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PubMed1998

The modified B-mammoplasty incision: an alternative skin-conserving technique for mastectomy with immediate breast reconstruction.

A modification of the B-mammoplasty incision (originally described by Regnault for reduction mammoplasty) is presented for patients undergoing skin-conserving mastectomy and reconstruction. This approach has several advantages; not only does it facilitate good exposure for the oncological surgeon to carry out the mastectomy, but it can easily be extended into the axilla to allow nodal clearance and microvascular access. It creates a suitable pocket into which a flap can be tailored or implant/expander inserted, and further adjustment of the breast size or shape can be undertaken easily. Most importantly, the scar is confined to the infralateral aspect of the breast, leaving the aesthetically important upper and medial breast skin scar free.

Adult↗
PubMed1997

[Clinical research of nipple-areola preserved mastectomy and one-stage breast reconstruction with rectus abdominis musculocutaneous flaps].

OBJECTIVE: To discuss the method for nipple-areola preserved mastectomy with one-stage breast reconstruction in cancer surgery. METHODS: Because of the merits of sufficient blood supply and plasticity of rectus abdominis musculocutaneous flap, we used one-stage breast reconstruction after modified radical mastectomy. The incision line was covered and the nipple-areola was preserved. The reconstructed breast was naturally in contour. RESULTS: 21 cases were treated from 1990 to 1995, and 18 of them received horizontal-rhombus shaped rectus abdominis musculocutaneous flaps and 3 longitudinal-rhombus flaps for breast reconstruction. Nipple-areola was preserved in 16 cases. Objective evaluation after operation showed that the excellent and satisfied rate reached to 90.5%; and subjective evaluation showed that the excellent and satisfied rate reached to 95.2%. Thirteen cases have been followed up for 3 years, and 9 for 5 years. Three-year survival rate was 100% (13/13), and 5-year 88.9% (8/9). CONCLUSION: The method is recommendable for the treatment of stage I-II breast cancer.

Adenocarcinoma↗
PubMed1976

Experience with subcutaneous mastectomy.

A review of 67 patients who had undergone subcutaneous mastectomy indicates that the procedure should be used with well defined criteria. Both the patient and the surgeon should understand clearly that the procedure does not afford absolute protection against breast cancer. In proper perspective, used in appropriate circumstance, subcutaneous mastectomy is one more tool in the physician's armamentarium against breast disease-- a tool that may offer relief and satisfaction, with only moderate risk of morbidity.

Adult↗
PubMed1998

[One-stage reconstruction of the breast after mastectomy with skin preservation].

Our experience points to the advantages of preserving a cutaneous flap remaining after mastectomy followed by one-stage reconstruction using a recto-abdominal flap of silicone expanders and endoprostheses. The procedures used provided for removal of the halo-papillary complex, skin scarred by biopsy, the entire mammary gland tissue with the subaxillary, subclavicular and subscapular lymph nodes. The epithelium was removed from the recto-abdominal flap which was placed into a cutaneous pouch after mastectomy. A small round piece of the flap skin replaced the defect caused by halo removal. As a result, both breasts were practically symmetrical and identical in volume. When silicone implants are used, the skin pouch is filled with an expander installed under musculus pectoralis major. Since October, 1995, 26 such operations have been carried out.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1978

[Preoperative radiotherapy and curative radiotherapy without mastectomy in carcinoma of the breast (author's transl)].

The aim of preoperative radiotherapy of mastocarcinoma is to reduce the size of the tumor to enable radical surgery in the third stage. This method is preferable to postoperative radiotherapy for anatomical and radiobiological reasons. It has not yet been possible to prove beyond doubt that preoperative radiotherapy also has a favourable effect on symptom-free survival. Curative radiotherapy without mastectomy is recommended for tumors of 2 - 3 cm size which are mobile, in small and medium-sized breasts, if the axilla is free or has only 1 - 2 mobile lymphatic nodes. Tumorectomy must be followed by surgical revision of the axillary region. High-voltage equipment is mandotory for radiotherapy. Results obtained to date are in no way inferior to those of mastectomy. Local control rate is 90-100%. The cosmetic result is usually excellent.

Breast Neoplasms↗
PubMed1993

The psychological and cosmetic aspects of breast conserving therapy compared with radical mastectomy.

An evaluation of the psychological and cosmetic morbidity of 31 patients who had undergone breast conserving treatment (BCT group) and 71 patients who had undergone radical mastectomy (RM group) revealed that 85% and 73%, respectively, were satisfied with their operative results. BCT appeared superior to RM in relation to body image, with 93% of the BCT group indicating BCT as a future choice of treatment, whereas only 35% of the RM group indicated RM as a future choice of treatment. For 59% of the BCT patients, the results were considered excellent or good by a physician, but fear of recurrence was frequently expressed by both groups even though an early stage of breast cancer had been significantly more common in the BCT group than the RM group. Sexual adjustment was the same in both groups. Body image was thus concluded to have been improved by BCT rather than RM, but psychological morbidity was essentially the same in both groups.

Adaptation, Psychological↗
PubMed2006

Fifteen-year results of a randomized prospective trial of hyperfractionated chest wall irradiation versus once-daily chest wall irradiation after chemotherapy and mastectomy for patients with locally advanced noninflammatory breast cancer.

PURPOSE: To analyze the results of a Phase III clinical trial that investigated whether a hyperfractionated radiotherapy (RT) schedule could reduce the risk of locoregional recurrence in patients with locally advanced breast cancer treated with chemotherapy and mastectomy. METHODS AND MATERIALS: Between 1985 and 1989, 200 patients with clinical Stage III noninflammatory breast cancer were enrolled in a prospective study investigating neoadjuvant and adjuvant chemotherapy. Of the 179 patients treated with mastectomy after neoadjuvant chemotherapy, 108 participated in a randomized component of the trial that compared a dose-escalated, hyperfractionated (twice-daily, b.i.d.) chest wall RT schedule (72 Gy in 1.2-Gy b.i.d. fractions) with a once-daily (q.d.) schedule (60 Gy in 2-Gy q.d. fractions). In both arms of the study, the supraclavicular fossa and axillary apex were treated once daily to 50 Gy. The median follow-up period was 15 years. RESULTS: The 15-year actuarial locoregional recurrence rate was 7% for the q.d. arm and 12% for the b.i.d. arm (p=0.36). The rates of severe acute toxicity were similar (4% for q.d. vs. 5% for b.i.d.), but moist desquamation developed in 42% of patients in the b.i.d. arm compared with 28% of the patients in the q.d. arm (p=0.16). The 15-year actuarial rate of severe late RT complications did not differ between the two arms (6% for q.d. vs. 11% for b.i.d., p=0.54). CONCLUSION: Although the sample size of this study was small, we found no evidence that this hyperfractionation schedule of postmastectomy RT offered a clinical advantage. Therefore, we have concluded that it should not be further studied in this cohort of patients.

Adult↗
PubMed1999

No serious late cardiac effects after adjuvant radiotherapy following mastectomy in premenopausal women with early breast cancer.

PURPOSE: To assess cardiac mortality, coronary artery disease, myocardial dysfunction, and valvular heart disease in women younger than 65 years of age, at least 10 years after adjuvant radiotherapy following mastectomy in early breast cancer. METHODS AND MATERIALS: Ninety women (45-64 years old) with Stage II breast cancer without relapse, included in the South Sweden Breast Cancer Trial (premenopausal arm), with or without adjuvant postoperative radiotherapy +/- cyclophosphamide were examined with myocardial scintigraphy and echocardiography/Doppler, 10-17 years after radiotherapy. Thirty-four patients had been irradiated for left-sided tumors, 33 for right-sided tumors, and 23 patients had not been treated with radiotherapy. The radiotherapy (conventional roentgen, electron beams, and high-energy photon beams combined, in each patient) included the chest wall and the regional lymph nodes, with a specified target dose of 38-48 Gy, administered in daily fractions of 1.9-2.4 Gy, 5 days/week. RESULTS: No cardiac deaths were found among the original 275 patients randomized to adjuvant therapy. In the 90 patients examined, abnormal findings were recorded for ECG (14 patients), exercise test (5 patients), myocardial scintigraphy (6 patients), thickening of valve cusps (14 patients), and mild valvular regurgitation (20 patients). All patients had normal systolic function. Diastolic dysfunction was observed in 6 patients (abnormal relaxation in 4 patients and restrictive filling abnormality in 2 patients). Although no significant differences were found between the 3 study groups, there was a tendency to more abnormal findings after radiotherapy. CONCLUSION: Women younger than 50 years of age at the time of adjuvant radiotherapy following mastectomy in early breast cancer, had no serious cardiac sequelae 13 years (median) later, despite partly old-fashioned radiation techniques.

Breast Neoplasms↗
PubMed1994

Natural History and Management of Isolated Local-Regional Recurrence Following Mastectomy.

The average incidence of isolated local-regional recurrence following modified radical mastectomy is 10% to 20%, but it can be as low as 5% or as high as 40%, depending on the presence or absence of various risk factors. One of the objectives of this article is to discuss how to evaluate the risk of locoregional failure. In addition, although the average overall survival rate following recurrence is approximately 40% at 5 years and 25% at 10 years, individual patient survival varies considerably and depends on a number of fairly well-documented prognostic features that are also discussed here. The unfortunate reality is that control of an isolated local-regional recurrence for the duration of life is not frequently achieved. Even with optimal irradiation, 50% of all patients will die with uncontrolled local-regional disease. The quality of life for patients with uncontrolled disease is often very poor, and some examples are shown here. For this reason, local-regional recurrence should be avoided. The way to avoid (or at least minimize) local-regional recurrence is to give postoperative irradiation to those who are at high risk for local-regional recurrence following mastectomy. This author considers the risk to be "high" when it reaches 25% to 30%.

Journal Article↗
PubMed2000

Mastectomy follow-up by biennial mammograms: is it worthwhile?

The value of follow-up after mastectomy for breast cancer is controversial. One reason is to detect metachronous tumour in the contralateral breast, but the optimum method for achieving this is undecided. The long-term follow-up policy of our unit is annual clinical review combined with biennial mammography. We have assessed the benefit of this policy in the detection of tumours of the contralateral breast. The case notes of 216 patients undergoing mastectomy between 1978 and 1985, under the care of one consultant surgeon (DJTW) were reviewed. Follow-up was complete to December 1997, thus allowing a minimum follow-up of 12 years. The development of a metachronous tumour was recorded as was its method of detection : either clinically, by the patient or the clinician, or by routine mammography. Two-hundred and five patients were available for follow-up of the contralateral breast. Seventeen (8.3%) developed metachronous tumours. Eight were detected by the patient, 4 by the clinician and 5 by routine follow-up mammography. Biennial mammography does not appear to be beneficial in breast cancer follow-up. More work is required to determine the benefits of more frequent mammography, with or without breast self-examination and clinical review within the hospital environment or within primary care.

Journal Article↗
PubMed2002

The time-course of metastases from breast cancer after mastectomy and breast-conserving surgery with and without isolated local-regional recurrence.

We have examined time intervals between events in 390 metastatic breast cancer (MBC) patients whose distant failure developed within 10 years from initial surgery of Stage I/II disease. All of the patients underwent axillary dissection and mastectomy (n=295) or breast-conserving surgery (BCS, n=95), between 1983 and 1987. Distinctions have been made between distant failure with (n=79) and without (n=311) isolated local-regional recurrence (LRR). The median survival time after first relapse was significantly longer with intrabreast (30 months) and chest wall (24 months) than with distant relapse (15 months), but with axillary (17 months) or with supraclavicular (17 months) relapse survival was similar. The delay between LRR and distant metastasis was shorter with axillary (7 months) and supraclavicular (9 months) than with breast (20 months) and chest wall (12 months) recurrences. The median postmetastatic survival time by site of first relapse was significantly shorter with supraclavicular (6 months) and axillary (9 months) than with distant site relapse (15 months) but with intrabreast (12 months) or with chest wall (11 months) recurrence survival was similar. In MBC, regional recurrences are associated with a shorter interval between events than with local recurrences. The shortened intervals for patients with regional recurrence suggest that metastases existed at the time of initial surgery. The question of whether prevention of local or regional recurrence or both improves cause-specific survival after mastectomy or BCS needs to be answered in randomized studies.

Journal Article↗
PubMed2002

Breast cancer in the inframammary fold: is preserving the inframammary fold during mastectomy justified?

INTRODUCTION: Preservation of the inframammary fold (IMF) during mastectomy facilitates breast reconstruction. The true incidence of breast cancer in the IMF is not well known. We report our experience of this condition. METHODS: The site and clinical features of initial presentation and recurrence of breast cancer within the breast in a consecutive series of 580 patients between 1997 and 2000 was studied. RESULTS: Primary breast tumours were detected within the IMF in four patients (0.7%). Only two tumours presenting within the IMF were visible on mammography. During the follow-up period, there were five patients with local recurrences involving either breast or skin flaps, but no breast cancer recurrence was observed in the IMF. CONCLUSION: Tumours within the IMF are rare but its occasional occurrence requires reconsideration of the safety of preserving the IMF at mastectomy.

Journal Article↗
PubMed1998

Eccentric skin resection and purse-string closure for skin reduction with mastectomy for gynecomastia.

Skin redundancy following mastectomy for gynecomastia does not shrink and resolve in a predictable manner. Excess skin can be addressed best with resection at the time of the original operation if the scar can be minimized. Previously described techniques for resection of skin have shortcomings that include unacceptable scars, poor nipple positioning, and bulkiness of redundant, folded dermal tissue. The current technique for grade 2 and some grade 3 gynecomastias is performed with the creation of a 20-mm-diameter nipple-areolar complex based as a cephalad flap and designed eccentrically around the existing nipple. Eccentric skin resection in the vertical and horizontal planes is performed below the areolar flap. Wide access for completion of mastectomy is gained. The wound is then closed with a subcutaneous purse-string suture and inset of the areolar flap so that the scars are confined to the circumareolar area. This allows immediate skin recontouring with minimal skin scar. The patient does not have to endure prolonged anxiety while awaiting skin contracture, and this procedure eliminates the possible need for secondary surgery to resect redundant skin.

Anesthesia, Local↗
PubMed2006

Skin-sparing mastectomy and radiotherapy: an update.

Despite the lack of randomised controlled trials and paucity of the published data, the current evidence suggests that the post-mastectomy radiation therapy (PMRT) does not represent a contraindication to skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) in the multidisciplinary setting. Although PMRT is associated with a higher incidence of complications, a satisfactory cosmetic outcome can be achieved in most patients. Radiation has a deleterious effect on autologous flap reconstruction that relies on fat for volume replacement such as the deep inferior epi-gastric perforator (DIEP) flap reconstruction and this method of reconstruction should be delayed until RT is completed. Until better methods of RT delivery are developed to minimise complications, women at high risk of requiring PMRT, can be safely offered SSM and IBR with a sub-pectoral saline-filled tissue expander and this can be replaced with a permanent prosthesis or converted into an autologous flap reconstruction after the completion of RT. Any capsule formation can be surgically treated at this stage. This new concept, known as immediate-delayed reconstruction, can avoid the cosmetic and RT delivery problems that can occur after IBR.Furthermore, prior RT does not represent a contra-indication to SSM and IBR, however it increases the incidence of complications.

Editorial↗
PubMed2006

Mammary Paget's disease occurring after mastectomy.

BACKGROUND: Mammary Paget's disease and extramammary Paget's disease are neoplastic conditions, in which there is intraepithelial (usually intraepidermal) infiltration by neoplastic cells showing glandular differentiation. Mammary Paget's disease occurs exclusively on the nipple/areola complex from where it may spread to the surrounding skin. CASE PRESENTATION: We here describe a case of Paget's disease occurring on the thoracic wall site of a previous simple mastectomy, and also briefly summarise the most important aspects leading to a diagnosis of mammary Paget's disease. CONCLUSION: To the best of our knowledge, this is the first reported case of mammary Paget's disease occurring after mastectomy. The absence of the nipple/areola complex obviously raised some questions concerning whether it was mammary or extra-mammary Paget's disease, and how it could occur in the absence of the nipple/areola complex.

Journal Article↗
PubMed2002

Implant-based breast reconstruction following mastectomy.

Post-mastectomy breast reconstruction with prostheses can be performed immediately at the time of mastectomy or delayed for several months or years. It falls into three main categories namely implant-only, expander-implant and expandable implant reconstruction. Sometimes it is combined with the latissimus dorsi myocutaneous flap. Logistically prosthetic reconstruction can be single-stage (with implant-only or expandable implants) or two-stage (traditional expander-implant technique). Over the last decade a wide variety of prostheses has become available which materially vary in shape, surface and consistency. Prosthetic breast reconstruction provides satisfactory results in properly selected patients and has the advantages of simplicity, shorter operating time, hospital stay and recuperation. Additionally there are no extra scars or distant donor site morbidity. It is, however, more prone to additional unplanned revisional surgical procedures than autogenous tissue reconstruction. In general two-stage reconstruction gives more predictable results as it gives the surgeon the opportunity to adjust the reconstruction at the planned 2nd stage, while in practice, single stage reconstruction may be more prone to unplanned revisional surgery. The best results are obtained in patients with small minimally ptotic breasts while those with larger and/or more ptotic breasts often require a contralateral balancing procedure to achieve symmetry. This paper outlines the surgical options and the prosthetic range available at present.

Journal Article↗
PubMed1989

[Surgical procedure for secondary breast reconstruction after mastectomy].

The type of reconstruction is determined by the mastectomy deformity and requirements for symmetry. There are five basic techniques. A silicone breast implant placed submuscularly beneath the available tissues is the most straight-forward procedure. Latissimus dorsi flap is used with a silicone breast implant when additional skin and/or muscular cover is needed. Transverse rectus abdominis musculocutaneous utilizes excess lower abdominal tissue for reconstruction of the breast with autogenous tissue. The tissue expander is most frequently used following modified radical mastectomy. The external oblique rectus abdominis musculofascial turn-over flap is an attractive new technique.

Breast Neoplasms↗
PubMed1990

Achievements of physical therapy in patients after modified radical mastectomy compared with quadrantectomy, axillary dissection, and radiation for carcinoma of the breast.

Flexion of the shoulder, abduction, and external rotation in 90 degrees abduction are impaired after operations for breast cancer. We compared postoperative range of motion in 27 patients who underwent modified radical mastectomy and 21 patients who underwent quadrantectomy with axillary dissection and radiation therapy. The patients in the quadrantectomy group demonstrated a significantly higher range of flexion on postoperative day 1 and the day of suture removal. After 3 months, all patients had regained their preoperative range of flexion, with no difference between the groups. The better compliance of the quadrantectomy group to physical therapy may indicate that they suffer less pain and require a briefer or less intensive course of physical therapy.

Adult↗