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PubMed1988

[New aspects of adequate postoperative prosthetic management following mastectomy].

The availability of one unitised organ replacement model is no longer sufficient for adequate prosthetic care at any time. The first phase of a complex system of prosthetic care was completed by the development of "femi-Form", an epithesis master model, in 1982. Two more variants were introduced in 1986, "femi-Form S" and an interim prosthesis. The complex system of prosthetic care in its totality is considered to be an important step in public health. Great attention is given to it in the GDR for follow-up treatment in the context of tumour diseases. Manufacturers are expected to go to great lengths in developing adequate prosthetic devices for postoperative care. However, it is a challenge to the medical profession to speed up and generally support the introduction of this complex post-mastectomy system.

Breast Neoplasms↗
PubMed1988

[Surgical tactics in post-mastectomy edema of the arm].

Based on examinations and treatment of 210 patients with postmastectomy edema of the extremity (with operations made on 75 of them) the authors have developed a clinico-surgical classification of the postmastectomy edema with special reference to the character of morphologic alterations of soft tissues which determinates tactics of treatment and choice of surgical methods (LVA, phlebolysis of the subclavian vein, RRO or their combination in different succession). Phlebographic and tonometric examinations are shown to be necessary, their findings being compared for the establishment of indications for phlebolysis for stenosis of the vein resulting from X-ray therapy and long stump of the musculus pectoralis minor in radical mastectomy after Holsted.

Adult↗
PubMed1987

[Control study of bacterial infections in patients with carcinoma of the breast subjected to radical mastectomy].

Surgical patients have a high risk of infections. In the breast surgery, a "clean" surgery, the infection rate should not be more than 2%. In this work, we have studied 174 women with breast cancer, which did not receive the antibiotic prophylaxis. After surgery the patients were monitored for infective complications. The total incidence of infections was 5.1%: 3.4% of surgical wound infections and 1.7% of nosocomial infections. The preoperative antibiotic therapy should not be used in the "clean" surgery, as the mastectomy, except in the patients with high infective risk. In fact we can prevent the wound infections of breast surgery with adequate control measures about the aseptic procedures of operating suite, the members of the surgical team and the preparation of the patient.

Bacterial Infections↗
PubMed1987

A ten year study of partial mastectomy for carcinoma of the breast.

Since 1970, 334 patients have undergone partial mastectomy, axillary dissection and irradiation for treatment of invasive carcinoma of the breast. The average follow-up period is 59 months. Survival curves were calculated for the entire study group and for patients classified by tumor size, nodal status and stage of disease. The five year over-all survival rate for 334 patients is approximately 87 per cent; the ten year survival rate is approximately 64 per cent. Of the 334 patients, 247 (74 per cent) have been observed for at least two years. Fourteen of these patients (5.7 per cent) have had a recurrence of carcinoma develop within the treated breast.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

Breast reconstruction after mastectomy. The Cape Town experience.

As methods have advanced, trends in breast reconstruction after mastectomy have changed considerably with more emphasis being placed on reconstruction by means of tissue expansion. Indications for using the various methods available are discussed and their advantages and disadvantages enumerated. By May 1987, 95 breasts in 88 patients had been reconstructed at Groote Schuur Hospital with few complications. The challenge remains one of improving the appearance of reconstructed breasts.

Breast↗
PubMed1987

The technique of segmental mastectomy (lumpectomy) and axillary dissection: A syllabus from the National Surgical Adjuvant Breast Project workshops.

Surveys conducted by the American College of Surgeons indicate an increasing trend toward the treatment of primary breast cancer by segmental mastectomy and radiotherapy. This operation has never been formally taught in training programs, and scant standard descriptive material exists. The National Surgical Adjuvant Breast Project conducted a series of workshops to develop guidelines for the performance of the operation. The essential points are (1) pathologic control of margins to ensure complete surgical excision, (2) surgical principles of complete tumor excision, (3) attention to optimum cosmetic results, and (4) axillary dissection for accurate staging and regional control of the disease. This article summarizes the recommendations made at those workshops.

Axilla↗
PubMed1986

An aborted, prospective, randomized trial of sclerotherapy for prolonged drainage after mastectomy.

Annually, approximately 100 of the 400 postmastectomy patients we studied have persisting serous drainage. Sclerotherapy with the use of tetracycline has been advocated to decrease serous drainage and the formation of seromas. Reports in the literature suggest that the use of tetracycline for treatment has been efficacious and that it is not painful. We devised a prospective, randomized controlled trial to study the effects of tetracycline on patients with prolonged persisting drainage. Six patients in the control group had the drains left in place until the drainage diminished. One of these patients had a seroma develop after the drains were removed. Eight patients were treated with tetracycline. Four of these patients had seromas develop after the drains were removed. Three of the eight patients had severe reactions of pain when the tetracycline was introduced into the drains. Because of the severe pain associated with sclerotherapy treatment and the lack of demonstrable benefit in those treated, we terminated the study. We did not find tetracycline to be of help in treating patients with prolonged drainage after mastectomy and some of those patients had severe pain develop from the treatment.

Drainage↗
PubMed1986

Treatment of primary breast cancer without mastectomy. The Los Angeles community experience and review of the literature.

Between 1977 and 1983, 150 women with primary breast cancer, ranging in age from 26 to 84, were treated with a breast-sparing procedure involving lumpectomy, axillary node dissection, external beam radiotherapy, and 192-iridium implant. Median follow-up to date is 46+ months, with a range of 14 to 96+ months. All surviving patients have been followed for a minimum of 24+ months. Actuarial disease-free survival projected to 8 years is 79% for the entire group, 100% for the five noninfiltrating intraductal cancer patients, 97% for the 71 Stage I patients, and 68% for the 74 Stage II patients. Eighteen of the 150 patients (12%) have developed local recurrences thus far. Five (3%) have developed second, nonbreast, primary tumors. This community-based study, examined together with other published reports of similar procedures and compared to published results following mastectomy, helps confirm lumpectomy-radiotherapy as a legitimate approach to the management of primary breast cancer.

Brachytherapy↗
PubMed1986

The effect of surgical technique on local recurrence rates following mastectomy.

The effects of two different axillary techniques, i.e. sampling and dissection, in combination with mastectomy for operable carcinoma are compared. The dissection technique when combined with radiotherapy gives better local disease control than sampling. This also confirms the proposition that an axillary sampling technique is an inefficient method of staging breast cancer and its use will result in inferior local disease control.

Breast Neoplasms↗
PubMed1986

[Prognostic significance of isolated local recurrences in breast cancer following mastectomy and axillary node excision. Apropos of 77 recurrences in 2362 patients].

During the years 1958-1984, 2 362 patients presenting with breast carcinoma were treated at the Fondation Bergonié by modified radical mastectomy and followed or not by radiotherapy or adjuvant chemotherapy. A retrospective analysis of this series showed that 77 patients (3.3%) presented an isolated locoregional recurrence as the first sign of treatment failure. A chest wall recurrence alone was noted in 47 patients, while 30 presented an involvement of the lymph nodes, sometimes associated with chest wall disease. The prognosis' factors of isolated locoregional recurrence, studied by multidimensional analysis by Cox's model are by decreasing order the disease free interval and the Scarf and Bloom's histologic grade. The median survival is 29 months after isolated locoregional recurrence and the survival curve is very similar to that of patients with isolated bone metastatic recurrences (median survival of 26 months) and slightly better than the median survival of patients with non osseous metastasis (median survival of 16 months).

Axilla↗
PubMedDate not supplied

Single-stage subcutaneous breast-prosthesis implantation and modified radical mastectomy for invasive carcinoma.

In eighteen patients modified radical mastectomy for invasive carcinoma was immediately followed by breast reconstruction. The prosthesis was placed subcutaneously. There were no infections and no definitively lost prostheses. One prosthesis had to be replaced subpectorally after 55 days due to a small skin necrosis occurring after radiotherapy. One hematoma had to be evacuated and one small skin necrosis was excised and sutured per primam. There were no local recurrences but the follow-up is short (3 years and 4 months). Postoperative radio- and chemotherapy were not affected by the reconstruction.

Adult↗
PubMed1985

[Breast reconstruction following radical mastectomy with myocutaneous latissimus dorsi flap].

Reconstruction of the female breast following radical mastectomy is bond to some criteria of cancer. Various methods are possible. At present the best method is the amplification of the skin cover by a latissimus-dorsi-myocutaneous flap in combination with augmentation by prosthesis. The other breast is adapted to size and level of the reconstructed breast. A quarter to half a year later the latter will be completed by substitution of the areola. This not too difficult surgical procedure yields good results and relieves the women from the psychical burden of being mutilated.

Breast↗
PubMed1985

Simple mastectomy under local anaesthesia.

Nine patients with locally advanced carcinoma of the breast underwent simple mastectomy under regional anaesthesia (1% lignocaine and 1:100,000 adrenaline). Preoperative sedation was provided by oral lorazepam. There were no technical problems, evidence of lignocaine toxicity or excessive operative blood loss and no wounds became infected.

Aged↗
PubMed1985

[Sinus histiocytosis in the lymph nodes of breast cancer patients having undergone extensive radical mastectomy].

Sinus histiocytosis in the regional lymph nodes of 45 patients with breast cancer who had undergone extended radical mastectomy was studied by histological examination of 2,294 resected lymph nodes. Sinus histiocytosis was divided into three grades, marked, moderate, and mild to negative, by Ohmori's classification. The results indicated that: 1) sinus histiocytosis correlates fairly well with clinical stage, especially with the n-factor, and 2) the degree of sinus histiocytosis shows little difference between three groups of regional lymph nodes. The authors concluded that sinus histiocytosis dominates the prognosis and represents some aspect of a reticuloendothelial response of the whole body to carcinoma.

Breast Neoplasms↗
PubMedDate not supplied

[Evaluation of survival in a sample of patients treated with radical mastectomy for mammary carcinoma].

Survival and its modalities were studied in 40 patients subjected to Halsted's operation for breast cancer between 1960 and 1972. The following parameters were considered: age at time of surgery, onset of tumour before or after menopause, age of commencement of menopause, married or single, number of pregnancies, breast feeding, regularity of menstrual cycle, prior breast disease, time elapsed between first symptoms and mastectomy, side affected, quadrant affected, involvement of ipsilateral lymph nodes, histological type, complementary X-ray treatment, ovariectomy, and medical hormone therapy.

Adult↗
PubMed1979

The brassiere shop: a front line of assistance to the mastectomy patient.

This report presents information received from a sampling of breast prosthesis fitters which is of importance to surgeons working with mastectomy patients. The characteristics of various types of external prostheses are described. Shop fitters relate their attitudes about patients, describe patients' reactions to cancer and surgery and the problems encountered in proper fitting, and discuss their limitations as counselors. Fitters' negative attitudes toward reconstruction mammaplasty are also presented. The authors discuss these attitudes and raise questions about appropriate interaction between surgeons and prosthesis fitters.

Breast Neoplasms↗