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PubMedDate not supplied

Breast reconstruction following mastectomy.

Modern breast reconstruction techniques provide the women faced with breast cancer with a reliable source of rehabilitation and an alternative to breast loss subsequent to cancer treatment. As a member of the breast management team, the reconstructive surgeon provides valuable input on the appropriate timing and techniques for surgery. With the surgical oncologist and the plastic surgeon working together, the mastectomy and breast reconstruction can often be combined in one operation with less skin removal, shorter scars, and reduced inconvenience for the patient. Techniques of tissue expansion permit breast reconstruction without additional scars or significant hospitalization. With the development of autogenous tissue breast reconstruction techniques, women are also able to have natural, long-lasting breast reconstruction without the need for a breast implant.

Adult↗
PubMed2000

Conservative treatment vs. mastectomy without radiotherapy in aged women with breast cancer--a prospective and randomized trial.

OBJECTIVE: To determine whether tumorectomy with tamoxifen in women over 70 years achieves the same treatment results as mastectomy plus tamoxifen. MATERIAL AND METHODS: Prospective randomized analysis of 121 patients over 70 with breast cancer clinically negative axilla and tumor up to 4 cm diameter. Randomization was according to even or odd birth month. Branch A: Madden operation + tamoxifen 20 mg OD (once/day). Branch B: Tumorectomy to disease free margins + tamoxifen 20 mg OD. RESULTS: Survival rate of five years for the Madden operation was 69% and for tumorectomy 71.4% with a mortality from other causes of 23.1%. Survival probability (specific death) at 5 years was of 93.4% for the Madden group and 95.2% for tumorectomy. A significant increase of the mortality was observed in those patients that had recurrences, no matter of treatment given. Specific death cause did not vary with age, but did for other causes, this being significant. CONCLUSIONS: Tumorectomy plus tamoxifen demonstrated to be as effective as Madden Op. plus tamoxifen in women over 70 years with T1-T2-N0 disease.

Aged↗
PubMed2003

[A new technique for post-mastectomy breast reconstruction: the Muscular Flag Flap (MFF)].

The possibility of breast reconstruction after a mastectomy resulting from breast cancer is still not widely exploited, and perhaps because it is relatively uncommon and unknown, is not widely practised. The plastic surgeons who were pioneers in this field know just how hard it has been to reach the stage we are at today. This leads to longer operating times, in the context of over-worked operating theaters in which time was already at a premium, and this is expecially the case in peripheral hospitals lacking in-house resources for surgical reconstruction and dependent on outisde specialist consultants. In order to address this problem, a new single-operation surgical technique, MFF (Muscular Flag Flap) has been developed. The surgical techniques adopted at present are based on immediate reconstruction or successive reconstruction. The MFF technique was developed as a response to demand for intraoperative reconstruction even when "demolition" is extensive and the breast large. This will reduce the need to operate the contralateral breast. Upper and lower pectoralis major muscle flaps are created in order to produce a large enough pocket for the final prothesis. The elasticity of this muscle is such that a large pocket is possible. The pectoralis major muscle will then envelop at least two thirds of the prosthesis. Projection of the reconstructed cone and a more anatomically normal profile are obtained. This method gives excellent esthetic results in a single operation. Thanks to the collaboration of the hospitals of Ivrea, Pinerolo and Alba over a period of approximately one year, about 80 patients have been very successfully treated using this techhnique. Rapid functional and social recovery have been observed, with no particular problems. In view of the above, we confirm that this new surgical technique will be of considerable benefit to patients.

Breast Implantation↗
PubMedDate not supplied

Breast reconstruction following mastectomy.

There are numerous reconstructive options for patients undergoing mastectomy for breast cancer. These include autologous tissue transfer and implant reconstruction. Various factors play a role in determining the appropriate reconstructive course including the type of cancer resection and patient characteristics including comorbidities, smoking, body habitus, and patient preference. Patient education is an important component to minimizing the psychological trauma and emotional stress that accompanies treatment for breast cancer. All patients with breast cancer should be aware of their reconstructive options.

Breast Neoplasms↗
PubMed1990

[The prevention of deep venous thromboses after radical or modified mastectomy interventions].

With the aim of preventing deep vein thrombosis after radical or modified mastectomy, 100 patients were randomly assigned to one of two different groups: the first group was treated with defibrotide (400 mg b.i.d. e.v.) starting from the day before the operation and continuing for the following seven days. The second group was given calcium heparin (5,000 IU b.i.d. by s.c. route) from day 0 to the 7th post-operative day. Neither side effects nor DVT or PE were observed. The quantity of fluids from the drainages rapidly decreased in both groups from the first day to the third one, while the quantity of blood cells was negligible starting from the second post-operative day. On this basis defibrotide may be considered an effective and well tolerated drug for the prevention of DVT.

Female↗
PubMed1990

Mastectomy or breast conservation in the management of primary breast cancer: psychosocial factors.

A diagnosis of breast cancer causes significant emotional, social, and vocational upheaval which diminishes over time. However, newly diagnosed breast cancer patients are mentally capable of making treatment decisions and should be offered the available treatment options. A significant proportion of patients who have the option of breast conservation will choose mastectomy instead. Saving the breast does not significantly alter adjustment problems.

Adaptation, Psychological↗
PubMedDate not supplied

[Breast reconstruction after mastectomy. Critical analysis of 240 cases].

A retrospective study on 240 cases of breast reconstruction was undertaken in order to make a critical analysis of the results of different techniques as silicone prosthesis, tissue expanders, and the myocutaneous flaps of latissimus dorsi and rectus abdominis. The authors discuss the indications, advantages, inconveniences and complications of each technique and point out the particular indications for each one, depending on the type of mastectomy performed and the quality of the remaining tissues. Good results can be obtained using prosthesis, or flaps, but the indications must be very criterious, as the number of complications may be high, and many operations might be needed to achieve a satisfactory result.

Adult↗
PubMed1988

The result of breast reconstruction after mastectomy for breast cancer in 109 patients.

One hundred and eleven breast reconstructions after a mastectomy for carcinoma in 109 patients are reported. Depending on the quality of muscle and skin coverage, reconstructions were performed either with a latissimus dorsi musculocutaneous flap or a subpectoral prosthesis (including expander prosthesis). The follow-up involved 90 patients. The purely aesthetic results as well as the very positive result of reconstruction with regard to appearance in clothing, participation in sports, and self-esteem were of great importance to the patients. The difference in ptosis, the most obvious shortcoming in our reconstructions, is discussed. Attention is given to the importance of flap planning and the restoration of the anterior axillary fold in the latissimus dorsi flap reconstructions. The disappointing results of tissue expansion and the shortcomings of the nipple-areola reconstructions are discussed.

Adult↗
PubMed1993

Survival following breast-conserving surgery and irradiation or modified radical mastectomy in patients with invasive breast cancers with a maximum diameter of 1 cm.

The reported relapse-free survival for women with invasive breast cancers measuring no more than 10 mm in dimension ranges from 75% to 95%, with axillary status an important prognostic factor in most series. Further study of prognostic variables in this most favorable subset is notably limited. We retrospectively reviewed the records of 168 women with invasive breast cancers < or = 10 mm treated with either breast conserving surgery+axillary dissection (AXD) and radiation therapy, or mastectomy+AXD. The actuarial survival and survival free of distant metastases (DMFS) at 7 years was 95% and 97%, respectively. Location and size of the primary tumor were most important in predicting outcome, although statistical significance was not achieved. The 5-year distant metastases-free survival (DMFS) was 100% for central and inner quadrant tumors, compared to 97% in those with outer quadrant tumors, p = 0.18. The 5-year DMFS was 100%, 95%, and 98% for patients with cancers 2-5 mm, 6-9 mm, and 10 mm, respectively, p = 0.15. Status of the axillary lymph nodes, type of breast surgery, clinical tumor status (palpable vs. nonpalpable), age, menopausal status, histologic grade, systemic therapy, or histologic type were not found to have a significant impact on prognosis.

Adult↗
PubMed1993

Immediate breast reconstruction after mastectomy.

Immediate breast reconstruction after mastectomy can be performed safely with a low incidence of complications. There is no evidence that reconstruction with a submuscular implant interferes with subsequent oncologic care, followup, or outcome for patients.

Adult↗
PubMed1997

[Effects of tobacco smoking on the incidence of flap necrosis after mastectomy].

One hundred and fifty-nine women undergoing mastectomy (simple or modified radical) were followed for the development of flap necrosis. The incidence of flap necrosis was found to 14%. The only significant risk factor for the development of flap necrosis was found to be smoking, which increased the risk by 4.9 times. The effects of nicotine and carbon monoxide, the two principal known detrimental factors in tobacco smoke, are described. Prophylactic efforts are advised.

Cicatrix↗
PubMed1997

Segmental mastectomy and tamoxifen alone provide adequate locoregional control of breast cancer in elderly women.

We wished to determine whether tamoxifen and local excision without breast radiation or axillary lymph node dissection provides adequate local and regional control of breast cancer in elderly women. The records of 36 women with breast cancer who were more than 70 years old and were treated only with tamoxifen and local excision from January 1985 to July 1996 were retrospectively reviewed. These patients had refused, or were considered too ill for, standard therapy. The mean follow-up was 44.1 months. Twenty-two (61%) were alive without disease, and six (17%) died of unrelated causes, without recurrence. Two (6%) were alive with metastasis, and five (14%) died with metastasis. One patient developed a breast recurrence, which was reexcised. A second patient developed metastasis and axillary recurrence, which was treated with modified radical mastectomy. Pathologic grade, tumor size, and estrogen receptor and margin status were not predictive of recurrence. In conclusion, despite the omission of breast radiation and axillary dissection, there were only two locoregional recurrences, and both were easily treated surgically. In this select group of patients, local excision and tamoxifen provided adequate locoregional control of breast cancer in elderly women.

Aged↗
PubMed1998

Breast conservation or mastectomy in breast cancer: factors affecting the choice of operation.

BACKGROUND AND AIMS: In the surgical treatment of breast cancer, breast conservation is considered preferable to mastectomy provided that certain prerequisites are fulfilled. This retrospective analysis reports those factors which affected the choice between operations. MATERIAL AND METHODS: In 1993, a total of 104 women were operated on for breast cancer or carcinoma in situ in the Department of Surgery, University Central Hospital of Turku. There was a palpable tumour in 75%. In 23% the disease was found at mammography screening. RESULTS AND CONCLUSIONS: Breast conservation was achieved in 24%. The proportion was about the same whether the disease was found at screening or clinically (27% and 23%). In the presence of a palpable tumour breast conservation tended to succeed slightly more often than in wire-guided operations (26% versus 19%).

Adult↗
PubMed2005

Skin sparing mastectomy and immediate breast reconstruction.

OBJECTIVE: To evaluate skin sparing mastectomy(SSM) and immediate breast reconstruction(IBR) in terms of the survival, chances of recurrence, aesthetic restoration and prevention of psychosocial problems. DESIGN: An interventional study. PLACE AND DURATION OF STUDY: The Department of Plastic and Reconstructive Surgery, CMH, Rawalpindi from November 1998 to November 2003. MATERIALS AND METHODS: Twenty-eight patients of breast cancer, included in the study, were discussed in a Multidisciplinary Breast Clinic. Detailed metastatic work-up was performed. In all patients SSM with en-bloc level II axillary clearance and IBR was done. RESULTS: The patients' age ranged between 25-46 years. Two patients (7%) were nullipara. Tumor size was T1 in 10 (36%) and T2 in 18 patients (64%). In all the patients a circum-areolar incision was used. A contralateral uni-pedicled TRAM flap was used in 24 (86%) and latissimus dorsi flap in 4 patients (14%). All the flaps survived completely. There was marginal necrosis of native skin flaps in 03 (10.5%), infection in 03 (10.5%), axillary seroma in 03 (10.5%) and abdominal seroma in 01 patient (3.5%). As late complication 5 patients (19%) developed fat necrosis. Adjuvant chemotherapy was given in 6 (21%) and adjuvant radiotherapy in 4 patients (14%). No recurrence encountered in maximum follow-up . We found an excellent aesthetic restoration in 23 (82%), good in 1 (3.5%) and fair in 4 patients (14%). CONCLUSION: SSM for patients with early breast cancer is an oncologically safe procedure. IBR can greatly reduce the psychological trauma associated with breast loss including diminished feelings of feminity, decreased libido, social behavior, sense of mutilation and depression.

Adult↗
PubMed2001

Skin-sparing mastectomy with sentinel lymph node dissection: less is more.

Skin-sparing mastectomy is an emerging technique useful for patients with early-stage breast cancer who are not candidates for breast conservation surgery and are candidates for immediate plastic surgery reconstruction of the breast. Coupled with sentinel node surgery to assess lymph node status, the goal of this technique is to achieve maximal breast and axillary tissue conservation without compromising thorough tumor resection.

Axilla↗
PubMed1977

An information and discussion program for women after a mastectomy.

We discuss a pilot program of information and group discussion that was presented to a group of women who had had a mastectomy. The program was initiated to determine the nature of the unmet psychosocial needs of this group and to evaluate a means of meeting them. We held three weekly group sessions where information on the medical and psychological aspects of breast cancer were imparted by films, and videotapes, and small group discussions of mutual problems. Self-administered questionnaires completed by participants in the program were used to ascertain the characteristics of those attending and to assess their response to the experience. We found that the need for psychosocial services to be greatest in the year immediately after operation and to persist as long as decades later. We also found that this group method of psychological rehabilitation meets needs not met by other programs held in a more clinical setting and on a one-to-one basis.

Connecticut↗
PubMed1982

Chemotherapy before and after mastectomy in stage III breast cancer.

Seventeen patients with stage III breast cancer were treated by modified radical mastectomy preceded and followed by multiagent cytotoxic chemotherapy. The preoperative treatment resulted in a decrease in size of the primary tumor, facilitating the subsequent surgical procedure. There were no serious surgical complications. Wound healing was uneventful. Median disease-free survival time was 29 months and median survival time was 40+ months. Six of the 17 patients are living free of recurrence from more than 33 to more than 79 months after initial therapy.

Adult↗