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PubMed2001

[Breast reconstruction using gluteal inferior free flaps. 34 cases in 30 patients].

Recent evolution of breast reconstruction favorised autologous tissues, without prosthesis. 34 gluteal inferior free flaps have been performed in 30 patients aged from 33 to 72 years for immediate reconstruction (6) or secondary reconstruction (28), unilateral (26) or bilateral (8 flaps); after complete mastectomy (21 included a bilateral one), partial mastectomy (3), sub-cutaneous mastectomy with skin-sparing mastectomy (3 bilateral cases), radical mastectomy with radiolesion (2), non efficient reconstruction using prosthesis (2). The myocutaneous flap vascularized by gluteal inferior artery was anastomosed on thoracodorsal pedicle or on humeral vein. Added procedures have been symmetrizations (21), flap modifications (21), nipple reconstruction (20). Thirty three flaps presented good survey. Cosmetic results were excellent in five cases, good in 21 cases, middle in eight cases. Flap disadvantages were: possible failure of microsurgery with vessel thrombosis and flap necrosis, long operative time (average five hours), variable quality of the skin flap and hypoesthesia of the posterior area of buttock. Flap advantages were: the suffisant volume (300 to 500 g), the simple procedure to raise the flap (after specific training) and discrete scar of the donor site. This flap seems to be a excellent method for autologous mammary versus TRAM flap or latissimus dorsi added fat flap.

Adult↗
PubMed2005

Tumour localisation with a metal coil before the administration of neo-adjuvant chemotherapy.

Complete clinical response (CR) with tumour disappearance is not uncommon after neo-adjuvant chemotherapy (NAC) for locally advanced breast cancer, avoiding 25% mastectomies by facilitating breast-conserving procedures. We reviewed our series to understand the feasibility and utility of marking the cancer site before administering NAC. In total, 23 women (median age 47 years) with T2-4, N0-1, M0 tumours were considered unsuitable for breast conserving surgery between January 2002 and November 2003, thus received NAC following a coil placement at the core of tumour. All patients had the coil successfully inserted and no migration or infection was recorded. Eight patients (35%) had a radiological CR (rCR) including 3 (13%) with pathological CR (pCR). In total, 87% patients were managed conservatively. The insertion of a metal coil is a simple mean to provide a landmark for localisation and excision when the breast lump becomes impalpable and radiologically undetectable after the administration of NAC.

Adult↗
PubMed1987

Mammary masses in the adolescent female.

Disease of the breast is uncommon in the adolescent female. Of 25,650 surgical specimens examined at The Children's Memorial Hospital in Chicago from 1974 through 1985, only 40 lesions were of adolescent breast origin in females. The ages of the patients ranged from 12 to 22 years. The most common lesion was fibroadenoma (19) followed by gigantomastia and cystosarcoma phyllodes. A malignant lesion is rare in this age group and both instances in this series had predisposing factors (for example, prior regional radiation in childhood). The findings of this study, plus that of the literature reviewed, emphasize conservative treatment with observation followed by simple excision when the patient nears completion of the development of the breast in most instances.

Adenofibroma↗
PubMedDate not supplied

Gynecomastia due to hormone therapy for advanced prostate cancer: a report of ten surgically treated cases and a review of treatment options.

AIMS AND BACKGROUND: Gynecomastia is an abnormal increase in the volume of the male breast that is generally considered to be due to an increased estrogen/androgen ratio. Pathological causes of gynecomastia include organic diseases and therapy, such as the administration of estrogens and antiandrogens, which alter the ratio of circulating hormones. Hormone therapy for prostate cancer is generally well tolerated but often accompanied by the occurrence of gynecomastia and breast pain or tenderness. The increased use of antiandrogens as monotherapy is leading to an increase in the number of patients affected by gynecomastia. Treatments are available to alleviate or prevent the development of gynecomastia, including medical treatment with antiestrogens and aromatase inhibitors. Alternatively, mastectomy with excision of the gland, liposuction or an association of the two techniques have proved to be effective. Radiation therapy may provide effective relief from the breast pain associated with gynecomastia. In this paper we show the good results of mastectomy performed with a lower semicircular periareolar incision in men suffering from gynecomastia due to antiandrogen therapy for inoperable prostate cancer. In addition, we present a review of the various techniques used for the treatment of gynecomastia. METHODS AND STUDY DESIGN: During the period from September 1998 to May 2001, 10 patients receiving hormone treatment for metastatic or inoperable prostatic cancer were selected for the study if they had breast pain and bilateral gynecomastia. Five of these patients had been offered prophylactic radiotherapy before treatment but refused, while the remaining five patients had refused radiotherapy after hormone treatment. These patients were therefore given the option of surgical treatment. Before surgery all patients underwent clinical and ultrasound examination of the breast. All surgical samples were examined histopathologically. During follow-up clinical examinations were carried out one week, one month, six months, one year and two years after surgery. RESULTS: The results were satisfactory in all patients especially from an aesthetic point of view. Moreover, breast pain disappeared about one week after surgery. After a follow-up of 6-36 months (average, 22.8 months) no recurrences were observed. Only a few immediate postoperative complications were recorded (hematoma in one case and seroma in another). Histological examination of the excised glands showed fibrosclerotic tissue and a small amount of fat. CONCLUSION: Surgical liposuction can be considered an effective treatment for gynecomastia, in particular in the very early stages because the breast becomes irreversibly fibrous as the disease progresses. This surgical technique is simple and effective and is therefore to be considered favorable, especially because of the very short hospitalization and the absence of complications.

Androgen Antagonists↗
PubMed2005

Occult breast lesions: A comparison between radioguided occult lesion localisation (ROLL) vs. wire-guided lumpectomy (WGL).

Mammographic screening increases the number of impalpable breast cancers requiring surgical excision. It is important to optimise the localisation technique to remove the smallest amount of tissue, still adequately excising the lesion. The last 65 wire-guided lumpectomies (WGLs) were compared vs. the first 65 radioguided occult lesion localisations (ROLLs) performed for impalpable breast cancers. Data collection included patient's age, radiological abnormality, pre-operative core biopsy, type of primary surgery, length of localisation and excision, hospital stay, cancer size, weight and volume of the excised specimen, clearance margins. All patients were successfully localised with ROLL and WGL. Localisation time was reduced with ROLL (P<0.001). Clear margins were achieved in 83% ROLLs and 57% WGLs (P=0.001). Pathological cancer size and specimen weight were similar in both groups, although the specimen volume was slightly smaller for ROLL. A total of 74% ROLLs had excellent cosmetic outcomes and 26% good, vs. 55% excellent and 45% good in WGLs. A larger amount of normal breast tissue was excised with WGL, without achieving any better cancer clearance. ROLL provides a feasible alternative to WGL. This quick and simple technique achieves an improved rate of clear margins.

Adult↗
PubMedDate not supplied

[A method of submacroscopic study of the whole human breast (author's transl)].

A method of submacroscopic study of the whole human breast is described. Breasts are removed surgically or at autopsy. Serial thin sections (2mm.) are defatted, stained, clarified, preserved in sealed plastic bags, observed under a dissecting microscope and photographed. The lesions found are interpreted and removed for histological examination. The method is simple, allows a careful and complete study of the glandular lesions and appears to be suitable for studies on origin and development of human breast cancer.

Adult↗
PubMed1986

Tumor volume, nodal status, and metastasis in breast cancer in women.

The relationship between primary tumor volume at detection, number of positive nodes, and probability of and time until first distant metastasis was examined for a group of 2,663 women with breast cancer. Time until metastasis was shown to decrease and probability of metastasis to increase as tumor volume and number of nodes increased. Either factor remained significant after correction for the other. Simple proportional hazards models were shown to be inadequate to describe the data. Graphic techniques were used to obtain nonparametric estimates of the forms of the relationships between tumor volume, nodal status, and the time course of the occurrence of metastasis. A simple calculation demonstrated that the average contribution per cell to the probability of metastasis decreased with increasing volume.

Breast Neoplasms↗
PubMed2004

Outer breast quadrants demonstrate increased levels of genomic instability.

BACKGROUND: Theory holds that the upper outer quadrant of the breast develops more malignancies because of increased tissue volume. This study evaluated genomic patterns of loss of heterozygosity (LOH) and allelic imbalance (AI) in non-neoplastic tissues from quadrants of diseased breasts following mastectomy to characterize relationships between genomic instability and the propensity for tumor development. METHODS: Tissues from breast quadrants were collected from 21 patients with various stages of breast carcinoma. DNA was isolated from non-neoplastic tissues using standard methods and 26 chromosomal regions commonly deleted in breast cancer were examined to assess genomic instability. RESULTS: Genomic instability was observed in breast quadrants from patients with ductal carcinomas in situ and advanced carcinomas. Levels of instability by quadrant were not predictive of primary tumor location (P =.363), but outer quadrants demonstrated significantly higher levels of genomic instability than did inner quadrants (P =.017). Marker D8S511 on chromosome 8p22-21.3, one of the most frequently altered chromosomal regions in breast cancer, showed a significantly higher level of instability (P =.039) in outer compared with inner quadrants. CONCLUSIONS: Non-neoplastic breast tissues often harbor genetic changes that can be important to understanding the local breast environment within which cancer develops. Greater genomic instability in outer quadrants can partially explain the propensity for breast cancers to develop there, rather than simple volume-related concepts. Patterns of field cancerization in the breast appear to be complex and are not a simple function of distance from a developing tumor.

Breast↗
PubMed1984

Experience and refinements with the supero-medial dermal pedicle for nipple-areola transposition in reduction mammoplasty.

The supero-medial dermal pedicle was reported only once in a small group of patients. Further experience and refinements have shown the technique, with a relative thick pedicle augmenting the medial quadrant, to offer good areolar support and permit extensive reduction of the lateral breast. This method was used on 78 patients with a follow-up of up to 2 1/2 years. It was found to be suitable, simple, and safe, and it preserves the sensory qualities of the areola. The increased sophistication and understanding, as presented here, may have borne fruit in the performance of this technique.

Breast↗
PubMed1979

Applanation tonometry of breasts.

We present a simple method for measuring intramammary pressure. We believe this technique could be helpful in evaluating the firmness of breasts following the implantation of prostheses, and capsulotomies done for this reason.

Breast↗
PubMed1985

Electron arc therapy: physical measurement and treatment planning techniques.

An electron beam arc therapy technique has been developed for the treatment of the post-mastectomy chest wall using a clinical linear accelerator modified for arc therapy. The effects on the dose distribution of primary X ray collimators, secondary cerrobend blocks attached to the accelerator accessory tray, and tertiary cerrobend casting of the treatment area on the patient's thorax have been investigated. Multiple electron energies within the same arc, variable rad per degree, and variable shaped secondary and tertiary applicators have been employed to optimize dose uniformity across the treated surface. A computerized treatment planning program has been developed to aid in visualization and optimization of dose distributions. A simple technique to estimate the width variation in the secondary collimator necessary to compensate for radial patient thickness changes in the cephalocaudad direction is described. Electron beam energies of 6 MeV, 9 MeV, 12 MeV, 15 MeV, and 18 MeV have been studied. The physical measurements needed to implement this technique are described, and a comparison of electron arc therapy dose distributions with other standard treatment techniques is presented.

Breast Neoplasms↗
PubMed1980

[Chronology of breast cancer using Gompertz' growth model].

The chronology of carcinoma of the breast based upon the size of the primary tumour and of its metastatic nodes in a simple exponential growth model leads to anomalies. The Gompertz model may be substituted for it in order to date the primary tumour and its metastases at the price of a hypothesis: the asymptotic size of the carcinoma. Its value has little influence on the initial doubling times chosen as a new time unit. 337 radical mastectomy specimens out of 500 examined fulfilled the necessary conditions for a precise quantitative study. If the age of the lesion expressed by taking the initial doubling time as a time unit is called K, the mean age of the primary carcinoma at the time of the first metastasis (FM) is K = 35. Its size is 15 mm3 and its diameter 3 mm. 90% of lymph node metastases occurred at K = 43 (size of primary carcinoma 125 mm3; diameter 6 mm). These results are in agreement with others obtained on theoretical or experimental bases. They tend to show that the earliest diagnosis, taking technical possibilities into account, cannot be early enough to precede lymphatic spread.

Adult↗
PubMed1986

Post-mastectomy breast reconstruction using the inflatable tissue expander.

Breast reconstruction following mastectomy has previously relied on the insertion of a silicone gel implant or the use of a myocutaneous flap. We report the use of an innovation, the inflatable tissue expander, for both immediate and delayed breast reconstruction in 26 patients where soft tissue cover was inadequate to permit the use of the silicone implant. By serial inflation of the tissue expander with saline, sufficient tissue cover was achieved for a second operative placement of a silicone prosthesis of appropriate volume to match the normal breast. To date, 10 patients undergoing delayed reconstruction and 5 of 16 patients with immediate reconstruction have had their final prosthesis inserted, while 3 women are satisfied with the result of the expandable implant and desire no further surgery. Only two technical complications have arisen with loss of the expander in one patient who had had recent radiotherapy and in another the tissue expander was placed much too high on the chest wall. Mechanical failure occurred in three cases where disruption of the seam led to sudden deflation in two and a slow leak from the injection port developed in one. One patient also attempted self-inflation leading to deflation of the tissue expander. The cosmetic results were subjectively and objectively very good with capsular distortion present in only one case. We feel that the inflatable tissue expander is simple and safe to use, may be used for immediate reconstruction without compromising the ablative surgery and should be a choice available to general surgeons for providing safe and cosmetically acceptable reconstructive surgery.

Adult↗
PubMed1999

Mastectomy or lumpectomy? Helping women make informed choices.

PURPOSE: To develop an instrument to help clinicians inform their patients about surgical treatment options for the treatment of breast cancer and to evaluate the impact of the instrument on the clinical encounter. METHODS: We developed an instrument, called the Decision Board, to present information regarding the benefits and risks of breast-conserving therapy (lumpectomy plus radiation therapy) and mastectomy to women with early-stage breast cancer to enable them to express a preference for the type of surgery. Seven surgeons from different communities in Ontario administered the instrument to women with newly diagnosed clinical stage I or II breast cancer over an 18-month period. Patients and surgeons were interviewed regarding acceptability of the instrument. The rates of breast-conserving surgery performed by surgeons before and after the introduction of the instrument were compared. RESULTS: The Decision Board was administered to 175 patients; 98% reported that the Decision Board was easy to understand, and 81% indicated that it helped them make a decision. The average score on a true/false test of comprehension was 11.8 of 14 (84%) (range, 6 to 14). Surgeons found the Decision Board to be helpful in presenting information to patients in 91% of consultations. The rate of breast-conserving surgery decreased when the Decision Board was introduced (88% v 73%, P =.001) CONCLUSION: The Decision Board is a simple method to improve communication and facilitate shared decision making. It was well accepted by patients and surgeons and easily applied in the community.

Adult↗
PubMed1989

[Long-term results following breast reconstruction].

A ten-year experience of breast reconstruction (BR) at the Gustave-Roussy Institute (Paris) provides material for a long-term analysis of carcinologic and cosmetic results. Carcinologic results have been studied in a group of 120 breast reconstructions which was matched to a group of 120 mastectomies without BR. No statistical difference was observed both for the overall survival and the disease-free survival in both groups. The percentage of local recurrences in the reconstructed breast was inferior, but not statistically, to the percentage observed in the controls providing a good argument in favour of the BR inocuity. Cosmetic results were analyzed on photographs according to a previously defined scale. They show a 55% percentage of satisfactory results when all the techniques of BR are mixed. A comparison between the cosmetic results according to the technique of BR demonstrates the superiority of the rectus abdominis flap which provides a higher rate of satisfactory results (63%) as compared to the results observed after simple reconstruction (53%) or latissimus dorsi (44%). A psychologic study of 150 BR shows that every patient underwent a specific psychological process called mourning work. The degree of satisfaction is not linked to objective results. Overall, 93% of the groups were satisfied, would do it again and would advise it for others; 7% were dissatisfied for surgical or emotional reasons.

Breast↗
PubMed1992

Pathological features predictive of local recurrence after management by conservation of invasive breast cancer: importance of non-invasive carcinoma.

The pathological features of 236 clinical stage I and II invasive breast carcinomas treated by conservation were reviewed. On follow-up (minimum 2 years) 13 patients (6%) have developed breast relapse, 10 (4%) regional lymph node relapse and 26 (11%) distant metastases. Nineteen patients have died from breast carcinoma. On univariate analyses lymph node metastases, increasing amounts of non-invasive carcinoma and multiple foci of invasion were significant risk factors for breast relapse. A Cox's multivariate analysis showed the first two of these to be independently significant. The results are in agreement with other published series and confirm that assessment of non-invasive carcinoma is important. The study compares simple quantitation with the original method reported to define cases with an "extensive intraduct component".

Breast Neoplasms↗
PubMed2005

Improving the accuracy of a photographic assessment system for breast cosmesis.

AIMS: To determine how the accuracy of a photographic system for cosmetic assessment of the breast after conserving treatment can be maximised. MATERIALS AND METHODS: Photographs of 40 women undergoing breast-conserving treatment for breast cancer were taken. Upward and lateral retraction was measured using a digitiser to enter the locations of reference marks on the photographs into a computer programme. In the readings produced, reduction in three potential sources of variation was considered by determining how few repeated photographs or measures were necessary to achieve an estimate within +/-2 mm of a mean value obtained from a large series. These included variation between assessments of the same photograph, between different photographs of the same patient and between different observers. We also sought to determine whether the attachment of white nipple markers (WNM) at the time of photography would reduce variation. RESULTS: A minimum of five readings was required from each photograph in order to obtain a result that was stable (defined as within 1 mm of that achieved by 20 readings). Using similar criteria, we found that at least four photographs of each patient were required, and that each should be assessed by at least four observers. The addition of WNM reduced the standard deviations by 36-45%. CONCLUSION: The use of WNM, which is simple, quick and cheap, is effective in reducing variation and can be recommended for use in clinical trials where overhead costs need to be contained.

Adolescent↗