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PubMed1999

Thoracic epidural anesthesia for pain relief and postoperation recovery with modified radical mastectomy.

The purpose of this study was to investigate whether thoracic epidural anesthesia (TEA) provides better postoperative pain relief and recovery than general anesthesia (GA) for modified radical mastectomy (MRM) surgery. Sixty-four patients rated as American Society of Anesthesiologists (ASA) 1 to 3 who underwent MRM surgery were included in the study. In TEA group patients, 2% lidocaine (15-20 ml) was administered via the epidural route as primary anesthesia, in conjunction with midazolam (5-10 mg) and fentanyl (<250 microg) for amnesia. The GA patients were maintained with isoflurane and 50% nitrous oxide in oxygen. After operation the patients were given pethidine (1 mg/kg IM) as required for pain relief. The time to first pethidine requirement, total pethidine consumption, worst pain score, bed rest time, satisfaction score, and anesthesia-related side effects were recorded for 2 days after surgery. The results show that TEA provided a more prolonged analgesic effect than GA after operation. A longer time to first pethidine requirement (19.2 +/- 1.5 vs. 7.6 +/- 2.5 hours) (p < 0. 001) and decreased pethidine consumption (17.2 +/- 7.0 vs. 76.3 +/- 17.4 mg) (p < 0.001) were observed in the TEA group than in the GA group, respectively. A worse visual analog scale (VAS) pain score was observed in the GA group (5.7 +/- 0.6) than in TEA patients (4.3 +/- 0.4) (p < 0.01). The average bed rest time was significantly shorter in the TEA group (16.9 +/- 0.9 hours) (p < 0.01) than in the GA group (27.1 +/- 4.1 hours). Overall satisfaction scores were significantly higher in the TEA group (4.4 +/- 0.1) (p < 0.01) than in the GA group (3.5 +/- 0.2). Side effects were observed at a higher frequency in the GA group (16/32) (p < 0.0001) than in the TEA group (3/32). The frequency of pethidine injection for pain relief was significantly lower in the TEA group (8/32) (p < 0.0001) than in the GA group (24/32). The total hospital cost (NT 64,392 +/- 3,523 vs. NT 53,806 +/- 2,817) (p = 0.0342) and anesthesia cost (NT 7,968 +/- 246 vs. NT 5,268 +/- 262) (p < 0.0001) are also significantly lower in the TEA group than the GA group. In conclusion, TEA provided better postoperative pain relief and recovery and lower cost than GA for MRM surgery.

Analgesics, Opioid↗
PubMed2003

Locoregional failure 15 years after mastectomy in women with one to three positive axillary nodes with or without irradiation the significance of tumor size.

BACKGROUND: There is insufficient evidence to suggest the routine use of postmastectomy radiotherapy (PMRT) in patients with one to three positive axillary nodes and T1/2 tumors. We have assessed the risk of locoregional recurrence (LRR) with or without RT in this group of patients, and focused on the results in subgroups defined by tumor size. PATIENTS AND METHODS: 249 women with T1/2 tumors and one to three positive nodes underwent mastectomy and axillary dissection between 1983 and 1987. Locoregional RT of 50 Gy was given to 175 patients. Chemotherapy or hormonal therapy was administered to 41 and 71 women, respectively. The median follow-up time of survivors was 189 months (range, 167-227 months). RESULTS: The rates of isolated LRR without or with RT were 16% (12/74) and 8% (14/175), respectively (p = 0.05), and the total (with or without distant relapse) LRR rates 23% and 12%, respectively (p = 0.03). 15-year overall survival amounted to 41% without RT and to 52% with RT (p = 0.2). The rates of isolated LRR for patients treated with chemotherapy or hormonal therapy only were 25% and 12%, respectively. In the absence of RT, age (> 45 vs = 45 years; p = 0.06), tumor size (T1 vs T2; p = 0.07), and extranodal invasion (ENI; absent vs present; p = 0.09) were related to the risk of developing an isolated LRR. On multivariate analysis, only tumor size (relative risk [RR], 3.92; 95% confidence interval [CI], 1.11-15.14) and age (RR, 3.37; 95% CI, 1.03-11.09) emerged as independent significant predictors, whereas ENI (RR, 1.50; 95% CI, 0.81-2.77) did not. In the T1 subgroup, the estimated 15-year isolated LRR rate was 9% (3/36) without and 9% (8/99) with RT (p = 0.9775). 15-year disease-free survival amounted to 62% and 57%, respectively (p = 0.5153). For patients without RT, according to the age groups (= 45 vs > 45 years), the 15-year rates of isolated LRR were 9% and 9%, respectively (p = 0.9910). In the T2 subgroup, the estimated 15-year isolated LRR rate was 30% (9/38) without and 10% (6/76) with RT (RR, 0.33; 95% CI, 0.12-0.92; p = 0.0244). 15-year disease-free survival amounted to 32% and 50%, respectively (p = 0.1213). For patients without RT, according to the age groups (< or = 45 vs > 45 years), the 15-year rates of isolated LRR were 57% and 16%, respectively (p = 0.0049). CONCLUSION: Patients with T1 tumor and one to three positive nodes are at low risk of isolated LRR either with or without RT. Patients with T2 tumor and one to three positive nodes are at high risk of isolated LRR without RT. Our findings support the routine use of PMRT in patients with T2 tumor, especially those aged < or = 45 years.

Adult↗
PubMedDate not supplied

Circumareolar mastectomy in female-to-male transsexuals and large gynecomastias: a personal approach.

Breast reduction or amputation in female-to-male surgery presents a specific surgical problem: obtaining a good breast shape of the masculine type. Over a 2-year period, 17 patients (12 female-to-male transsexuals and 5 extreme gynecomastias) were operated on using the circumareolar approach for subcutaneous mastectomy. The nipple-areola complex was left on a very wide deepithelialized dermal pedicle, and the final closure of the wound was performed using a round-block technique followed by numerous fine sutures to reduce wrinkling. This technique provides naturally flat masculine breasts, leaving sufficient dermal vascularization for the nipple-areola complex which is of the utmost importance. All the patients were very satisfied with the result because of the periareolar scar only. Two areolar necroses occurred due to perforation of the thin vascular dermal pedicle: one superficial which epithelialized spontaneously in a short period of time and one deeper which required skin grafting.

Adult↗
PubMed2003

Preventive mastectomy in patients at breast cancer risk due to genetic alterations in the BRCA1 and BRCA2 gene.

BACKGROUND: The availability of genetic testing for inherited mutations in the BRCA1 and BRCA2 gene provides potentially valuable information to women at high risk of breast and ovarian cancer. METHODS AND FOCUS: We review the literature on the value of prophylactic surgical strategies in patients with hereditary predisposition to develop breast cancer and discuss the surgical options available in high-risk cancer patients, decision analyses, and possible complications. RESULTS: Preventive surgical interventions to reduce cancer risk in high-risk patients are often strongly recommended. A patient's life-time risk to develop breast cancer in the presence of BRCA1 and BRCA2 mutations is 50-90%. Despite the reduction in the risk of developing breast cancer, prophylactic mastectomy often leads to significant physical and psychological sequelae.

Breast Neoplasms↗
PubMed1976

A primary axillary approach for the radical mastectomy operation.

A retrograde method for mastectomy that performs the axillary dissection first is described, and experience with eighty-six cases of infiltrating carcinomas of the breast treated in that manner is presented. The method has reduced the number of standard radical procedures by more than half, and a decrease in operative bleeding was noted.

Adult↗
PubMed1976

Delayed mastectomy after outpatient breast biopsy. Long-term survival study.

Forty-one patients who had outpatient biopsy and delayed mastectomy (most within 3 days) were subjected to long-term survival study. The ten year and longer survival studies revealed no deleterious effects from this procedure. The improved statistics were believed due to operation on lesions considered clinically benign, the short period of delay, and a low incidence of axillary metastasis.

Aged↗
PubMed1977

Breast reconstruction after mastectomy.

Reconstruction of the breast contour and areolanipple complex can be undertaken in patients who have had mastectomy for carcinoma of the breast. Although the reconstructed breast is not normal, the restored contour and simulation is gratifying for those patients who have sought this procedure.

Adipose Tissue↗
PubMed1979

Breast reconstruction after mastectomy.

The mastectomy patient presenting to the plastic surgeon often relates a profound sense of deformity. The current state of the art in breast reconstruction allows the plastic surgeon to intelligently address this deformity with procedures capable of achieving pleasing aesthetic results. If adequate soft tissue is present, implantation in the submuscular plane has proved satisfactory. However, if soft tissue deficiencies exist, highly acceptable results have been consistently achieved using the latissimus dorsi myocutaneous flap.

Breast↗
PubMed1984

Subclavian artery occlusion 42 years after mastectomy and radiotherapy.

Left subclavian artery occlusion developed in a patient 42 years after a left radical mastectomy and radiotherapy. The vascular supply was successfully reconstructed by a graft from the right subclavian artery to the left brachial artery. Clinical and experimental evidence has demonstrated that radiotherapy can damage large vessels [2,4,5]. It is our contention that radiotherapy was the causative factor in the case of subclavian artery occlusion reported herein.

Aged↗
PubMed1984

Surgical approach to lymphedema of the arm after mastectomy.

Lymphedema of the arm remains an unsolved and incurable complication of mastectomy. None of the current surgical procedures offer a cure for this chronic condition. Of the methods available, it appears that skin and subcutaneous excision performed in stages can provide a reduction in the size of the arm when it reaches proportions that impair normal activity.

Adipose Tissue↗
PubMed1985

The uses of external nipple-areola prostheses following reconstruction of a breast mound after mastectomy.

Following reconstruction of the breast after mastectomy it is common practice to allow a "settling" period before grafting the nipple-areola complex. A selection of external nipple-areola prostheses are described which can be used until surgical reconstruction can be carried out and which are helpful in determining the correct position of the nipple-areola grafts. It has been found that some patients actually prefer to use the prostheses permanently for dress purposes rather than undergo an additional operation.

Breast↗
PubMed1986

The search for volumetric symmetry in reconstruction of the breast after mastectomy.

The difficulty in achieving volumetric symmetry in the course of reconstruction of the breast after mastectomy is emphasised. The published methods of estimating breast volume are outlined before describing a new apparatus relying on the displacement of air within a large calibrated cylinder and which, by objective and clinical evaluation, has proved to be gratifyingly accurate. The method of achieving symmetry is illustrated in a patient originally referred with an inadequate breast mound reconstruction.

Breast↗
PubMed1988

Reconstruction of breast after super-radical mastectomy with a pedicled latissimus dorsi flap and a free TRAM flap.

Reconstruction of the breast after super-radical mastectomy is difficult because not only a breast mound but also the subclavicular and anterior axillary regions must be reconstructed simultaneously. If a defect is extremely large a single flap cannot fulfil these two purposes. For this goal we use two flaps, an ipsilateral pedicled latissimus dorsi musculocutaneous flap and a free TRAM flap pedicled on the inferior epigastric vessels. A latissimus dorsi flap along with a silicone gel prosthesis is used to reconstruct a breast mound and the free TRAM flap is transferred to augment the subclavicular and anterior axillary regions. We have used this technique successfully in three cases.

Adult↗
PubMed1990

The use of tissue expanders in immediate breast reconstruction following mastectomy for cancer.

From April 1985 to March 1987, 50 women had 56 mastectomies for documented cancer. A tissue expander was used for immediate reconstruction in each case. The patient records were used to determine morbidity and mortality, as well as to examine the effect of reconstruction on adjuvant therapy, cancer surveillance, adequacy of cancer surgery and patient satisfaction. The patients were followed up for an average of 13 months. Fifty-two of 56 expanders were successfully replaced with a permanent prosthesis. Forty-seven women remain alive. Local or regional recurrence did not occur in any women within the study period. Complications, of which superficial skin necrosis was most common, occurred in 35% of reconstructions and were investigated critically. Patient satisfaction was high. Dissatisfaction was not related to the incidence of complications but rather appeared to reflect the success of the patient's cancer treatment.

Adult↗
PubMed1984

Nurses' perceptions of early breast cancer and mastectomy, and their psychological implications, and of the role of health professionals in providing support.

The literature on the psychological precursors and outcomes of cancer and the role of the surgeon and nurse in the psychological management of early breast cancer, is briefly reviewed. A questionnaire study tapped nurses' perceptions of the disease and its treatment, patients' problems and the provision of psychological support. Their responses indicated mixed attitudes toward treatment outcomes, but a general enthusiasm for health education. Mastectomy itself was seen as posing serious social problems by half the sample, and serious sexual problems by more than three-quarters, and many felt that the support currently provided for patients is inadequate. While nurses saw themselves as having a key role in giving comfort, they were less likely to see themselves in the role of counsellor. Many of the sample felt that they had not been trained to provide psychological care at this level. Here, the skills of a specialist nurse were looked for, in the case of counselling the patient herself, or the authority of the doctor, when counselling husbands.

Breast Neoplasms↗
PubMed1987

Psychiatric morbidity following mastectomy: preoperative predictors and types of illness.

One hundred and twenty-two women with primary operable breast cancer were interviewed before, 3 months after and 12 months after mastectomy. Twenty-six percent of women had psychiatric symptoms 12 months after operation which justified a research diagnostic criteria diagnosis but most of the illnesses were mild; only 5% of women were regarded as being psychiatrically ill by a psychiatrist. The patients psychiatric state preoperatively, the treatment package received by the patient and the patient's marital relationship were related to psychiatric outcome three months after operation. The patient's psychiatric state preoperatively, her marital status, social class and menopausal status were all predictors of psychiatric outcome 12 months after operation. These results are discussed in terms of the practical way in which women at risk of psychiatric illness postmastectomy could be identified preoperatively by a nurse counsellor.

Adult↗
PubMed1979

Subcutaneous mastectomy as ultimate treatment of galactorrhea.

Galactorrhea, caused by hyperprolactinemia can successfully be treated by bromocriptine. Continuous long-term use of this drug is not always desirable or possible because of side-effects. In cases of hyperprolactinemia with severe galactorrhea, where surgical or radiological therapy is not possible and long-term treatment with bromocriptine is not acceptable, subcutaneous mastectomy might be considered as an ultimate solution.

Adult↗
PubMed1986

Post mastectomy pain after brachial plexus palsy: metastases or radiation neuritis?

Three patients have been reported who developed metastatic tumour within the neural tissue of the brachial plexus three years, four years and fourteen years respectively after treatment of breast carcinoma by simple mastectomy and postoperative radiotherapy. A fourth patient who developed bilateral upper limb paralysis after radiotherapy for a lymphoma is also reported. At exploration of the brachial plexus extensive fibrosis was present in all cases with metastases only diagnosed through biopsy of neural tissue. The clinical features and the role of surgery are discussed in the light of our experience and a review of available literature.

Adult↗