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At least 1,369 records · Page 76Linked to original sources
PubMed2002

[One stage skin-sparing breast repair after mastectomy].

Breast-conserving therapy has become very popular in the past 20 years. This treatment is beneficial only for early stages of breast cancer. When breast-conserving therapy is not indicated, skin-sparing mastectomy with immediate breast reconstruction using silicone implants or autogenous tissue is the surgical method of choice. The authors have analyzed the results obtained at three hospitals of Moscow, Novosibirsk, and Tula. A total of 58 breast repairs, including 23 with silicone expanders, 35 with TRAM-flaps were performed by February 2000. They accomplished different designs of skin incisions in relation to the size and site of a tumor and to the shape of the breast. These groups comprised patients with breast cancer T1-2No-1Mo. The follow-up averaged 25.8 months (range 5-52 months). All the patients underwent combined and complex treatments. The median of overall survival was not not achieved. One patient died from dissemination. Two-year acturial survival was 86.8% (one local recurrence). The incidence of postoperative complications was 34.7% in the implant group and 14.2% in the TRAM-flap group.

Breast Neoplasms↗
PubMed2002

Anaesthesia for bilateral mastectomy in a Jehovah's Witness patient with epilepsy and review of alternatives to homologous blood transfusion.

The anaesthetic management of a Jehovah's Witness patient for bilateral mastectomy for carcinoma of the breast is described. The patient is also a known epileptic patient who developed fits the night before surgery. Surgery was re-scheduled for one week later to allow control of the epilepsy. Surgery was carried out under general anaesthesia. The patient refused blood transfusion. Modified normovolaemic haemodilution was the alternative to homologous blood transfusion used in the patient. This was safe except for the post-operative morbidity due to severe anaemia in the patient. The surgical outcome was good. The safety of not transfusing blood in Jehovah's Witness patient for surgical procedures for which blood transfusion is needed is well illustrated by this case. A review of alternatives to homologous blood transfusion is done.

Anesthesia↗
PubMed2002

[Toilet mastectomy: palliative treatment in women with advanced breast cancer].

The clinical evolution and patients morbimortality in a 2nd. level attention General Hospital of the Social Security, with diagnosis of locality advanced breast cancer is analyzed. Conventional treatment with chemotherapy and radiotherapy was administered comparing results to patients with toilet mastectomy. Better benefits in groups of palliative mastectomized women was demonstrated.

Adult↗
PubMed2002

[A case of recurrent breast cancer with carcinomatous pleurisy successfully treated with combined chemoendocrine-therapy of CTF (CPA, THP and 5-FU) and anastrozole following instillation therapy 12 years after radical mastectomy].

A 52-year-old female underwent radical mastectomy at the age of 41 for left breast cancer (n0, positive for ER). After a few years of adjuvant TAM therapy, follow-up was stopped at the age of 50 with no recurrence. She had suffered from symptoms of cold since January 2001 and came to our hospital complaining dyspnea on February 11. CXP showed pleural effusion of the entire thoracic cavity and she was admitted to the hospital immediately. Pleural exudate cytodiagnosis showed carcinomatous pleurisy; however, dyspnea and thoracic effusion were improved by continuous thoracic drainage and instillation therapy. Various examinations demonstrated that the carcinomatous pleurisy was due to recurrent breast cancer. They also showed local recurrence, left supraclavicular lymph node metastasis and multiple bone metastasis. Thus, combined chemoendocrine-therapy of CTF (CPA, THP and 5-FU) and anastrozole was administered. After 6 cycles of CTF, the carcinomatous pleurisy, local recurrence and left supraclavicular lymph node metastasis were diagnosed as CR by CXP, chest CT and US and multiple bone metastasis were diagnosed as PR by bone scintigram. The patient continues to be treated on an outpatient basis with no recurrence about one year after the beginning of the treatment (6 months after CTF 6 cycles) and she is taking anastrozole continuously.

Anastrozole↗
PubMed1976

Subcutaneous mastectomy and fibrocystic disease of the breast.

There has been a considerable amount of data presented to implicate moderate to severe fibrocystic disease as a strong precursor of breast cancer. When a premenopausal woman with nodular breasts presents a biopsy examination characterized by sclerosing adenosis, intraductal hyperplasia and/or papillomatosis, microcystic disease, macrocystic disease, or lobular neoplasia, her malignant potential will be much greater than when these disease processes are absent. As a result, a prophylactic subcutaneous mastectomy is indicated and breast reconstruction with either an immediate or a delayed mammary prosthesis implantation should be performed.

Adult↗
PubMed2003

A study of the patient factors affecting reconstruction after mastectomy for breast carcinoma.

Breast shape may be retained after surgery for breast cancer with either wide local excision (WLE) and radiotherapy or mastectomy (M) and immediate reconstruction (M+R). We determined the proportions of patients who would be suitable for these options, would accept them, and if they declined M+R their reasons for doing so. Over a 10-month period 177 women were assessed at a combined breast clinic by general and plastic surgeons and by radiation oncologists. A prospective record was made of the patient demographic data, the clinical decisions (and their reasons), and the patient choices (and their reasons). A transverse rectus abdominis myocutaneous flap was the commonest method of reconstruction. One hundred thirty-five (76%) were judged to be suitable for locoregional surgery. Of these M+R was offered to 83 patients, whereas 53 were not considered because of combinations of cosmetic considerations (31), risk factors (25), old age (13), and oncological factors (nine). Fifty-one of the 83 (61%) offered M+R declined it because they preferred a simpler procedure (34), regarded breast appearance as unimportant (15), preferred breast conservation (five), did not have a partner (three), felt that they were too old (two), or had religious reasons (two). Ultimately 69 (51%) underwent M, 34 (25%) WLE, and 32 (24%) M+R. There was no correlation between acceptance or not of M+R and age, race, employment, education level, or marital status. We conclude that many patients were suitable for M+R, but fewer than half accepted it; this decision was unrelated to age, race, employment, or marital status.

Age Factors↗
PubMed2000

Postoperative intramuscular dextromethorphan injection provides pain relief and decreases opioid requirement after modified radical mastectomy.

BACKGROUND: Narcotics are still the therapeutic mainstay for postoperative pain relief. However, many unwanted side effects are accompanied. NMDA antagonists have been demonstrated to produce analgesic and antihyperalgesic effects, moreover, to possess potentiated effect of narcotics on postoperative pain management. AIMS: To examine whether postoperative dextromethorphan (DM), an antitussive and also an NMDA antagonist, intramuscular injection (I.M.) reduced pain and analgesic requirement after modified radical mastectomy (MRM). METHODS: Sixty-one patients scheduled for MRM were included and randomly allocated into two groups. For the control group (n=31), patients received chlorpheniramine maleate (CPM, 20 mg) I.M., while in the DM group (n = 30), 40 mg DM containing 20 mg CPM (I.M.) was given at the end of surgery. Meperidine (1 mg/kg, I.M.) was prescribed for postoperative pain relief, if ask. The time to first meperidine injection, total meperidine consumption, worst pain score, bed-rest time, and meperidine-related side effects were recorded for 48 hours postoperation. RESULTS: A longer time to first meperidine injection (20.3 +/- 1.4 vs 1.5 +/- 0.2 hr, p < 0.001) and lower meperidine consumption (10.7 +/- 4.0 vs 70.7 +/- 8.9 mg, p < 0.001) were observed in the DM group than the control group. The average bed rest time was significantly shorter in the DM group than in the control group (18.9 +/- 1.5 vs 23.4 +/- 1.6 hr, p < 0.001). The number of patients who required meperidine injection (6 vs 27, p < 0.005) and meperidine-related side effects were significantly lower in the DM group than in the control group (1 vs 7, p < 0.025). No difference was noted in worst VAS pain score between the DM and the study groups. CONCLUSION: Postoperative DM I.M. injection provided an analgesic effect and reduced meperidine requirement after MRM.

Analgesics, Opioid↗
PubMed1992

[Saving the musculus pectoralis minor in radical mastectomy].

Eighty-five patients were surgically treated for postmastectomy edema of the upper extremity. In 20 of them, phlebolysis of the subclavian vein was performed. It was established that the vein was most often compressed by a long stump of the small pectoral muscle. Surgery and subsequent radiation treatment create unfavorable conditions for the muscle leading to its morphologic restructuring. Classic mastectomy after Halsted-Meier is recommended.

Arm↗
PubMed1992

Subcutaneous avulsion of the breast caused by a seat belt injury. Report on a case requiring emergency mastectomy.

A 60-year-old female car driver wearing a combined three-point lap-shoulder seat belt was involved in a head-on-collision. The entire right breast was separated from the chest wall, whereas the overlying skin remained intact. The injury resulted in a rapid development of a monstrous haematoma in the retromammary space, and required emergency mastectomy. Seat belt lesions of the female breast are seldom referred in the literature.

Accidents, Traffic↗
PubMed1992

Correlation between first disease-free interval from mastectomy to second disease-free interval from chest wall resection.

Between 24 November 1977 and 16 September 1988, 18 consecutive chest wall resections for recurrent breast cancer after failure of radiotherapy, were evaluated as of 1 January 1990. Chest wall involvement was the only site of recurrence in 14 patients (Group I), and the most painful of the multiple recurrences in the remaining four (Group II). Of Group I, chest wall recurrence was local in eight patients (four with necrosis after radiotherapy), regional in four, and distant in two. Chest wall reconstruction was effected by contralateral breast flap in six, by random cutaneous flap in seven and by myocutaneous flap in the remaining five. Cosmetic results were better if both marlex mesh and myocutaneous flap were used. Of Group I, at surgical/pathological staging, one recurrence with sarcomatous findings, two multiple recurrences and residual cancer in all necrosed local recurrences were found: in three of these cases radionecrosis was prominent. Mortality was 0% and surgical morbidity 5%. For Group I, median disease-free interval from mastectomy was extended from 1611 days to 3220 by recurrence resection, and disease-free interval from chest wall resection was 28% cancer-free at 1657 days, without any difference between the local vs regional-distant recurrence. Correlation factor between first and second disease interval was 0.99 and R2 was 0.98. For Group II, survival was 0% at 635 days. Chest wall resection must be considered as an important part of palliative treatment in breast cancer, but the results reflects the biology of the disease more than the chest wall surgery.

Breast Neoplasms↗
PubMed1992

Breast reconstruction following mastectomy with pedicled and free TRAM flaps.

The authors present a group of nine patients after mastectomy. Breast reconstruction was performed by transposition (3) or by free transplantation (6) of a TRAM flap. Based on a review of literary reports, and on their own experience, the authors consider this procedure to be a reliable and effective method of breast reconstruction.

Adult↗
PubMed2003

Sentinel lymph node mapping with emulsion of activated carbon particles in patients with pre-mastectomy diagnosis of intraductal carcinoma of the breast.

BACKGROUND: The most common tracers used for lymphatic mapping in sentinel lymph node dissection (SLND) are blue dye and radio-colloid. The former is associated with hypersensitivity, and the latter is not available in some institutions. It is still unclear as to which subsets of patients benefit most from SLND. In this study, we tried to evaluate the usefulness of activated carbon in SLND in the early stages of breast cancer. METHODS: Patients with palpable lesions diagnosed as ductal carcinoma in situ (DCIS) or intraductal carcinoma with micro-invasion (DCMI) from their core-needle biopsy specimens were eligible for the study. A 0.4-0.6 cc emulsion of activated carbon particles (ACP) was injected peri-lesionally or subdermally, 5 minutes before modified radical mastectomy. When the axillary compartment was entered, the black-stained sentinel nodes (SLNs) were dissected and examined with H&E stain by frozen section. The extension of subsequent axillary lymph node dissection (ALND) was determined by the status of the sentinel nodes. RESULTS: Twenty-eight patients were diagnosed as DCIS and 10 as DCMI initially. The SLNs were successfully localized in 33 patients (86.8%), with an average of 2.4 SLNs dissected. The SLNs were positive for metastasis in three patients, and the non-sentinel axillary lymph nodes (ALNs) were also positive in one of them. The final diagnosis of these patients turned out to be infiltrating ductal carcinoma. The SLNs were negative for metastasis in 30 patients, and all the ALNs of these patients were also negative. Among these 33 patients, the final diagnosis was up-graded in nine (27.3%), including the three patients with positive SLNs. The SLNs were not identified in five patients, and the ALNs were positive for metastasis in one of them. CONCLUSIONS: ACP is an acceptable tracer for lymphatic mapping in SLND. For patients with palpable, biopsy-proven DCIS or DCMI, SLND can be used to select patients for ALND.

Breast Neoplasms↗
PubMed2003

Comparison of remifentanil and fentanyl in patients undergoing modified radical mastectomy or total hysterectomy.

OBJECTIVE: To compare the efficacy and safety of remifentanil and fentanyl in patients undergoing a modified radical mastectomy or total hysterectomy. METHODS: Fifty-four patients were evenly randomised into remifentanil group and fentanyl group. Anesthesia was induced by propofol (1 - 2 mg/kg) and either remifentanil (2 microg/kg) or fentanyl (2.5 microg/kg), and was maintained with inhalation of nitrous oxide in oxygen (2:1) and continuous infusion of either remifentanil (0.2 microg.kg(-1).min(-1)) or fentanyl (0.03 microg.kg(-1).min(-1)). RESULTS: The number of patients exhibiting light anesthesia responses in the remifentanil group during intubation and the maintenance of anesthesia was significantly less than that in the fentanyl group. Both systolic and diastolic blood pressures in the fentanyl group were significantly higher than those in the remifentanil group during intubation, skin incision, maintenance of anesthesia and extubation. The time to opening eyes on command and the time for extubation after surgery was comparable between the two groups. More patients in the remifentanil group (25 patients) required bolus injection of morphine for postoperative pain relief than those in the fentanyl group (5 patients, P < 0.05). There was no significant difference between the two groups in terms of side effects. CONCLUSIONS: Under the condition of this study protocol, the anesthetic and analgesic effects of remifentanil are more potent than those of fentanyl. Remifentanil can offer superior intraoperative hemodynamic stability in comparison with fentanyl, and has no compromising recovery from anesthesia.

Adolescent↗
PubMed1992

[The usefulness of extended radical mastectomy in patients with breast carcinoma].

Extended radical mastectomy (EXT) in 1, 137 patients with breast carcinoma was devised to eradicate all possible sites of local nodal metastases including internal mammary chain during the years 1962 through 1990. The tumors had to be mainly any T located in medial-half, central (excluding less 1.0 cm or histologic type with good prognosis) and T size measuring 3.0 cm or more in lateral-half. Prognostic outcomes were analysed by the presence or absence of nodes involved. The 10-year relapse free survival in patients with internal mammary node (IMN) only invaded and both axillary (AX) & IMN invaded were 47.8% and 40.1%, respectively. The incidence of relapse free survival at 10 years in relation to the number of positive AX and IMN indicated virtually favorable--1 positive: 71.4%, 2 or 3 positive: 61.3% and 4-9 positive: 53.7%. In our study, the frequency of IMN involvement calculated 24.1% from all quadrants of the breast. In comparison of nonrandomized series with medial-half and lateral-half tumors which involved positive IMN, comprising 95 and 28 patients of the total (n = 495), relapse free survivals at 15 years were 36.5% and 17.5%, respectively. It was presumed that the benefit of EXT would be found in medial-central tumors.

Breast Neoplasms↗
PubMed2004

[Electron arc therapy: application of chest wall irradiation after mastectomy].

With the development of multidisciplinary treatment for cancer, great changes have taken place in the therapeutic strategy of breast cancer. However, radiotherapy as a method of local management, still plays an important role in the combined treatment of breast cancer. The recurrence in the chest wall ranks the first, accounting for 44-69% of the total local-regional relapse, therefore, the chest wall is commonly regarded as the most important target of radiotherapy after mastectomy. The traditional irradiation techniques cannot reach an ideal dose distribution due to the irregular shape of the chest wall. Electron arc therapy, by using the electron characteristics of dose distribution, combining the shape of thorax and the depth of target volume, make the dose distribution of target volume more reasonable, decreases the dose of heart or lung and has more clinical benefit than traditional techniques. On the other hand, it had been demonstrated by some clinical research that irradiation with electron arc could provide a high rate of local control and generally acceptable acute and long-term toxicity, comparing with the traditional irradiation techniques.

Breast Neoplasms↗
PubMed2003

[Mastectomy and reconstruction: what kind of safety, which attitude?].

Breast reconstruction should be regarded as a significant part of breast cancer treatment. Immediate reconstruction has the advantages of a better cosmetic result, a better illness approach and of avoiding the need of a second major operative procedure. Immediate and early delayed reconstruction does not significantly increase the risk of local or systemic disease recurrence and the type of surgery performed should depend on the further therapy chosen. Skin-sparing mastectomy--a new technique--preserves the skin envelope and should be proposed to patients with central breast cancer.

Breast Implants↗
PubMed1992

Treatment-resistant psoriasis due to a mastectomy sleeve: an extensive Koebner response.

The Koebner or isomorphic response refers to the appearance of a dermatosis at sites of trauma. This process was first described by Heinrich Koebner in a man with psoriatic plaques in areas of trauma. Many types of trauma are capable of producing koebnerization. We report a case of extensive koebnerization in response to the wearing of a mastectomy sleeve, worn to reduce lymphedema. Both the chronic pressure produced by the device and the trauma of applying the sleeve produced the necessary dermal and epidermal trauma to elicit the Koebner response.

Adult↗