behaviors, and program planning in homeless African-American women.

Adaptation, Psychological↗
PubMedDate not supplied

[Conservative treatment of breast carcinoma in small breasts: new minimally invasive surgical technique].

To achieve satisfactory cosmetic results after breast conserving treatment (BCT) of cancer in patients (with small breasts, the association of BCT and bilateral video-assisted augmentation mammoplasty with differentiated prosthesis volume was performed. From January 2001 21 small breast pts with breast cancer (stage T1N0M0) were treated with BCT and immediate trans-axillary video-assisted breast reconstruction with differentiated volumes. In 15 patients sentinel node biopsy was performed and 6 patients required total axillary dissection. Tumor-free margins were confirmed by histological examination. All patients underwent postoperative radiotherapy. Cosmetic results were evaluated through 6 parameters: breast shape with and without underwear, symmetry, mobility, inframammary fold, tenderness. We observed 4 minor complications: seroma3, paresthesia and slight arm weakness. Mini-invasive surgical revision was required in 3 cases due to scar retraction of the prosthesis pocket. Prosthesis volume resulted 30% (range, 0-47%) higher in the affected side. Cosmetic result was positive in 85% of cases (excellent 15%, good 45%, fair 25%). Trans-axillary video-assisted breast mammoplasty with differentiated prosthesis volumes allows to obtain good aesthetic results in small breast patients and to extend BCT indications with a low morbidity rate.

Adult↗
PubMed2005

Long-term outcome of breast-conserving therapy for breast cancer.

PURPOSE: We present a retrospective analysis of long-term therapeutic results for patients treated in our institution to evaluate the efficacy of breast-conserving therapy (BCT). PATIENTS AND METHODS: The study population was 99 patients (102 breasts) with stage 0, I, and II breast cancer who underwent breast conservation therapy between April 1990 and November 1997. The entire breast was irradiated to a median dose of 50 Gy (range, 50-60 Gy) in 25-30 fractions. An additional 10 Gy in five fractions with 6-12 MeV electrons was given to 23 breasts (23%) with positive surgical margins. RESULTS: The 5-/10-year overall survival, cause-specific survival, relapse-free rate, local recurrence, and regional recurrence rates were 94.6/93.3%, 95.7/94.5%, 88.2/77.5%, 4.2/8.5%, and 2.0/6.3%, respectively. In both uni- and multivariate analyses, age < 40 years was a significant prognostic factor for local recurrence. No severe morbidity was observed. CONCLUSION: The long-term clinical outcome of BCT for early breast carcinoma patients in our department was favorable. Patient age <40 was the most important factor associated with an increased risk of local recurrence in the ipsilateral breast.

Adult↗
PubMed2006

[Overexpression of NDRG1: relationship with proliferative activity and invasiveness of breast cancer cell line and breast cancer metastasis].

OBJECTIVE: To investigate the relationship between NDRG1 and metastasis of breast cancer and the effects of NDRG1 overexpression on the proliferation and invasion of breast cancer cells. METHODS: NDRG1 was detected at its protein level by immunohistochemistry (IHC) and its messenger RNA (mRNA) was detected by real-time reverse transcriptase-polymerase chain reaction (real time RT-PCR) in clinical breast cancer specimens. Liposome was used to transiently transfer NDRG1 into MDA-MB-231, a highly invasive human breast cancer cell line. The proliferation of MDA-MB-231 was measured by Bromodeoxy Uridine (BrdU) incorporation assay and the transfection effect on cell cycle distribution was determined by fluorescence assisted cell sorting (FACS). The invasive ability of the transfected cells was investigated by reconstituted matrigel invasion and polycarbonate filters migration experiments. RESULTS: NDRG1 expressions at protein and mRNA levels in tumors of patients with lymph node metastases were significantly lower as compared with those with localized breast cancers (P < 0.01). The amount of NDRG1 mRNA in MCF7, a relatively non-invasive breast cancer cell line, was 10.8 times higher than that in MDA-MB-231 cells (P < 0.01). The BrdU incorporation rate declined significantly (P < 0.05) in NDRG1 overexpressing MDA-MB-231 cells. An increase of the cell population at G(0)/G(1) phase was observed 48 hours post-transfection along with a decrease of cell population at S phase. Overexpression of NDRG1 significantly retarded the invasiveness of MDA-MB-231 cells in matrigel-coated invasion chambers (P < 0.05), when compared to cells transfected with control vectors. However, the migration abilities of cells with or without the transfection were virtually identical. CONCLUSIONS: NDRG1 expression reversely correlates with breast cancer metastasis and progression, and may serve as a prognostic biomarker for predicting early metastasis. The inhibition of proliferation and invasion demonstrated by our MDA-MB-231 transfection experiments implies that NDRG1 is a tumor metastasis suppressor gene and may be a new candidate for gene therapy against human breast cancer.

Breast Neoplasms↗
PubMed2006

Breast-conserving surgery in early-stage breast cancer (indications, local recurrences, survival, cosmetic results).

INTRODUCTION: Breast cancer is an extremely actual problem in modern medicine and surgery in particular. Constantly growing frequency, younger age of the newly diagnosed patients, severe psychological collapse of the patients and serious impairment of quality of life are only some of the factors determining actuality of the problem. AIM: The aim of the present survey is to make a retrospective comparative clinical analysis of the results obtained after breast-conserving surgery and simple mastectomy in terms of 5- and 10-year survival, local recurrences and cosmetic outcome. PATIENTS AND METHODS: Over a 19-year period, 269 breast cancer patients were treated in the Clinic. Breast-conserving surgery plus axillary lymph node dissection in levels I, II and III was performed in 66.17% of the patients. In 33.83% of the patients ablation of the mammary gland (simple mastectomy) plus axillary lymph node dissection was done. In both groups adjuvant radiation therapy was performed and patients with positive axillary lymph nodes were further subjected to chemotherapy. Adjuvant hormone therapy with anti-estrogen drugs was administered in estrogen positive patients. RESULTS: Study of the late (5- and 10-year) results showed that in complex treatment the recurrence rate in patients subjected to breast-conserving surgery (BCS) was 4.00% and in those treated by simple mastectomy (SM)--2.99%. The 5-year survival was 90.10% for the patients undergoing BCS and 88.89% for those treated by SM. The 10-year survival was 80.56% for the patients treated by BCS and 77.14% for those subjected to SM. CONCLUSIONS: Breast-conserving surgery is indicated in all patients in stage I and II of the disease and tumor measured up to 3.5 cm regardless of the axillary lymph nodes status. There is no statistically significant difference in the survival rate between the two compared groups and cosmetic results are much better in the patients subjected to breast-conserving surgery. When complex treatment is accomplished breast-conserving operations provide recurrence rate equal to that in simple mastectomy. Unfavorable prognostic factors for recurrence are younger age, bigger lump size, greater number of positive lymph nodes and estrogen/progesterone negative status.

Adult↗
PubMed1987

[1981-1983 breast feeding studies of 1,500 mothers in Dortmund and Haltern. II. Volume of breast milk in the maternity ward].

In two large maternity wards encouraging breast-feeding, breast-milk volumes (weighing of the baby before and after each feeding) and weight development of the infants were determined until dismissal. On days 2, 3 and 4, 20-30%, 60-70%, and 80-90% of the mothers, respectively, produced milk. The largest increase in milk volume ("Einschuss") usually took place between days 3 and 4. Milk volume increased from an average of 150-180 ml on day 4 to 270-300 ml on day 6. Development of milk production was independent of type of delivery; however, the usual delay of one day following caesarean section was not made up for until discharge. Fully breast-feeding mothers produced on the average the same amounts of milk as mothers at the turn of the century. Throughout their stay in the maternity ward, mothers with good breast-feeding experience produced more milk than those with bad or without any breast-feeding experience. Nursing all infants at fairly regular intervals during the day and at night is recommended in order to achieve that as many mothers as possible are fully breast-feeding on discharge. Comparing energy intake and weight development between groups of fully, partially and non breast-fed infants suggested a better utilization of breast-milk.

Body Weight↗
PubMed1995

Breast and ovarian cancer incidence in BRCA1-mutation carriers. Breast Cancer Linkage Consortium.

Dominant predisposition to early-onset breast cancer and/or ovarian cancer in many families is known to be the result of germ-line mutations in a gene on chromosome 17q, known as BRCA1. In this paper we use data from families with evidence of linkage to BRCA1 to estimate the age-specific risks of breast and ovarian cancer in BRCA1-mutation carriers and to examine the variation in risk between and within families. Under the assumption of no heterogeneity of risk between families, BRCA1 is estimated to confer a breast cancer risk of 54% by age 60 years (95% confidence interval [CI] 27%-71%) and an ovarian cancer risk of 30% by age 60 years (95% CI 8%-47%). Similar lifetime-risk estimates are obtained by examining the risks of contralateral breast cancer and of ovarian cancer, in breast cancer cases in linked families. However, there is significant evidence of heterogeneity of risk between families; a much better fit to the data is obtained by assuming two BRCA1 alleles, one conferring a breast cancer risk of 62% and an ovarian cancer risk of 11% by age 60 years, the other conferring a breast cancer risk of 39% and an ovarian cancer risk of 42%, with the first allele representing 71% of all mutations (95% CI 55%-87%). There is no evidence of clustering of breast and ovarian cancer cases within families.

Adult↗
PubMed1994

Economically disadvantaged females' perceptions of breast cancer and breast cancer screening.

This study examined 500 economically disadvantaged females' perceptions and screening practices regarding breast cancer. The vast majority of respondents did not identify themselves, or economically disadvantaged women in general, as more susceptible to breast cancer. Those who were the most knowledgeable about breast cancer were significantly more likely than the least knowledgeable to perceive themselves as more susceptible to breast cancer, to perceive breast cancer as less severe, to perceive fewer barriers, and to perceive more benefits to screening for breast cancer. Fifty-four percent of the women claimed they had previously had a mammogram. A series of t-tests were conducted to see if breast cancer knowledge or health beliefs would discriminate between those who had and those who had not had a mammogram. The only difference between the two groups was that those who had a mammogram were more likely to perceive greater benefits of mammography screening. The results of this survey indicate that there is considerable room for improvement in knowledge, perceptions, and practices of economically disadvantaged women regarding breast cancer.

Adult↗
PubMed1993

Detection of contralateral breast cancer by mammography in women with previous breast cancer and the impact of endocrine therapy.

AIMS: To determine the efficacy and extent of screening mammography for detection of contralateral breast cancer in a cohort of women with previous unilateral mammary carcinoma, and to assess the effect of endocrine therapy on the risk of developing cancer in the contralateral breast. METHODS: Women with previous breast cancer eligible for mammography were identified from the Auckland breast cancer data file and the extent and outcome of mammographic screening determined by questionnaire and survey of mammography reports. The extent of adjuvant hormonal therapy and development of contralateral breast cancer was ascertained from the ABCDF records. RESULTS: Of 703 eligible subjects, 59% had undergone screening mammography with a cancer detection rate of 17 per 1000 mammograms and a benign to malignant ratio was 1.7 to 1. Contralateral breast cancer developed in 2.9% of 1980 women with previous unilateral mammary tumours who did not receive endocrine therapy with 1.1% of 374 women who were given adjuvant hormonal treatment (p = 0.04). CONCLUSIONS: The efficacy of mammography in those screened was comparable to major overseas screening programs, but the proportion of women undergoing mammography in this high risk group was relatively low suggesting a need for greater promotion of mammography in Auckland. The use of adjuvant endocrine therapy significantly reduced the rate of development of contralateral breast tumours supporting the current development of formal trials of chemoprevention of breast cancer in women at high risk groups of the disorder.

Breast Neoplasms↗
PubMed1996

Strategy for breast conserving treatment--analysis of recurrence and prognosis after breast cosnserving treatment.

Two hundred and four patients with small breast cancer (T < or = 3.0 cm. N0 or N1a) were given breast conserving treatment (radiation group: 101, non-radiation group: 103) during the period from Feb. 1988 to Jan. 1995. Survival analysis of breast conserving treatment radiation group versus non-radiation group revealed the following: 1) Breast conserving treatment had a good prognosis, and a 5-year overall survival rate of 96.2%. 2) There was no significant difference of 5-year overall, disease-free and ipsilateral breast disease-free survival rate between the radiation group and non-radiation group. 3) Surgical margin involvement was the most significant risk factor in local recurrence after breast conserving treatment, and non-radiation was a possible risk factor. 4) Local recurrence was a significant risk factor for distant metastases after breast conserving treatment the same as node positive. These results suggested as follows: 1) Lumpectomy with a clear margin and radiation is the best choice for small breast cancer (T < or = 3.0 cm, N0 or N1a). 2) Adjuvant therapy after surgical treatment is necessary for local recurrence.

Axilla↗
PubMed1998

Mastectomy or lumpectomy? The choice of operation for clinical stages I and II breast cancer. The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Canadian Association of Radiation Oncologists.

OBJECTIVE: To assist women and their physicians in making the most clinically effective and personally acceptable decision regarding the choice of primary surgery for potentially curable breast cancer. OPTIONS: Breast-conserving surgery (BCS; also referred to as lumpectomy or wide local excision) or mastectomy. OUTCOMES: Local recurrence, metastasis-free survival, overall survival, cosmetic results. EVIDENCE: Systematic computerized citation search using MEDLINE (from 1980) and CANCERLIT (from 1985) databases to September 1995. Nonsystematic review of breast cancer literature until January 1997. BENEFITS: Minimization of disfigurement offered by BCS. HARMS: The need for radiotherapy and the greater costs associated with BCS. RECOMMENDATIONS: For patients with stage I or II breast cancer, BCS followed by radiotherapy is generally recommended. In the absence of special reasons for selecting mastectomy, the choice between BCS and mastectomy can be made according to the patient's circumstances and personal preferences. Mastectomy should be considered in the presence of any of the following: (a) factors that increase the risk of local recurrence such as extensive malignant-type calcifications visible on the mammogram, multiple primary tumours or failure to obtain tumour-free margins; (b) physical disabilities that preclude lying flat or abducting the arm, preventing the use of radiotherapy; (c) absolute contraindications for radiotherapy such as pregnancy or previous irradiation of the breast or relative contraindications such as systemic lupus erythematosus or scleroderma; (d) large tumour size in proportion to breast size; (e) the patient's clear preference for mastectomy. The following factors are not contraindications for BCS: the presence of a centrally located tumour mass, axillary lymph-node involvement or the presence of breast implants. Before deciding between BCS and mastectomy, the physician must make a full and balanced presentation to the patient concerning the pros and cons of these procedures. Whenever an open biopsy is performed on the basis of even modest suspicion of carcinoma, the procedure should be, in effect, a lumpectomy, using wide local excision of the intact tumour surrounded by a cuff of tumour-free tissue (by palpation and visual inspection). The following recommendations should be observed to provide optimum clinical and cosmetic results: (a) Tumour-involved margins should be revised; (b) Separate incisions should be used for removal of the primary tumour and for the axillary dissection except when these coincide anatomically; (c) Radial incisions should not be used except when directly medial or lateral to the nipple; (d) Drains and approximation sutures should not be used in the breast parenchyma. VALIDATION: Guidelines were reviewed and revised by the Writing Committee, expert primary reviewers, secondary reviewers selected from all regions of Canada and by the Steering Committee. The final document reflects a consensus of all these contributors and has +been endorsed by the Canadian Association of Radiation Oncologists.

Biopsy, Needle↗
PubMed1985

Nipple aspirates of breast fluid and the epidemiology of breast disease.

Epidemiologic data were obtained, and nipple aspiration attempted, from 289 healthy women, 548 women currently having or with a history of benign breast disease, 153 untreated women with breast cancer, and 106 women previously treated by mastectomy. Breast duct fluid was produced in detectable amounts by 59% of the controls and patients with benign or untreated malignant breast disease; in 35% the volume was in excess of 10 microliters. There were more secretors aged 30 to 50 years (72%), than either those who were younger (52%), or older (44%). Overall, 57% of premenopausal women were secretors, compared with 38% of postmenopausal women. Healthy women who had their menarche before age 13 years were more likely to be secretors. Neither parity, age at first completed pregnancy, nor body weight affected secretor status. There was a trend for the 141 benign breast disease patients aged 40 to 49 years to include more women yielding greater than 10 microliter of fluid (57%) compared with 46 controls (39%). Although breast cancer per se did not appear to influence secretor status, postmastectomy patients were more likely to secrete large fluid volumes, an effect that was particularly pronounced after menopause. Hormonal factors related to age and fibrocystic disease risk and endocrine activity after mastectomy may be the principal determinants influencing the secretion of breast duct fluid.

Adult↗
PubMed1992

Histologic types of benign breast disease and the risk for breast cancer. The Cancer and Steroid Hormone Study Group.

Specific histologic types of benign breast disease (BBD) may increase breast cancer risk. The authors analyzed data from a population-based, case-control study of women aged 20 to 54 with newly diagnosed breast cancer and control subjects randomly selected from the general population. A panel of pathologists classified the histologic findings of biopsy slides for 433 women with breast cancer and 261 control subjects, all of whom had a history of biopsy for BBD, as to the presence of epithelial hyperplasia, atypia, and other histologic features. When compared with women who had never had a breast biopsy, women with BBD without hyperplasia had an odds ratio of 1.5 (95% confidence limits [CL] 1.3 to 1.9), women with hyperplasia without atypia had an odds ratio of 1.8 (CL = 1.3, 2.4), and women with hyperplasia and atypia had an odds ratio of 2.6 (CL = 1.6, 4.1). Fibroadenoma was an independent risk factor for breast cancer (odds ratio = 1.7; CL = 1.1, 2.5). These findings suggest that women with BBD with epithelial hyperplasia either with or without atypia and women with fibroadenoma should be monitored carefully because of their elevated risk for breast cancer.

Adenofibroma↗
PubMed2000

Sudden hemorrhage of the breast caused by breast cancer: a case report and review of the literature.

A rare case of sudden hemorrhage caused by breast cancer is reported. A 71-year-old woman noted bleeding from her left breast. Physical examination of the left breast showed a localized open cavity accompanied by bleeding and coagulation. The patient had no history of breast trauma or anticoagulation therapy. Incisional biopsy followed by histological examination resulted in a diagnosis of granulation tissue with no cancer cells present. Mammography and ultrasonography indicated probable breast cancer. As a result, a second incisional biopsy was performed, which suggested invasive ductal carcinoma without histological skin invasion. A modified radical mastectomy was performed under a diagnosis of stage II breast cancer. Breast cancer with sudden hemorrhage is rare. We review the literature and discuss the cause of this unusual manifestation.

Aged↗
PubMed1996

Breast-duct endoscopy to study stages of cancerous breast disease.

BACKGROUND: In breast-cancer research, we lack reproducible non-invasive access to breast tissue. Breast cancer is thought to start in the lining of the milk duct or lobule. We have had no direct access to this area other than in tissue removed surgically or by fine-needle aspiration. Our objective was to explore an intraductal approach to studying breast cancer and precancerous changes by duct cannulation and endoscopy. METHODS: In this pilot study, women in a university hospital were asked to participate. Nine patients with previously diagnosed ductal carcinoma-in-situ (DCIS) or invasive breast cancer who were about to undergo mastectomy under general anaesthesia agreed. After the patient was asleep but before the operation, we spent 15 minutes cannulating their ducts, obtaining washings, and attempting endoscopy. The ducts that had been cannulated were marked by instillation of dye or other materials, the nipple was sutured shut, and the mastectomy proceeded as planned. The mastectomy specimen underwent extensive histopathological examination. FINDINGS: We were successful in intraductal cannulation and endoscopy in seven of the nine patients. In five of the nine, we obtained epithelial cells in the washings. In one the cells were consistent with proliferative disease, in three there was atypical epithelium, and in one there was frank DCIS. With several different contrast materials injected into separate duct orifices, DCIS was confined to a single duct system. INTERPRETATION: We found that the intraductal approach is feasible for the study of the early changes of breast cancer Technical difficulties include identification of the breast duct orifices, determining the distensibility of the duct, and developing a reliable technique to obtain washings.

Anesthesia, General↗
PubMed2003

Sulfotransferase 1A1 (SULT1A1) polymorphism, PAH-DNA adduct levels in breast tissue and breast cancer risk in a case-control study.

Gene-environment interactions are hypothesized to be major contributors to susceptibility to environmental carcinogens and interindividual variability in cancer risk. We present findings on associations between genetic susceptibility due to inherited polymorphisms of the Phase II detoxification enzyme sulfotransferase 1A1 (SULT1A1), breast cancer risk, and polycyclic aromatic hydrocarbon (PAH)-DNA adducts. A hospital based case-control study was conducted at the New York-Presbyterian Medical Center (NYPMC). The study utilized two control groups: one comprised of women with benign breast disease (BBD) and the other comprised of women visiting NYPMC for routine gynecologic checkups (healthy controls). Blood samples were collected from cases and controls; and breast tissue from pathology blocks was collected from cases (tumor and non-tumor tissue) and BBD controls (benign tissue). PAH-DNA adduct levels were measured by immunohistochemistry in breast tissue samples, and the SULT1A1 (Arg/His) polymorphism at codon 213 was determined by PCR RFLP analyses using DNA from white blood cells. Increasing number of His alleles was modestly associated with breast cancer case-control status, when cases were compared to healthy controls (p for trend = 0.08), when cases were compared to BBD controls (p for trend = 0.08) and when cases were compared to both control groups combined (p for trend = 0.07). Contrary to our hypothesis PAH-DNA adduct levels in breast tissue were not associated with SULT1A1 genotype. Our findings are consistent with a prior report that the Arg/His polymorphism in SULT1A1 is associated with breast cancer risk.

Arylsulfotransferase↗
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↗
PubMed1998

Immediate breast reconstruction for breast carcinoma using the periareolar approach.

Skin-sparing mastectomy with immediate breast reconstruction has shown to be oncologically safe while providing dependable aesthetic results. However, flap inset into the skin defect of the excised biopsy site and nipple-areola complex often results in a patchlike effect and transverse scars. By keeping the mastectomy incision solely around the areola, all breast skin can be preserved. Thus, in immediate breast reconstruction with replacement of the nipple and areola by a small skin island from a deepithelialized TRAM flap or latissimus dorsi muscle flap, the scar is kept at the natural border between areola and breast skin. Reconstruction of the nipple-areola complex further helps to camouflage the incision line. This may result in the best possible aesthetic outcome after mastectomy to date. The technique has been used in 17 breast cancer patients (intraductal cancer, n = 5; T1/T2 ductal cancer, n = 13) with good to excellent results. No local or distant recurrences have been seen; however, mean follow-up time is short (10 months). As the procedure of choice, a free TRAM flap was performed in nine patients for immediate reconstruction. The other eight patients were too slim for an autologous reconstruction; therefore, a latissimus dorsi muscle flap with a small skin island and a silicone implant were used. There were no major complications in either group. In contrast to traditional skin-sparing mastectomy, all breast skin is preserved with the periareolar approach. Therefore, special surgical expertise is required to ensure tumor free margins, especially with respect to the skin overlying the tumor. If these requirements are met, excellent results in breast reconstruction are amenable with adequate oncologic safety.

Abdominal Muscles↗