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PubMedDate not supplied

[Long term follow-up after radical mastectomy for breast cancer (author's transl)].

110 of 126 patients treated with Halsted mastectomy and postoperative loco-regional radiotherapy, during period 1961-1969 have been controlled. Overall 5 years survival resulted as following: Columbia Clinical Classification stage A 90,6%, stage B 66,6%, stage C 28,5%, stage D 33,3%; 10 years survival in patients operated on in the period 1961-64 was: stage A 69,2%, stage B 53,3%, stage C 40%, stage D 0%. On the basis of the satisfing results obtained the authors conclude that it appears by now unjustified to modify this method in treating stage A and B breast cancer either utilizing less extended resections, or renoncing to the postoperative irradiation.

Breast Neoplasms↗
PubMed1997

Breast reconstruction after mastectomy.

UNLABELLED: This activity is designed for primary care physicians. GOAL: To appreciate the significant advances and current techniques in breast reconstruction after mastectomy and realize the positive physical and emotional benefits to the patient. OBJECTIVES: 1. Understand basic and anatomic principles of breast reconstruction. 2. Discuss the options for breast reconstruction: a) immediate versus delayed; b) autologous tissue versus implant; and c) stages of reconstruction and ancillary procedures. 3. Provide a comprehensive overview of the risks and benefits of, as well as the alternatives to, each approach so primary care physicians can counsel patients effectively.

Adult↗
PubMed2000

Adjuvant radiation after modified radical mastectomy for breast cancer fails to prolong survival.

Recent literature has reported improved local disease control and overall survival in premenopausal node-positive (stage II, and III) breast cancer patients undergoing modified radical mastectomy (MRM) using radiation therapy (RT) combined with chemotherapy. To assess the efficacy of postoperative RT in our own community, we analyzed all patients undergoing MRM for carcinoma utilizing an extensive database from the three major teaching hospitals in Tulsa, OK, between 1965 and 1993. A total of 5257 patients underwent MRM during this time period. One hundred thirty-seven patients were excluded for insufficient data or because they were found to be at stage IV, leaving a total study population of 5125. Overall survival (OS), overall mean survival (MS), disease-free survival (DFS), and locoregional DFS (LRDFS) were analyzed for all patients and were further analyzed according to stage, lymph node involvement, and menopausal status. Median follow-up was 103 months. Statistical analysis was performed using Kaplan-Meier and t-tests. The DFS at 10 years was 65 per cent in the RT group and 80 per cent in the patients who did not receive RT (P = 0.00). No improved DFS was obtained in the radiation-treated patients, regardless of stage, lymph node involvement, or menopausal status. Similarly, the LRDFS at 10 years was 91 per cent in the RT group and 96 per cent in the patients who did not receive RT (P = 0.00). No improved LRDFS was obtained in the radiation-treated patients, regardless of stage, lymph node involvement, or menopausal status. The overall MS was 97 months in the RT group and 104 months in the patients who did not receive RT (P = 0.00). Comparisons of overall MS rates revealed apparent survival benefits from RT in the premenopausal node-negative group, postmenopausal one to four-positive-node group, and all stage I patients. This apparent survival advantage was not confirmed by Kaplan-Meier curves of OS. No other overall MS differences were detected according to stage, lymph node, or menopausal status. Using Kaplan-Meier survival curves, the OS in the RT group at 10 years was 46 per cent, and 63 per cent in the patients who did not receive RT (P = 0.00). No improved OS was obtained in the radiation-treated patients, regardless of stage, lymph node involvement, or menopausal status. These findings from a large breast cancer database failed to demonstrate any meaningful benefit from RT after MRM and serve to further question the efficacy of this treatment modality in postmastectomy breast cancer patients.

Breast Neoplasms↗
PubMed2000

[Reconstructive surgery after mastectomy--the anatomical prerequisites].

Reconstructive surgery of the breast after mastectomy occupies an important place in the complex treatment of breast cancer. The aim of the present study is to determine the capacity of the dermo-muscular flaps and to study the anatomical premises for their use under breast reconstructions. On the base of putrid material are created operative models of reconstructions of the breast with myocutaneous flaps m. rectus abdominis, m. latissimus dorsi and m. gluteus maximus. A study of the anatomical parameters of 64 female individuals, at an age from 51 to 73 years, has been conducted. It was found out that the myocutaneous flap m. rectus abdominis has an average volume of 590 cc and is formed basically of dermo-subdermal tissue (more than 80%). The myocutaneous flap m. latissimus dorsi has an average volume of 290 cc and is formed basically of muscular tissue (85%). The myocutaneous flap m. gluteus maximus has an average volume of 650 cc and is formed of subdermal and muscular tissue in the correlation 65/35%. The most suitable for breast reconstructions turns out to be the myocutaneous flap from m. rectus abdominis, since it provides sufficient amount of new tissue and uncomplicated surgical technique.

Aged↗
PubMed2000

[Primary breast reconstruction in connection with mastectomy for breast cancer. Indication, procedure and immediate surgical results].

Mastectomy and immediate reconstruction of 122 breasts were performed in 109 patients in close collaboration between plastic surgeons and general surgeons. In 56 patients reconstruction was performed using tissue expanders including 13 bilateral operations, 29 patients had a latissimus dorsi myocutaneous flap and 24 a free transverse rectus abdominis myocutaneous flap. There were 27 postoperative local complications in 122 reconstructions (22%), in five the reconstruction was lost. Only patients clinically in stage I were considered for reconstruction. After histopathological staging 27 patients received systemic treatment and 10 local radiotherapy as well. There was no complication during systemic therapy related to reconstruction. In 10 cases local radiotherapy was performed in full, with a delay of four weeks in one patient and a need for correction of the radiation field during treatment in one patient.

Adult↗
PubMed2000

[An anesthetic experience of a patient with subacute myelo-optico-neuropathy for bilateral mastectomy].

A 79-year-old woman with subacute myelo-optico-neuropathy (SMON) underwent a bilateral mastectomy for breast cancer. She has been suffering from SMON for 32 years. Her preoperative neurological examination revealed cryesthesia and dyskinesia in the lower extremity, and numbness in the crues. Physical examination revealed respiratory dysfunction. A combination of general anesthesia and epidural block was employed to minimize the dose of anesthetics which may affect the neuronal symptoms. Intraoperative course was uneventful and continuous epidural block was effective for postoperative pain control. There was no neurological deterioration postoperatively.

Aged↗
PubMed2000

Ultra-conservative skin-sparing 'keyhole' mastectomy and immediate breast and areola reconstruction.

The popularity of skin-sparing mastectomy (SSM) which preserves the breast skin envelope is increasing, but the risks and benefits of this approach are only beginning to emerge. A technique involving ultra-conservative SSM and immediate breast reconstruction (IBR) has been evaluated to establish the surgical and oncological sequelae of skin conservation. Between 1994-1998, 67 consecutive patients underwent 71 SSM and expander-assisted immediate latissimus dorsi (LD) breast reconstructions (follow up, 24.1 months; range, 2-52 months). Breast resection, axillary dissection and reconstruction were performed through a 5-6 cm circular peri-areolar 'keyhole' incision. Patients were discharged 6.5 days (range, 5-15 days) after the 3.9 h (range, 3.0-5.5 h) procedure, and expansion was completed by 4.0 months (range, 0-10 months). Local recurrence occurred in 3% of breasts at risk, skin envelope necrosis occurred in 10%, and contralateral surgery was required to achieve symmetry in 14%. SSM and IBR is an oncologically safe, minimal-scar procedure which can be performed by surgeons trained in 'oncoplastic' techniques. It results in low rates of local recurrence and complication, and reduces the need for contralateral surgery.

Adult↗
PubMed1975

Breast reconstruction after radical mastectomy.

The loss of the female breast by mastectomy for treatment of carcinoma is frequently a depressing psychologic experience. While some women learn to cope with the loss, others do not despite the use of specially constructed brassieres. Adaptations of implantation materials and basic plastic surgical techniques are now available for selected postmastectomy patients. These can be useful in modifying the altered body image of the patient who has lost her breast.

Body Image↗
PubMed2000

[Growth hormone and its interactions with chosen parameters of hormonal state in pre-menopausal women after mastectomy for breast cancer on adjuvant chemotherapy].

It seems, that quantitative changes of growth hormone (GH) in blood and imbalance between GH and hormones can influence the breast cancer cells proliferation, and can be a favourable element in breast cancer progression. The procedure to normalize hormonal system can have a therapeutic action. The aim of the presented work is to asses the plasma GH levels in 24 pre-menopausal women after mastectomy for breast cancer on adjuvant chemotherapy with cyclophosphamide, methotrexate, 5-fluorouracil (CMF). In this study interactions between GH and insulin like growth factor-I, prolactin, estradiol, progesterone (P), melatonin, cortisol and met-enkephalin were assessed. The control group was consisted of 16 healthy women. Plasma GH concentration and interactions between GH and studied parameters in women with breast cancer did not differ from healthy women. Highly significant positive correlation between GH and P after administration CMF was shown. CMF did not influence the interactions between GH and other studied parameters.

Adult↗
PubMedDate not supplied

The impact of contralateral breast cancer on the outcome of breast cancer patients treated by mastectomy.

PURPOSE: To evaluate the clinical and pathological features of breast cancer patients who develop contralateral breast cancer (CBC) and assess the impact of the second breast cancer on their prognosis. PATIENTS AND METHODS: This retrospective study includes 2136 women with stage I-III breast cancer treated between 1927 and 1987 at the University of Chicago Hospitals. A total of 132 (6.2%) developed CBC during a median follow-up period of 14.2 years; all of them were treated with mastectomy for both breast cancers. We compare the prognostic characteristics, treatments, and outcomes of patients who developed bilateral breast cancer with those who had only unilateral breast cancer (UBC). We also compare the features of the first and the second tumors among patients with bilateral breast cancer (BBC). RESULTS: The annual incidence rate for CBC remained constant at an average rate of 0.23%, resulting in a cumulative incidence rate of 6.2%. Patients with BBC were significantly younger than those with UBC (median age, 51 years vs 54 years). No other significant differences were observed between BBC and UBC patients. Among BBC patients, the second cancer was smaller (2.0 cm vs 3.0 cm) and was associated with a lower incidence of axillary node involvement (29% vs 52%). The development of CBC was associated with worse survival (hazard ratio = 1.46 in comparison with patients who did not develop CBC, 95% CI of 1.09-1.95). On multivariate analysis, factors that decreased the disease-specific survival (DSS) in patients with BBC were a higher number of positive lymph nodes of the first and second cancers, a larger size of the second cancer, and a shorter interval between the two primaries. DISCUSSION: At the time of diagnosis of first breast cancer, BBC patients were significantly younger than UBC patients. The second cancer among the BBC patients was at an earlier stage than the first one; however, no difference was noticed in the pathological feature between the cancer in the UBC patients and the first cancer of BBC patients. There is an indication that the longer the interval between the two cancers, the better the survival of the BBC patients.

Adult↗
PubMed2000

[A case of 19th year pulmonary metastasis after radical mastectomy for breast cancer].

A 72-year-old woman was admitted to our hospital for further evaluation of a abnormal shadow in left middle lung field. The patient had undergone right mastectomy for infiltrating ductal carcinoma 19 years ago. She had no symptom, but had a time of mass X-ray screening this year. Chest CT finding showed a nodule 2 cm in diameter with slight irregular margin in S6 of left lung. We couldn't determine preoperatively that this tumor was a metastatic lesion or a primary lung cancer. And first, tumor was taken out for intraoperative frozen section diagnosis. Pathologist didn't diagnose whether this tumor was a metastatic or primary. So, we performed left lower lobectomy and mediastinal lymphadenectomy. On postoperative histopathologic finding lung cancer resembled well previous breast cancer. In immunohistochemical study cancer cells from lung and breast of the patient were respectively positive for anti Estrogen Receptor (ER) and anti Gross Cystic Disease Fluid Protein-15 (GCDFP-15). In conclusion lung cancer was diagnosed as a metastatic lesion from breast cancer 19 years ago. The patient has been well 2 years postoperatively without recurrence. In this case immunohistochemical examination was very useful for differentiation metastatic lesion and primary one.

Aged↗
PubMed2000

Comparison of two radiation dose schedules in post mastectomy carcinoma of the breast.

In 108 histopathologically proved breast cancer patients, after surgical treatment with modified radical mastectomy, two radiation dose schedules have been compared. Radiation therapy was given on a 60Co teletherapy machine using gent pair technique for chest wall irradiation and direct fields for lymphatic drainage areas. The patients were randomly divided into two groups (Group A and Group B). 54 patients were given external radiotherapy 40 Gy/17 F/3.2 weeks and remaining 54 patients were given 45 Gy/20 F/4 weeks. Results of treatment in Group A versus Group B were as follows; chest wall failure 5/50(10%) versus 3/54 (5.6%), axillary lymphnods failure 3/50(6%) versus 4/54(7%), distant metastasis 16/50(32%) versus 15/54(28%). Radiation reactions were almost similar in both the groups. Skin reactions were most common radiation effects [45/50 (90%) in Group A and 43/54 (79.6% in Group B]. Thus no statistically significant difference in local control and efficacy of these two radiation dose schedules was observed in postmastectomy carcinoma of the breast.

Adult↗
PubMed1975

Androgens in breast cancer. III. Breast cancer recurrences years after mastectomy and increased androgenic activity.

To test the hypothesis that increased androgenic activity is involved in breast cancer, the urinary testosterone was assayed in 19 clinically cured breast cancer patients and in 22 patients developing metastases from breast cancer during the same period of observation (5 to 15 years after mastectomy). The levels in the clinically cured patients were near normal whereas those in patients with metastases were significantly above normal.

Age Factors↗
PubMed2000

[Simultaneous coronary artery bypass grafting on the beating heart without assisted circulation and radical modified Patey mastectomy--case report].

A case of 53-year-old female with unstable angina pectoris and primary right breast cancer is presented. Simultaneous operation including coronary artery bypass grafting and modified radical mastectomy was performed. On the beating heart coronary anastomoses were done without cardiopulmonary bypass (CPB) through median sternotomy (OPCABG). Immediately after OPCABG cancer operation was performed under stable hemodynamics without any bleeding tendency. There were neither perioperative nor postoperative complications noticed. Three months after operation adjuvant local radiotherapy was started. Concomitant surgical treatment seems to be safe and beneficial in carefully selected patients who have surgically correctable coronary artery disease and potentially curable breast cancer.

Anastomosis, Surgical↗
PubMed2000

[Transposition of the pedicled latissimus dorsi myocutaneous flap for the treatment of lymphedema of the upper limb after radical mastectomy].

OBJECTIVE: The clinical study was to improve the surgical treatment to upper limb lymphedema. METHODS: The author treated 12 cases of severe lymphedenia of the upper limb using the pedicled latissimus dorsi myocutaneous flap. The treatment was completed in one stage. RESULTS: The results were satisfactory in all the cases during the follow-up period of one to three years. No recurrence occurred. CONCLUSIONS: The method is a good treatment to secondary lymphedema of the upper limb after radical mastectomy as it possesses the advantages of casiness to perform, short operation time, reliable effects, very safety and accordance to physiology.

Arm↗
PubMed2001

Radiation after mastectomy in high-risk patients: is it necessary?

A retrospective review of cases from 1988 through 1992 was performed examining high-risk breast cancer patients treated with modified radical mastectomy without postoperative radiation at a single institution. Locoregional recurrence, distant metastases, overall survival, and number of lymph nodes removed were examined. This was compared with recent Danish and Canadian studies. Thirty-three premenopausal node-positive breast cancer patients had a 9 per cent locoregional recurrence rate. In the Danish and Canadian studies the locoregional recurrence rates were 32 and 21 per cent. These were reduced to 9 per cent and 10 per cent respectively in the radiated arms. Our locoregional recurrence in nonradiated patients was similar to that in the radiated arms of the studies and improved when compared with recurrence in their non-radiated controls. The adequacy of the axillary lymph node dissection was examined. In the current study a median of 18 lymph nodes were recovered with only 3 per cent containing less than 12 nodes. In the Danish study a median of seven lymph nodes were removed. Similarly in the Canadian trial a median of 11 nodes were removed. With complete axillary dissection results equivalent to those of postoperative adjuvant radiation is achieved. Further randomized controlled studies with standard axillary dissections are needed before the recommendation of routine postoperative radiotherapy.

Adult↗
PubMed2001

[Technical aspects of one stage reconstruction of mammary glands using autologous tissue after mastectomy for the mammary gland cancer].

In 36 patients the first experience of performance of one-stage mammarial glands reconstruction is presented, using tissues of their own after conduction of mastectomy for the mammarial gland cancer. In 27 women patients the transposition or free microvascular transplantation of lower musculocutaneous flap basing on m. Rectus abdominis (transverse rectus abdominis musculocutaneous TRAM-flap) was performed, in 9--transposition of m. Latissimus dorsi flap.

Adipose Tissue↗
PubMed2001

Effects of an educational intervention on the anxiety of women awaiting mastectomies.

The purpose of this experimental study was to assess the effects of an individualized psychocognitive educational intervention on preoperative anxiety in women awaiting mastectomies. A total of 60 women aged between 27 and 65 years were randomly distributed to two groups of 30 participants. Using the Situational Anxiety Inventory (IAS) along with repeated-measures variance analysis, it was noted that, immediately following the educational interventions (both experimental and control) there was a significant reduction (p < 0.01) of anxiety with the experimental group having an additional reduction of 4.83 (p = 0.05). The day before surgery, only the experimental educational intervention resulted in a significant reduction (p = 0.03) of anxiety, but the difference between the two educational interventions was not significant. These results appear to support Lazarus and Folkman's stress, appraisal and coping theory which states that direct action on cognitive perception can influence a feeling of threat as assessed through the level of anxiety.

Adaptation, Psychological↗