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At least 1,225 records · Page 68Linked to original sources
PubMed2004

Reconstruction of a partial mastectomy defect with the superficial inferior epigastric artery (SIEA) flap.

A case in which a superficial inferior epigastric artery (SIEA) flap was used to reconstruct a partial mastectomy defect is described. The SIEA vessels have been shown to be predictable and to match well with the recipient internal mammary vessels. In addition, this flap does not require opening of the anterior rectus sheath, and it is possible to design a smaller flap, which would allow closure at the donor site without translocation of the umbilicus. The risk of developing an abdominal hernia or bulge is therefore nonexistent, and a very low and more inconspicuous scar is produced, both of which are advantages for the patient.

Breast Neoplasms↗
PubMed1985

[Current status of the rehabilitation of post-mastectomy women in the Federal Republic of Germany].

The effectiveness of rehabilitation measures in acute in-patient clinics was assessed by questioning 220 women who had had a mastectomy. As criteria were used: function of the shoulder-arm region on the operated side; prevention of oedema and infection on the operated side; emotional support; supply of an external breast prosthesis. The results indicate that rehabilitation measures need to be improved. Deficiencies in counselling and supervision were noted with regard to oedema and infection prevention in 71%, emotional support in 69%, and supply of a prosthesis in 56%. The interviews also revealed that rehabilitation depended primarily on personal engagement of the medical personnel, less on the size and type of clinic. Increasing importance is ascribed to subsequent (long-term) medical care and supervision, as is provided in the FRG under insurance regulations.

Activities of Daily Living↗
PubMed1983

[The value of radiotherapy after modified radical mastectomy. 10-year results of the Heidelberg study].

Modified radical mastectomy was performed in 142 female patients with operable carcinoma of the breast. One of the two prospectively randomised groups received postoperative radiotherapy with 6000 rad. Survival rates were equal for both groups. Follow-up radiotherapy had a beneficial influence on survival rate and rate of distant metastases in median tumour sites. In lateral tumour localization the course of disease was less favourable with radiotherapy than without. Local relapse rates were slightly, however not significantly, lower after irradiation. The decisive prognostic criterium is T- and N-stage at the time of diagnosis.

Adenocarcinoma, Scirrhous↗
PubMed1981

[Conservative primary operation of carcinoma of the breast: subcutaneous mastectomy, lymphadenectomy and radiotherapy (author's transl)].

So-called nipple-preserving operations were performed as primary treatment of mammary carcinoma, predominantly in stage T1, in 135 women. The operation consisted of subcutaneous mastectomy, axillary lymphadenectomy, nipple biopsy and X-ray therapy. Most of the patients in whom more than two lymph nodes had carcinomatous changes also received chemotherapy. Survival of more than five years was achieved in 48 patients in stage T1. One woman died of carcinoma; in six there was further growth with metastases. In no case was there further growth in the nipple region. Although the numbers are small one can already state that the results are no worse than after more radical operations.

Adult↗
PubMedDate not supplied

Shoulder arthroplasty in patients with prior mastectomy for breast cancer.

Twenty women, all of whom had undergone mastectomy for breast cancer and 11 of whom had undergone radiation therapy, underwent shoulder arthroplasty. Two of these patients subsequently underwent resection arthroplasty for delayed infection and uncontrollable instability. Seventeen patients were available for follow-up, which averaged 4.6 years (range, 23 months to 13 years). There was significant improvement in pain (P < .0001), with no pain in 8, slight pain in 7, occasional moderate pain in 1, and moderate pain in 1 of the patients. A significant improvement in active motion occurred only in external rotation. Active elevation increased 7 degrees, from 92 degrees to 99 degrees; external rotation increased 17 degrees, from 25 degrees to 42 degrees; and internal rotation increased 1 level, to L3. All patients were pleased with their results. Complications were frequent. Apart from the 2 patients who underwent reoperation, 5 patients with preoperative lymphedema experienced exacerbation of their edema and 2 others developed new lymphedema. The edema returned to prearthroplasty levels or resolved in all patients by 5 months. In addition, antecubital vein thrombosis occurred in 1 patient, delayed long head of biceps rupture in 2 patients, and late rotator cuff tearing in 3 patients. In carefully selected patients, shoulder arthroplasty can be effective in pain reduction, but little increase in range of motion should be expected. Complications (often involving soft tissues) are frequent. New or increased arm edema can occur; however, edema resolved or returned to prearthroplasty levels in our patients.

Aged↗
PubMed2002

Early results of an endoscope-assisted subcutaneous mastectomy and reconstruction for breast cancer.

BACKGROUND: Subcutaneous mastectomy and reconstruction (SMR) is well established; however, most incisions are made directly on the breast, and the majority of patients care about visible scars even if they are satisfied with the reconstructed breast. METHODS: From August 1998 to March 2001, a total of 46 patients (including 2 bilateral cases) with breast cancer underwent SMR using a saline-filled prosthesis by lateral axillary incision. There were 25 patients who received previous SMR without endoscopic assistance (group A) and 21 patients who underwent an endoscope-assisted SMR (E-SMR) (group B). These 2 groups were compared for curability, morbidity, and cosmesis. RESULTS: The median follow-up period was 19.2 + 9.8 months (range, 5.8 - 35.2 months). No significant difference was found in clinicopathologic data between the 2 groups. The operation time was 176 minutes in group A and 237 minutes in group B, and the estimated blood loss was 189 mL vs 356 mL, respectively. No critical complications were seen in either group. The average length of incision was 10 cm in group A and 5.7 cm in group B. As for the patients' satisfaction, the incidence of "excellent" plus "good" ratings was 76% in group A and 90.4% in group B. CONCLUSIONS: E-SMR is a new option that can provide an improved operative view and better cosmetic results for the treatment of breast cancer than with SMR. The operation time is longer than for SMR, but the incision is drastically shorter, resulting in better cosmesis and increased patient satisfaction.

Adult↗
PubMed1983

Breast cancer treatment--current status. 2. Segmental mastectomy, alternative to total breast excision?

Loss of a breast to cancer can have a profound psychologic effect on a woman. Within the last few years, research in breast cancer has centered on trying to find procedures that are less mutilating than but just as effective as the conventional surgical procedures discussed in part 1 (page 126). In this second part by Dr Pilch, recent and ongoing studies of a newer promising method known as segmental mastectomy are reviewed. How simple excision with irradiation is being used in early disease is described in part 3 (page 151). Part 4 (page 161) considers adjuvant therapies in early and late disease.

Breast Neoplasms↗
PubMed1991

Breast reconstruction after mastectomy. What are today's options?

Breast reconstruction after mastectomy has evolved rapidly in recent years because of public awareness, patient demand, and technical advances. Various methods involving tissue expansion and flap procedures with and without prostheses are currently available. Management of the opposite breast and nipple-areola reconstruction are also options. Patients need to be in good general health to have reconstructive surgery.

Breast↗
PubMed2001

Pregnancy and tram-flap breast reconstruction after mastectomy: a case report.

A 38-year-old patient had a right radical (Patey) mastectomy for an infiltrating ductal carcinoma followed by chemotherapy and, one year later, a TRAM flap breast reconstruction. She was given clear and exhaustive information about the possible consequences of pregnancy, but despite this she became pregnant four months after the reconstruction. The pregnancy was taken to term despite the appearance at four months of a slow-growing abdominal hernia. In the light of our experience and that of others, we recommend an interval of at least 12 months between breast reconstruction with a TRAM flap and pregnancy.

Adult↗
PubMed2003

The quality of women's life after mastectomy in Poland.

From the increasing number of women who recovered from breast cancer arises more academic interest in their subjective opinions about the quality of their life (QL), particularly the physical, psychological, and social aspects of it. Our aim in this study was to evaluate the QL of Polish women after mastectomy. The research was performed on 480 randomly chosen patients who had been subjected to surgical treatment. The functional assessment of cancer therapy (FACT) scale version 4 and hospital anxiety and depression scale (HADS) were used during the research procedure. The lowest results within the global opinion of QL were obtained within the emotional sphere. The most frequent mental states experienced by the examined patients were worry, sadness, nervousness, fear, and depression.

Adult↗
PubMed2006

Comfort, control, or conformity: women who choose breast reconstruction following mastectomy.

Following breast amputation women commonly are presented with two choices: to wear a prosthesis or undergo reconstruction. Breast restoration is assumed to allow a full emotional and physical recovery from a breast cancer crisis. Surgical reconstruction is offered to women as the final step in regaining a sense of complete womanhood, enabling a sense of optimism that both body and self will "get back to normal." This article examines 5 women's accounts of breast reconstruction and asks how breast reconstruction figures in the remaking of self following mastectomy. Issues pertaining to the reasoning behind seeking out the procedure, experiences of finding the right surgeon, and how women feel toward their reconstructed postsurgical body are examined. In conclusion it is argued that a number of contradictory expectations are held by women seeking reconstructions. While women suggest that reconstruction will restore lost femininity, sexuality, and normalcy in most cases it is not the procedure that enables this but the elimination of the hassles of prostheses. In contrast to the complete sense of self they expected to regain through reconstruction they articulate a restoration that is simply pragmatic. It is only once women have undertaken this last bastion of hope that they are forced to renegotiate their sense of themselves as women with or without breasts.

Adaptation, Psychological↗
PubMed2002

DNA ploidy and cytonuclear area of peritumoral and paratumoral samples of mastectomy specimens: a useful prognostic marker?

OBJECTIVE: To investigate a possible relationship between DNA alterations in the "normal" residual mammary tissue of patients with breast cancer and survival. DESIGN: Prospective study. SETTING: University hospital, Spain. SUBJECTS: 162 patients operated on for breast cancer between 1991 and 1995. MAIN OUTCOME MEASURES: Cytology, histopathology, optic karyometry, DNA ploidy, and S-phase fraction measured by flow cytometry in peritumoral and paratumoral tissue. Mortality, and univariate analysis. RESULTS: DNA ploidy in peritumoral tissue was altered in 42 patients (26%), in 41 of whom the mean cytonuclear area was also altered. Of the 19 patients whose death within the study period was attributed to their cancer, 13 had peritumoral tissue in which both DNA ploidy and mean cytonuclear area were altered. On univariate analysis, there was significantly worse survival among the patients in whom both tumoral and peritumoral tissues were DNA aneuploid than among those in whom only tumoural tissue was DNA aneuploid (p < 0.0001). CONCLUSIONS: The presence of peritumoral or paratumoral tissue or both, with anomalous DNA content is associated with a reduced survival among women whose breast cancer has been treated by mastectomy. Additional studies including multivariate analysis are necessary to confirm our findings.

Biomarkers, Tumor↗
PubMed2006

Surgical site infection (SSI) rates among patients who underwent mastectomy after the introduction of SSI prevention policies.

OBJECTIVE: To describe the results of an intervention program to reduce the rate of surgical site infection (SSI) in the breast tumor department of a referral teaching hospital for patients with cancer. METHODS: Preventive measures introduced in the Breast Tumor Department of the study hospital included the following: starting in July 2000, use of sterile technique for wound care; starting in 2001, use of closed antireflux silicone evacuation systems, use of perioperative antimicrobial prophylaxis, provision of feedback to surgeons, and remodeling of the ambulatory wound care clinic. We conducted surveillance of all patients who underwent mastectomy between February 1 and December 31, 2001, and the SSI rate was calculated. A case-control analysis was performed for risk factors known to be associated with SSI. Results were compared with the data from 2000. RESULTS: The study included data on 385 surgeries. SSIs were registered in 52 (13.7%) of these 385, which was a rate 58.6% less than the 2000 infection rate (33.1%). Risk factors associated with SSI included concomitant chemotherapy and radiation therapy (OR, 3.6 [95% confidence interval {CI}, 1.9-7.1]), surgery performed during an evening shift (OR, 1.9 [95% CI, 1.1-3.6]), and insertion of a second drainage tube during the late postoperative period (OR, 2.8 [95% CI, 1.4-5.7]). The mean number (+/- SD) of postoperative visits to the outpatient wound care clinic was reduced from 11.6+/-7.1 in 2000 to 9.2+/-4.4 in 2001 (P<.001, Student's t test). The mean number of days that the evacuation systems were used was reduced from 19.0 to 16.0 days (P=.001, Student's t test). CONCLUSIONS: Continuous wound surveillance, along with feedback to surgeons, use of closed antireflux evacuation systems, and standardized practices in wound and drainage-tube care, decreased by 58.6% the rate of SSI in a breast surgical department with high rates of infection.

Female↗
PubMed1994

The CO 2 laser in mastectomy: a ten-year follow-up.

We compared the healing process, postoperative course, and follow-up of patients who underwent modified radical mastectomy in the conventional way with those who underwent a laser procedure. Sixty women, aged 33 to 77 years, who suffered from carcinoma of the breast were randomly divided into two groups: Group 1: surgery was performed using scalpel and electrosurgery; Group 2: surgery was performed with a CO 2 Sharplan laser, skin-to-skin including the axilla dissection; maximal power, 40-60 W. The postoperative course was uneventful in both groups. Wound healing was normal. Sutures were removed on the tenth day. Patients were followed at the Outpatient Clinic for 10 years. The circumference of the arm and forearm was measured at fixed points before surgery and at follow-up. Mammography and liver and bone scans were performed every year. Four Group 1 patients developed swelling and edema of 2 to 3 cm at 6 to 8 months after surgery. Also two patients from subgroup A developed local recurrence. No edema or swelling or local recurrence could be detected in patients operated by laser. Surgery with laser is preferable to the conventional approach.

Adult↗
PubMed2005

Breast cancer recurrence dynamics following adjuvant CMF is consistent with tumor dormancy and mastectomy-driven acceleration of the metastatic process.

PURPOSE: The aim of this study was to better understand human breast cancer biology by studying how the timing of metastasis following primary resection is affected by adjuvant CMF (cyclophoshamide, methotrexate, 5-fluorouracil) chemotherapy. PATIENTS AND METHODS: Discrete hazards of recurrence and recurrence risk reductions for treated patients relative to controls were analyzed for all patients enrolled in two separate randomized clinical trials [study 1 (386 women): no further treatment versus 12 cycles of CMF; study 2 (459 women): six versus 12 cycles of CMF] and a historical group (396 women: surgery alone) of axillary node-positive patients undergoing mastectomy. RESULTS: (i) Nearly all CMF benefit occurs during the first 4 years following resection/chemotherapy. (ii) The CMF recurrence rate reduction is largely restricted to two specific spans. These temporally separate recurrence clusters occur during the first and third year of follow-up, while the second-year recurrences are weakly affected. (iii) Prolonging adjuvant treatment from 6 to 12 months partially alters this recurrence timing, without appreciably affecting the overall recurrence rate. (iv) These effects upon the dynamics of post-resection occurrence are menopausal status-independent. CONCLUSIONS: At least two different therapeutically vulnerable proliferative events, resulting in clinical appearance of two metastasis temporally distinct clusters of post-resection cancer recurrence, apparently occur during the administration of adjuvant chemotherapy. Metastases that transpire outside of these temporal windows are refractory to adjuvant therapy. The dynamics of both post-treatment recurrence risk and CMF effectiveness are similar for both pre- and postmenopausal women, suggesting that post-resection mechanisms by which chemotherapy prevents metastases are similar, but of different magnitude in pre- and postmenopausal women. These findings are consistent with a metastasis model that includes tumor dormancy in specific micrometastatic phases (single cells and avascular foci) and with the acceleration of the metastatic process by the surgical resection of the primary breast cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1998

Successful treatment by radiation and hormone therapy of isolated local recurrence of breast cancer 24 years after mastectomy accompanied by immune thrombocytopenia: a case report.

We report a case of isolated local recurrence of breast cancer, which was accompanied by idiopathic thrombocytopenic purpura (ITP) and benign monoclonal gammopathy that presented 24 years after the patient underwent mastectomy. A 72-year-old female patient with a chest wall tumor was referred to our hospital in November 1994. Twenty-four years previously she had surgically treated breast cancer, of which the pathology was scirrhous carcinoma. Needle biopsy of the tumor revealed tubular carcinoma, which is compatible with local recurrence of breast cancer. She had no evidence of regional lymph node involvement or distant metastasis. Hematological and serological examination revealed a low platelet count accompanied by M-proteinemia (IgG, kappa-type) and a mild increase in platelet-associated IgG. She was initially treated with extensive-field chest wall radiation (60 Gy), followed by systemic administration of tamoxifen. Complete local control of isolated local recurrence (LR) was achieved after radiation therapy (RT) and the patient has been progression-free for more than 2 years. Platelet count recovered gradually to a normal level after achievement of complete remission induced by radiation and tamoxifen. This may be the first case suggestive of a paraneoplastic syndrome of immune thrombocytopenia accompanied by local recurrence of breast cancer.

Adenocarcinoma↗
PubMed2003

Patterns of care study: comparison of process of post-mastectomy radiotherapy (PMRT) in Japan and the USA.

BACKGROUND: The Patterns of Care Study (USPCS) by the American College of Radiology (ACR) has made significant contributions to improvements in the procedures of care for patients with breast cancer in the USA. The purpose of this study was to identify problems associated with the process of care for patients undergoing post-mastectomy radiotherapy (PMRT) in Japan compared with those in the USA. METHODS: The Japanese Patterns of Care Study Subgroup (JPCS) conducted a national survey in 1998-2000, involving 79 institutions and using two-stage cluster sampling of institutions and patients, which showed that between 1995 and 1997 PMRT was performed on 258 patients. The survey of the USPCS, involving 55 institutions, found that 407 patients received PMRT between 1998 and 1999. RESULTS: More than three axillary positive nodes were detected in 54% of the patients covered by the JPCS and in 46% of those covered by the USPCS. The clinical set-up of radiation treatment was planned without the aid of computed tomography or X-ray simulation for 25% of the JPCS patients and for 6% of the USPCS patients. The chest wall of 31% of the JPCS patients and of 98% of the USPCS patients was irradiated. The JPCS showed that inappropriate radiation techniques such as parallel opposed fields for chest wall irradiation were used for 3% of the patients in academic facilities, but for 25% of those in non-academic facilities (P = 0.0002). CONCLUSION: There is ample room for improvement in radiation treatment planning and chest wall irradiation techniques in Japan.

Breast Neoplasms↗
PubMed2005

Women's decision-making roles regarding contralateral prophylactic mastectomy.

BACKGROUND: Contralateral prophylactic mastectomy (CPM) is the removal of a nonaffected breast in a woman with unilateral breast cancer and is effective in reducing the risk of recurrences. Little is known about women's decision-making roles regarding CPM. METHODS: Women aged 18-80 years with CPM performed at one of six health maintenance organizations between 1979 and 1999 were surveyed. We determined women's reported decision-making roles at the time of CPM, analyzed their trends over time, and explored the association between decision-making roles and psychosocial outcomes following CPM. RESULTS: We received 562 responses (response rate = 73%); 431 completed items needed for this analysis. Most respondents were white, younger than 55 years at CPM, married, and had CPM within 10 years of completing the survey. Forty-five percent made the decision to undergo CPM alone, 37% considered their doctor's opinion, 15% shared the decision with their doctor and only 3% reported their doctor primarily made the decision. Women reporting active roles were more likely to be younger (P<.0008), college educated (P<.0001) and have CPM more recently (P = .002). Compared with those sharing the decision with their doctors, women with active roles were twice as likely to be satisfied 6 months following CPM (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 1.1 to 4.2) and report current concern about breast cancer (OR = 1.9, 95% CI = 1.0 to 3.4). CONCLUSIONS: Most women reported active or shared roles in decision making regarding CPM, particularly younger women, those with college education, and those with recent CPM. Women with active roles were more often satisfied in the short term but were also more likely to report current concern about breast cancer. Whether higher concern is related to insufficient input from clinicians should be explored. Prospective data are needed.

Adolescent↗