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At least 1,081 records · Page 60Linked to original sources
PubMed1995

Prevention of seromas in mastectomy wounds. The effect of shoulder immobilization.

OBJECTIVE: To determine if postoperative shoulder immobilization decreases the incidence of postmastectomy seromas. DESIGN AND SETTING: A prospective randomized trial of three surgeons' experiences at a community hospital. PATIENTS: Thirty-eight patients who underwent modified radical mastectomy from March 1991 through February 1993. MAIN OUTCOME MEASURES: Incidence of postmastectomy seromas and time required for patients to gain 110 degrees of shoulder abduction after surgery. RESULTS: Thirteen (72%) of 18 wounds in the maximum range of motion cohort developed seromas (72%) compared with one (6%) of 17 in the minimum range of motion cohort (P = .0005). The average time required for the patients with maximum range of motion to gain 110 degrees of shoulder abduction was 2.6 weeks, whereas the patients with minimum range of motion required an average of 5.0 weeks (P = .0127). CONCLUSION: Postmastectomy shoulder immobilization significantly decreases the incidence of wound seromas. Although this protocol resulted in a delay in return to normal shoulder mobility, no patients sustained long-term musculoskeletal dysfunction.

Aged↗
PubMed1999

Recurrent ductal carcinoma in situ after total mastectomy.

A case report is presented of a woman with recurrent DCIS occurring several years following a total mastectomy, the diagnosis of which was aided by a subpectoral saline implant. A discussion of factors associated with recurrence and a review of the literature is provided. A role for selective use of mammography in screening postmastectomy reconstructed breasts in patients at high risk for recurrence is suggested.

Adult↗
PubMed1996

Chromosome aberrations in prophylactic mastectomies from women belonging to breast cancer families.

Short-term cultures of samples from eight prophylactic mastectomies from five unrelated women who were genetically predisposed to breast cancer were analyzed cytogenetically. Clonal chromosome abnormalities were detected in five breasts. Three samples from two women had aberrations involving the short arm of chromosome 3, with a breakpoint in 3p14 in common. Three samples from three women had rearrangements of 1q. Two of them, one of which also displayed a 3p14 rearrangement, shared a breakpoint in 1q41. Both 1q41 and, in particular, 3p14 have been reported to be rearranged frequently in malignant breast proliferations. Whether alterations of genes in these bands are essential in mammary tumorigenesis and, if so, whether they are equally important in sporadic and in hereditary cases remains to be explored.

Adult↗
PubMed1975

Adrenalectomy with radical mastectomy in the treatment of high-risk breast cancer.

Bilateral adrenalectomy with radical mastectomy has been performed in a series of 17 postmenopausal women with breast cancer having metastasis in four or more axillary lymph nodes. Results to date show that both the recurrence and mortality rates are significantly lowered in this group of "high-risk" breast cancer patients by the combined treatment. Of these 17 patients, 14 are living and well with no evidence of disease. Six are surviving without recurrence 5 or more years since their primary treatment. The study also demonstrated that adrenalectomy patients on hormone replacement therapy are able to lead full and active lives for a long time without complications. This pilot study should be considered as a guide to future clinical trials rather than as an immediate recommendation for general therapy.

Adrenalectomy↗
PubMed1976

Natural history and survival of inoperable breast cancer treated with radiotherapy and radiotherapy followed by radical mastectomy.

This retrospective study evaluates the time and site of relapse as well as the median survival of 454 consecutive patients with T3-T4 Nx Mo breast cancer treated with radiation therapy from 1968 to 1972. Radiotherapy was delivered with kilovoltage to the first 221 patients and with cobalt to 233 patients, respectively. A group of 133 selected patients was subjected to radical mastectomy 6-8 weeks after completion of the irradiation. The incidence of first relapse was 45% within the first 18 months from starting radiotherapy. The incidence of relapse was higher in presence than in absence of regional adenopathy, with no statistical difference between T3 and T4. Inflammatory carcinoma showed the highest percent of relapse during the first 12 months (48%). The relapse rate appeared independent from type of irradiation. The site of first relapse occurred more often (68%) in areas distant from irradiation fields. Sterilization of both primary tumor and regional nodes was obtained only in 10% of patients. The median survival for the whole series was 2.5 years, with no significant difference between roentgen therapy (3 years) and cobalt (2.5 years). Unfavorable survival was directly related to the presence of regional adenopathies (2.3 years), especially in the supraclavicular fossa (1.4 years) and of inflammatory carcinoma (1.2 years). Patients treated with radiotherapy followed by surgery showed a median survival of 3.9 years compared to 2.1 years for those given only irradiation. The importance of sequentially combining chemotherapy with radiotherapy is discussed.

Breast Neoplasms↗
PubMed1976

Bone metastases from breast cancer at the time or radical mastectomy as detected by bone scan. Eight-year follow-up.

Sixty-four women with Stage II breast cancer who had Sr85 bone scans at the time of radical mastectomy were followed for 8 years in a prospective study. Those women with positive scans had a slight, but statistically significant, increased incidence of metastic disease, particularly for metastases to bone.However, 40% of those women with positive bone scans and negative roentgenograms survived 8 years without evidence of any metastatic disease. Therefore, it has not been shown at this time that bone scans should be obtained in order to exclude bone metastasis before regional therapy for breast cancer is instituted. Also, a significant percentage of women with negative bone scans developed both bone and soft tissue metastases. As many as 30% of asymptomatic women with a history of breast cancer and positive bone scans and negative bone roentgenograms may still harbor disease in bone after 8 years.

Adult↗
PubMed1978

Patterns of relapse and survival following radical mastectomy. Analysis of 716 consecutive patients.

The records of 716 consecutive patients with breast cancer randomized from January 1964 to January 1968 between radical and extended radical mastectomy not followed by postoperative radiation therapy were reviewed. Relapse and survival rates were related to different patterns with the intent to define, on clinical basis, the high-risk groups in whom systemic adjuvant treatment can be attempted. The 10-year relapse rate was 52.9% for the whole series. In patients with negative axillary nodes (N-) this finding was 27.9% compared to 75.5% for patients with positive nodes (N+ 1-3: 66.5%, N+ greater than 3: 83.6%). The relapse rate was also affected by concomitant involvement of internal mammary nodes (IMN): N- IMN+: 60%, N+ IMN+: 96.7%. The corresponding 10-year survival rates were as follows: 59.7% (total), 81.9% (N-), 39.6% (N+), 53.7% (1-3), 25.6% (greater than 3), 45.8% (N- IMN+), 20.5% (N+ IMN+). In N+ patients relapse and survival rates were directly proportional to the size of primary tumor, while this trend was not present in N- patients. Location of primary tumor as well as menopausal status showed no direct effect on relapse and survival. In both nodal groups the sites of first relapse were documented to occur preferentially in distant organs and tissues.

Adult↗
PubMed1978

Identification of breast cancer patients with high risk of early recurrence after radical mastectomy. II. Clinical and pathological correlations. A report of the Primary Therapy of Breast Cancer Study Group.

A prospective study of factors that might be helpful in predicting recurrence of breast cancer during the 2 years after radical mastectomy has been completed in 381 women by the Cooperative Breast Cancer Group (National Cancer Institute). Identification of clinical factors which might be associated with such recurrence has been achieved. A multivariate analysis of the data was oriented toward the identification of clinical factors other than lymph node status that might be simultaneously used to predict recurrence because of the current trend of cancer therapy toward more limited surgery. Degree of differentiation of the tumor, blood vessel invasion, patient age and tumor size were identified as important predictors of recurrence for premenopausal patients and tumor size was identified as important for postmenopausal patients. The addition of axillary lymph node status to these factors, however, made a significant improvement in the prediction equation for both pre- and postmenopausal patients. Studies of this type are of particular value to understand further the biology of breast cancer which is necessary to develop rational primary and adjuvant treatment strategies.

Adult↗
PubMed1980

Identification of breast cancer patients with high risk of early recurrence after radical mastectomy: III. Steroid hormones measured in urine.

The relationship of the levels of selected urinary steroid metabolites to breast cancer recurrence after radical mastectomy was studied. An analysis of variance of the steroid measurements suggested that the measurements standardized to per gram of creatinine were the appropriate measure to use in exploring these relationships. No significant associations were found for premenopausal patients; however, for postmenopausal patients, low levels of total 17-ketosteroids were associated with a reduced two-year recurrence-free rate whereas low and high levels of OHA and high levels of total estrogens were associated a relatively low high two-year recurrence-free rate. Because of the large number of significance tests performed and the lack of consistent patterns, it is questionable whether the observed associations are of any importance. Including these steroid quantities in a multivariate regression model along with previously determined clinical prognostic factors indicated that the steroid determinations were the least important variables and did not make a significant contribution to the fit of the model.

17-Ketosteroids↗
PubMed1981

A comparison of the psychological effects of breast-saving procedures with the modified radical mastectomy.

Twenty women who underwent conservative surgical treatment of their breast cancer were compared with 20 women who underwent modified radical mastectomies on several indices of body image and psychological adjustment. The women were matched by pairs in terms of age and time postsurgery, and were group matched with respect to marital status. Women who underwent conservative surgical procedures showed significantly greater intactness of their external body boundaries, and significantly less change and weighted change in overall body satisfaction than women in the modified radical group. There were no significant differences between the groups with respect to body anxiety, general psychological adjustment, or marital satisfaction. The results with respect to body boundary and body satisfaction were interpreted to be the result of the less intrusive surgical procedures used to treat the breast cancer. Since body anxiety did not appear to be affected differentially by the two procedures, it may be that women in both groups were highly concerned about their bodies as a result of having had cancer. It was suggested that there was no difference in the psychological adjustment of the two groups because the women in the modified radical group were representative of that population which adjusts well to surgery. Finally, it was concluded that marital satisfaction is stable regardless of the surgical procedure undergone to treat the breast cancer.

Analysis of Variance↗
PubMed1984

Conservative treatment versus mastectomy in breast cancer tumors with macroscopic diameter of 20 millimeters or less. The experience of the Institut Gustave-Roussy.

A clinical trial was conducted at the Institut Gustave Roussy between October 1972 and December 1980 to compare mastectomy with local excision plus Cobalt-irradiation, in patients with breast cancer tumors of 20 mm in diameter or less at macroscopic examination. Low-axillary dissection and extemporaneous histologic examination were carried out for all patients. If one or more positive nodes were found, complete axillary dissection was performed. The study included 179 patients. No significant difference was detected in either overall or relapse-free survival between the two groups, although the conservatively treated group showed slightly better results. The results of conservative treatment were esthetically satisfactory in 92% of the cases. The trial included a second randomization for the patients with positive axillary nodes to assess the value of nodal area irradiation; 72 patients were studied in this part of the trial. No significant differences were found between the two groups after adjustment for the number of positive axillary nodes, although the no-nodal irradiation group showed better results and less complications than the nodal irradiation group.

Axilla↗
PubMed1984

Immediate reconstruction of the breast after mastectomy. Is it safe?

The authors have reviewed the results of their first 85 immediate reconstructive procedures following mastectomy for breast cancer. acceptable cosmetic results were obtained in most patients with no mortality or life-threatening morbidity. There were a number of problems related to the wounds and the prostheses, which decreased with increasing experience. There was a moderate increase in blood transfusion requirements, and a considerable increase in operating time. No detrimental effect on tumor behavior was observed when assessed as part of a case-control study. It is concluded that this approach is feasible and safe, and deserves further evaluation.

Adult↗
PubMedDate not supplied

Clinical follow-up after bilateral risk reducing ('prophylactic') mastectomy: mental health and body image outcomes.

BACKGROUND: In Manchester, approximately 120 women at > or = 1:4 lifetime risk of breast cancer have considered preventative surgery since 1992. Women treated within the Manchester protocol receive two genetic counselling sessions, a psychological assessment and a surgical consultation pre-operatively and annual follow-up post-operatively. The vast majority of women have breast reconstruction. METHODS: Since 1996, mental health and body image have been assessed in women attending annual follow-up using self-report questionnaires: the 28-item General Health Questionnaire (GHQ) and 10-item Body Image Scale (BIS). Women with high scores are assessed by clinical interview together with a proportion who have no significant problems. RESULTS: Between 1995 and 1999, 76 women completed surgery. Ten were awaiting post-operative review and 60 (91%) attended for follow-up of whom 45 (75%) were interviewed. Questionnaire data were available for 52 (79%) women, mean age 40.8 years (range 27-58). Six women were gene mutation carriers and of these three had had breast cancer. One additional patient was affected but had not been genetically tested. Eight (17%) of 47 women with assessments in the first post-operative year scored in the 'caseness' range on the GHQ: the mean GHQ score was 3.8 (S.D. 6.7), range 0-25. Results were comparable with those for women attending the Family History Clinic for risk assessment. The mean score on the BIS was 5.1 (S.D. 5.5), range 0-25, comparable with scores for women undergoing conservative surgery for breast cancer. Twenty-one percent of women reported no negative change in body image following surgery (i.e. zero questionnaire summary scores) and the majority of changes reported were of minor degree (item scores 0 or 1). The most frequently reported changes were in sexual attractiveness (55%), feeling less physically attractive (53%) and self-consciousness about appearance (53%): a third of women felt less feminine to a minimal degree. These results appeared stable over time. A minority of women had more serious psychological or body image concerns, usually in relation to surgical complications: they received further psychiatric intervention. CONCLUSIONS: For the majority of women there is no evidence of significant mental health or body image problems in the first 3 years following Bilateral Prophylactic Mastectomy (BPM), but women who have complications warrant additional psychological help. Careful pre-operative preparation and long-term monitoring are advocated in this new field of cancer prevention.

Adult↗
PubMedDate not supplied

Influence of some anthropometric parameters on the risk of development of distal complications after mastectomy carried out because of breast carcinoma.

The analysis included 46 women after radical breast amputation because of cancer with which lymphoedema occurred in the upper limb, as well as 51 women in whom no lymphoedema occurred during the period of the observation. Both groups were subjected to a comparative analysis as for height, body mass, and weight-height indexes: BMI, Quetelet, Rohrer, and Pignet-Verwaeck. The results show that women with high body mass, obesity (BMI > 30.0), and high values of the Quetelet (>370), Rohrer (>1.59), and Pignet-Verwaeck (>93.1) indexes are threatened to a significant degree with lymphoedema of the upper limbs after cancer-related mastectomy. On the other hand, slim body build and low index values appear to be a factor protecting from the occurrence of lymphoedema of the upper limb.

Arm↗
PubMed1976

Simple mastectomy and pectoral node biopsy.

Evidence is presented to support the view that biopsy of the pectoral and axillary tail nodes obtained at simple (total) mastectomy gives a reliable estimate of axillary node status. The technique is described.

Axilla↗
PubMed1976

A prolonged course of cyclophosphamide as an adjunct to mastectomy in the primary treatment of breast carcinoma.

Cyclophosphamide given after mastectomy for 4-6 months to a consecutive series of patients seen in one surgical practice in the years 1964 and 1965 significantly improved the 10-year survival rate of the treated patients as compared with the patients seen consecutively in the same surgical practice in the years 1957-63. Staging showed that the improvement was due to a significant increase in the survival rate in the patients with histologically negative axillary nodes (P less than 0-01). There was no significant difference in survival in the node positive or advanced disease groups.

Breast Neoplasms↗
PubMed1978

Radical mastectomy: a 27-year survey.

Records of 736 cases of breast cancer presenting to one of the authors (J. D. Y.) have been kept over 27 years. The principles of treatment have remained the same throughout the survey. A radical mastectomy was carried out for stage I and early stage II cases, and when axillary nodes were histologically involved, immediate radiotherapy was given. The 5-, 10- and 15-year survival figures are reported.

Adult↗
PubMed1979

Wound drainage following radical mastectomy: the effect of restriction of shoulder movement.

A randomized prospective clinical trial has been performed to determine the effect of temporary immobilization of the shoulder on wound drainage following radical mastectomy. In 64 patients admitted to the trial the mean volume of drainage was reduced by 40 per cent in those who had shoulder movement restricted for the first 7 days after operation when compared with the group in whom early arm exercises were encouraged. The mean drainage time was reduced by 29 per cent. Shoulder immobilization did not result in increased shoulder stiffness, although there was an increased incidence of mild lymphoedema of the arm.

Adult↗