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PubMed1976

Contour restoration following simple or modified radical mastectomy.

With the increasing performance of modified radical mastectomy in the treatment of female breast cancer, satisfactory restoration of contour can be performed by a relatively simple procedure. In a large number of patients, this constitutes the optimal rehabilitation in the appropriate circumstances. It is hoped that with an increasing awareness of the possibility of this type of restoration, the procedure will be more widely applied.

Adult↗
PubMed1994

[Factors determining the choice between mastectomy and conservative treatment in the Côte-d'Or department (France). The Côte-d'Op6 register of gynecological cancers].

The aim of this study is to check, for a defined period and within a geographic area, whether the increased use of breast conserving treatment was related to changes in tumor characteristics, or whether changes in therapeutical practice persisted after adjustment on patients and tumor characteristics. From 1982 to 1990, 1,952 women with invasive carcinomas were registered in the French "departement" of Côte-d'Or. Seventeen hundred and seven non metastatic patients were treated by loco-regional surgery. A breast conserving surgery was performed in 60% of cases. The incidence of this treatment raised from 32% in 1982 to 73% in 1987. In univariate analysis, factors determining the type of tumor excision were: age, hormonal status, tumor size, tumor location, "clinical seriousness", nodal status, multiple tumors, inflammatory tumors, neoadjuvant treatments and year of diagnosis. Age and tumoral factors remained significant in a logistic regression analysis. Other factors being constant, the odds ratios of mastectomy was 12.9 times lower in 1987-1990 than in 1982, and 2.1 times lower than in 1985-1986, showing a "period effect". Ninety four percent of patients treated by breast conserving surgery were irradiated post operatively, showing that the clinical research recommendations were well transferred to the clinical practice in this department.

Adult↗
PubMed1994

[Sexual function in women with breast carcinoma in relation to the time interval after mastectomy].

Within the framework of more extensive research in a group of women after treatment of breast cancer the authors paid attention also to changes of sexual function in relation to the time which elapsed after ablation (modified radical mastectomy). 151 patients replied to the question pertaining to changes of the general status of sexual intercourse after treatment of carcinoma, as compared with the year preceding establishment of the diagnosis. With regard to their replies the probands were divided into four sub-groups: A-paradoxical improvement of sexual life (n = 12, 7.9% of the group, mean age 42.3 years), B-sexual life unaltered (n = 82, 54.3%, mean age 45.1 years), C-slight sexual dysfunction (n = 32, 21.2%, mean age 46.0 years), and D-severe sexual dysfunction (n = 25, 16.6% of the group, mean age 48.3 years). Attention was focused on the time intervals: under one year, 1-2 years and more than 2 years after operation. In addition to an analysis of changes in sexual function the authors compared also the neuroticism of different subgroups assessed by means of a N5 questionnaire. Rather surprisingly the authors proved a significantly more frequent deterioration of sexual function in patients after a prolonged interval following operation. This relationship applies even when the age factor of probands is eliminated. The significantly highest ratio of women with a marked neurotic symptomatology was found in patients with slight sexual dysfunction (subgroup C).

Adult↗
PubMed1994

[Anesthesia for modified radical mastectomy with breast reconstruction].

We investigated the factors influencing the amount of intraoperative bleeding, the factors influencing postoperative blood transfusion and the effect of postoperative analgesia retrospectively in 71 patients who underwent modified radical mastectomy with breast reconstruction. The amount of intraoperative bleeding decreased significantly in hypotensive anesthesia using epidural anesthesia compared with that with prostaglandin E1. Patient's weight and body surface area are the factors which influenced the amount of intraoperative bleeding. No patient received intraoperative blood transfusion. The amount of postoperative bleeding was significantly greater in 14 cases with blood transfusion and the amount of intraoperative bleeding was not significantly greater in blood transfusion cases. Fifty-one patients received epidural morphine intraoperatively. The dosage of postoperative analgesic was significantly less in these patients.

Aged↗
PubMed1994

[A choice of reconstructive plastic surgery with endoprosthesis of the breast after radical mastectomy].

The creation of silicone endoprosthesis led to new approaches in solving the problems of plastic replacement of the breast after radical mastectomy. Two variants of reconstructive plastic operations with endoprosthetics of the breast were employed: group one--the formation of the seat of the endoprosthesis using a transposed musculocutaneous flap from the latissimus dorsi muscle; group two--the formation of the seat of the endoprosthesis by stretching the skin with a specially designed stretcher-expander and subsequent implantation of the endoprosthesis. The first method is rather injurious, sometimes cannot be performed because of anatomical contraindications, and is fraught with the development of necroses in the transposed tissues. Among 34 patients operated on by the first method two had marginal necrosis of the skin above the endoprosthesis. No complications were recorded among the 46 patients who underwent operation by the second method. The condition of the endoprosthesis and the tissues surrounding it was appraised in the immediate and late periods by radiological and ultrasonic examination. The variants of endoprosthetics of the breast which we applied may be employed with competence in clinical practice, but a reconstructive-plastic operation with the use of a skin expander is preferable.

Adult↗
PubMed1994

[Breast reconstruction after mastectomy].

A variety of procedures can be used in breast reconstruction following mastectomy depending on the condition of the residual tissue. A silicone implant or tissue expander is used when the skin and subcutaneous fatty tissue are preserved, although silicone implants are no longer used in the United States. Alternatively, a lateral abdominal flap, lateral thoracic flap, latissimus dorsi flap, or rectus abdominus myocutaneous flap may be used. We have performed breast reconstruction using the latissimus dorsi myocutaneous flap without a silicone implant, and the vertical axis of the rectus abdominus myocutaneous flap was also used. Nipple-areola reconstruction was also investigated.

Abdominal Muscles↗
PubMed1994

Unusual consequence of a fall: pressure sores of both breasts resulting in bilateral partial mastectomy.

An elderly patient is described who developed severe pressure sores of both breasts resulting in bilateral partial mastectomy. She presented with hypothermia after lying prone on the floor for over 48 h. Additional contributing factors included medication with benzodiazepines, overweight and age. The pathophysiology of the unusual predilection area of the pressure sores is discussed.

Accidental Falls↗
PubMed1994

[Simultaneous radiochemotherapy in locoregional recurrent breast carcinoma after mastectomy. Results in patients with macroscopic residual tumor R2].

PURPOSE: The aim of this study was to create a treatment policy for macroscopic persistent tumor (R2) in the case of locoregional recurrent breast cancer after mastectomy. The large amount of persisting tumor cells before radiation therapy requires an aggressive therapeutic regime as known by literature. In this tumor situation our therapeutic concept is the combined simultaneous radiation and chemotherapy. PATIENTS AND METHODS: A retrospective evaluation of treatment and follow-up data of 71 patients was made. The median follow-up was 26.4 months. The local radiation therapy was combined with simultaneous chemotherapy, radiotherapy was triggered by the rhythm of chemotherapy: chemotherapy was given by CMF regime with modification according to dosage. Duration of chemotherapy was 2 weeks followed by 2 weeks without any therapy. Four courses of this regime were given. Irradiation was done simultaneously to chemotherapy using a split course technique. All patients had a visible and palpable macroscopic residual tumor before starting therapy so that the result of therapy could be documented easily. RESULTS: At the end of the therapy the complete remission rate (CR) was 89%. This was not depending on radiation dose if more than 30.00 Gy were given. For patients with CR the 5-year-probability of a re-recurrence infield is 29%. The rate of re-recurrence was depending on radiation dose. Increasing the dosage by boost technique above 50.00 Gy decreased re-recurrence to 50% of the value found by dosage of less than 50.00 Gy. Due to ipsilateral re-recurrence outfield the 5-year-probability for ipsilateral local tumor to be controlled continuously is 45%. The median overall survival rate of all patients was 32.5 months. Patients without haematogenous metastases at the beginning of the therapy and continuous local tumor control reached a median survival rate of 42.6 months in contrast to patients with haematogenous metastases or no local tumor control which had a median survival rate of 26.3 months (p < 0.04). CONCLUSION: The combined simultaneous radio-chemotherapy in the case of locoregionally recurrent breast cancer with macroscopic residual tumor (R2) is a successful treatment concept. A prospective study was initiated by ARO study group of the German Cancer Society to improve these data.

Adult↗
PubMed1993

[Initial experience with the fish-shaped incision in mastectomy].

The authors are showing their early experiences with the modified mastectomy with the use of the fish-shape incision, first published by Nowacki and Towpik in 1988. The fish-shaped incision reduces the amount of the skin in the axilla by adding two triangles on the lateral edge of the incision, prevents the "dog ear" deformity and makes the clearance of the axilla easier.

Female↗
PubMed1994

Chylous fistula: an unusual occurrence after mastectomy with immediate breast reconstruction.

Postoperative lymphatic complications of mastectomy and immediate reconstruction are well documented, consisting predominantly of lymphorrhea, lymphocele, and chronic lymphoedema. Chylous fistula is a hitherto undescribed entity complicating breast surgery. It was managed successfully by cessation of oral intake and the use of intravenous fluids, as is recommended in the treatment of chylous fistulas occurring elsewhere in the body. Although these are exceedingly rare, all plastic surgeons doing breast reconstruction should be aware of chylous fistulas and their treatment.

Breast Neoplasms↗
PubMed1993

Lymphoedema post-mastectomy: is elevation alone an effective treatment?

In an attempt to obtain information about the efficacy of arm elevation on the reduction of lymphoedema following mastectomy, a study on 33 patients was carried out in which both the control, contralateral and lymphoedematous arms were elevated for periods of 1 and 5 h. There were statistically significant (p < 0.05) reductions in the volumes of the control and lymphoedematous arms after 1 and 5 h of elevation. After 1 h of elevation, significantly more fluid was removed from the control arm (2.7%) than the lymphoedematous one (1.3%). At 5 h there was no significant difference in the volume of fluid removed from the control arm (3.3%) compared with the lymphoedematous one (3.1%).

Adult↗
PubMed1977

Subcutaneous mastectomy in the large ptotic breast.

A procedure is described for doing a subcutaneous mastectomy on large ptotic breasts. The method employs a reduction of the skin brassiere, free transplantation of the areola-nipple, and a double layer closure technique.

Breast Diseases↗
PubMed1977

[Stewart-Treves syndrome: post-mastectomy angiosarcoma].

A case is reported of angiosarcoma occuring in the chronic-lymphedematous right arm of a 56 year-old woman 9 years after radical mastectomy for cancer of the right breast. This is a characteristic example of Stewart-Treves syndrome (angiosarcoma in chronic lymphedema). The patient died within the year from multiple metastases. About 200 such cases are reported in the literature: the prognosis is bad, the best therapy reported being amputation of the extremity. Early diagnosis is essential through frequent checks for chronic lymphedema, which is seemingly the crucial etiologic factor in the occurrence of this angiosarcoma. Histogenesis has yet to be fully explained.

Amputation, Surgical↗
PubMed1993

Reflex sympathetic dystrophy after modified radical mastectomy: a case report.

Despite the long history of descriptions of reflex sympathetic dystrophy (RSD), much confusion remains regarding its pathogenesis, diagnosis, and treatment. It most commonly occurs after trauma and is more frequent in women, white persons, and the elderly. The first case of RSD after mastectomy is reported and the proposed pathophysiology and management of RSD are reviewed.

Arm↗
PubMed1993

The modified radical mastectomy of Patey: technique and experience.

We report our experience from 193 patients with breast cancer treated by Modified Radical Mastectomy of Patey and describe the technique used, amplified by illustrations. We achieved a low morbidity viz symptomatic lymphoedema five cases, chronic shoulder stiffness one case, skin grafting two cases, and all cases of chest wall pain cleared by four years. Cancer recurred, to date, local in nine cases (4.6%), local and systemic in 17 cases (8.9%) and systemic in 27 cases (13.9%). We compile, for the first time, all references by Patey and Richard Handley to the procedure. We recommend the operation as achieving complete primary clearance with safe and full axillary node removal. Histological state of the nodes allows rational decisions on adjuvant therapy with hormones and chemotherapy.

Breast Neoplasms↗
PubMed1977

Subcutaneous mastectomy for gigantomastia in an adolescent girl. Case report.

A 12-year-old patient with macromastia had 8,000 gm of breast tissue removed in a reduction mammaplasty. After a recurrence 14 months later, she had a subcutaneous mastectomy in which 2,000 gm more of breast tissue was removed from the breast and silicone prostheses were inserted. She has a good result, and we think this last operation should be used more often in these cases.

Adolescent↗
PubMed1993

Recurrent coumadin-induced soft tissue necrosis resulting in mastectomy.

A 58-year-old woman developed Coumadin-induced necrosis of the left breast, resulting in a mastectomy. This patient had experienced an earlier episode of coumadin-induced necrosis that resolved spontaneously. The etiology of this rare complication is unknown. The literature has suggested that patients can be restarted on Coumadin without difficulty. This case and others in the literature suggest that this may not be true. Patients requiring long-term anticoagulation should be considered for other treatment modalities if they develop Coumadin-induced skin necrosis.

Breast↗
PubMed1996

[Effects of mastectomy on dimensions of psychological and psychosocial experience and behavior of affected women].

The present study deals with the issue of how mastectomy will impact selected dimensions of psychological and psychosocial experience and behaviour in the women concerned. The study had comprised 21 women, mean age 55. 73 years, with a breast cancer diagnosis given between 1 and 21 years ago. Data collection was carried out using a 17-item questionnaire standardized for this purpose. Factor analyses produced four clearly interpretable factors. Study findings suggest that breast cancer surgery will not inevitably result in impaired sexual behaviour and experience in the affected women, whereas it is sure to impact, to varying degrees, on the factors and dimensions of "body image and self-image", "psychological and psychosomatic complaints" as well as anticipated "performance capacity and social relationships". Intercorrelations among questionnaire items are set out. It has further been found that the variables "time of breast removal" and "life age" had exercised only negligible influence on the women's questionnaire response, and that the psychosocial support experienced post-surgery was reported to have primarily come from the circle of family and friends, and less so been extended by self-help groups or medial staff. Concluding, the need for integrated rehabilitative measures is pointed out.

Adaptation, Psychological↗