[Pre-invasive tumors and precancerous conditions of the breast: local procedure--biopsy, tumor resection, subcutaneous mastectomy or simple mastectomy? Indications and results].
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Biopsy↗
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Overview of randomized trials comparing radical mastectomy without radiotherapy against simple mastectomy with radiotherapy in breast cancer.
An overview of mortality in the mature randomized trials comparing radical mastectomy without radiotherapy against simple mastectomy with radiotherapy has been conducted. These trials mark a transitional period between radical mastectomy and simple mastectomy as the generally preferred surgical treatment and as such are not strictly trials assessing the value of postoperative adjuvant radiotherapy. All known mature trials have been included and these four trials have entered a total of 3236 patients, in whom 1678 deaths have been recorded. Overall, no significant difference in survival was seen, but there was a nonsignificant trend for patients given radiotherapy to do worse after 15 years of follow-up.
Breast Neoplasms↗
[Mammary reconstruction after subcutaneous mammectomy and simple mastectomy: our technical orientation].
The authors present their technical guidelines about the operative procedure for high risk benign breast lesions. Various reconstructive managements, conditioned by aesthetical-oncological evaluations, are proposed.
Aged↗
Role of simple mastectomy in treating patients with breast cancer.
From 1945 to 1971, 473 patients had simple mastectomies as the primary treatment for their breast cancer (421 had either a simple mastectomy alone [26%], a simple mastectomy followed by postoperative radiation therapy [64%], or preoperative irradiation followed by simple mastectomy [10%]). More than one half of these patients were "inoperable" by standard surgical criteria. The local recurrence rate was 24%, which compares favorably with the reported 48% local recurrence rate for "inoperable" patients treated by radical mastectomy. These recurrences were on the chest wall in two thirds of the patients and in the regional lymph nodes of the other third. No statistical differences in survival or recurrence rate could be correlated with the site of the primary cancers in the breasts or among the three treatment groups.
Breast Neoplasms↗
[82 mammary reconstructions immediately after subcutaneous mammectomy or after simple mastectomy. Critical evaluation of results].
The authors review their experience on 25 patients subjected to bilateral subcutaneous mastectomy and 16 patients subjected to bilateral simple mastectomy with immediate submuscular insertion of prosthesis for high risk benign breast lesions. The best aesthetic results were observed with subcutaneous mastectomy (and immediate reconstruction by prosthesis) in patients with small-middle non ptotic breasts. In addition, the authors believe that high risk lesions in large breast are better treated with simple mastectomy and immediate reconstruction by tissue expander.
Aged↗
Nipple placement in simple mastectomy with free nipple grafting for severe gynecomastia.
Severe gynecomastia with excessive skin is difficult to treat by only periareolar excision or suction-assisted lipectomy or both. In these patients, total mastectomy and free nipple grafting may be the best option. Placement of the nipple, however, has been arbitrary. With use of 20 "aesthetically perfect" men as models, standard nipple distances were identified. The average sternal notch-to-nipple measurement was 21 cm. In addition, two consistent ratios were identified. The nipple plane was located 0.33 times the distance from the sternal notch to the pubis, and the internipple distance was 0.23 times the chest circumference. With use of preoperatively obtained measurements of the sternal notch to pubis and chest circumference, accurate nipple placement can be accomplished.
Adult↗
A comparison between the results of simple mastectomy and tumorectomy for breast cancer: the problem of local recurrence.
Between 1963 and 1981, 1139 patients had surgery for unilateral breast cancer at the Charlottenburg Gynaecological Clinic of the Free University Berlin. A total of 948 patients had a simple mastectomy and 191 patients had an extended tumorectomy (or lumpectomy) with subsequent radiotherapy (40 Gy). Retrospective analysis of "matched cases" treated by tumorectomy or mastectomy showed the rate of local recurrence after tumorectomy to be nearly double that after simple mastectomy (8.7% after tumorectomy, 4.7% after mastectomy). Life expectancy with a local recurrence after conservative surgery, was however, better than that after simple mastectomy.
Berlin↗
A prospective audit of simple mastectomy under local anaesthesia.
The treatment options for breast cancer in elderly or unfit patients can be complicated by their coexistent medical problems. This study assesses the feasibility of simple mastectomy under local anaesthesia by means of a prospective audit on 36 patients with breast carcinoma and an ASA grade of 3 or worse. In 27 patients the tumour had escaped from tamoxifen control, no patients having had previous radiotherapy. Operation time ranged from 40 to 70 min, average blood loss was 200 ml and an average inpatient stay of 5 days. Only two patients had a resection margin less than 1 cm and in none was there significant morbidity or mortality despite the patients' poor pre-operative medical condition. This confirms the potential of using local anaesthetic for simple mastectomy. Eliminating the morbidity/mortality due to general anaesthesia widens the range of treatment available (especially to medically unfit patients) giving them the option of a rapid resolution to what could be a distressing protracted condition.
Adult↗
Local recurrence after simple mastectomy.
A retrospective study was carried out to determine the clinical significance of local recurrence after simple mastectomy and node biopsy for primary operable breast cancer, without postoperative irradiation or systemic adjuvant therapy. Local recurrence was defined as a histologically proven lesion in or deep to the mastectomy skin flaps. A total of 966 patients with a median follow-up of 7 years were reviewed. Of these, 223 (23 per cent) developed local recurrence but half the tumours were small single lesions; 70 women had multiple discrete lesions and 21 diffuse carcinomatous dermal infiltration. Local recurrence showed significant associations with tumour grade, nodal status and the presence of lymphovascular invasion in the primary tumour. A predictive index containing these three variables was constructed. Adjuvant irradiation of the flaps is recommended for patients with high scores; such women would otherwise have a 39 per cent chance of developing local recurrence by 5 years. Different types of local recurrence have different chances of responding to local therapy: 13 per cent of single local recurrences, 32 per cent of multiple spot recurrences and 70 per cent of the diffuse type failed to respond to local therapy. Local recurrence predicts reduced patient survival.
Aged↗
A comparison between suction and corrugated drainage after simple mastectomy: a report of a controlled trial.
A randomized prospective trial of closed suction wound drainage compared with corrugated wound drainage after simple mastectomy for early breast cancer (lesion confined to the breast and without skin ulceration) is reported. Fifty-one patients were admitted to the study and there was no difference between the two groups with respect to local complications such as ifection, skin necrosis and collection under flaps and wound healing. Dressings require to be performed significantly less frequently with suction as opposed to corrugated drainage and suction drains were removed significantly sooner than corrugated drains. It is concluded that closed suction wound drainage should be used after simple mastectomy.
Bandages↗
Simple mastectomy and axillary node sampling (pectoral node biopsy) in the management of primary breast cancer.
Axillary node sampling was introduced as a means of defining those patients whose primary breast cancer was treated by simple mastectomy in whom postoperative radiotherapy could be avoided safely. The authors have initiated controlled randomized trials in Cardiff and Edinburgh which have indicated that, provided that nodes are identified for histologic examination, simple mastectomy, node sampling, and selective radiotherapy give equal survival rates to routine radical treatment, whether this is by surgery or radiotherapy. Provided sampling of nodes is adequate and histologically proven, locoregional control also is satisfactory. A current randomized trial comparing this policy with Patey mastectomy has allowed comparative studies of axillary node status. These and follow-up data indicate that for a valid assessment, three to four nodes should be identified by the surgeon for histologic examination, the false negative rate being less than 10%.
Axilla↗
Simple mastectomy with postoperative irradiation versus extended radical mastectomy in breast cancer. A twenty-five-year follow-up of a randomized trial.
From November 1951 to December 1957, all patients with untreated breast cancer admitted to the Radium Centre in Copenhagen were randomized before their operability was evaluated into two groups, if the patients were operable, viz. simple mastectomy with postoperative x-ray treatment or extended radical mastectomy. Twenty-five-year results are presented, showing no difference in survival or recurrence-free survival of the operable patients. Histological grading was performed in nearly all cases. Patients with grade 1 tumours had a better survival than grades 2 and 3, but there was no difference in survival between the two treatment groups, when histological grading was taken into account. Histological node positive patients had more grades 2 and 3, tumours, whereas node negative patients had more grade 1 than grades 2 and 3 tumours. Premenopausal women had a significantly better survival than postmenopausal in all stages.
Age Factors↗
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↗
One-stage simple mastectomy with immediate reconstruction for high-risk patients. An improved technique: the biologic basis for ductal-glandular mastectomy.
The heterogeneity of human breast carcinoma appears to be a cumulative interrelationship of genetic and environmental factors that may be identifiable with a high risk for carcinogenesis. Until breast cancer prevention is realized, one-stage total ductal-glandular mastectomy with immediate reconstruction may be offered as an alternative to simple mastectomy for women at high risk for developing cancer. This technique affords the complete extirpation of breast tissue at a deep plane with flaps that are identical in thickness to those elevated in classic mastectomies for invasive cancer. Breast reconstruction with submuscular prostheses in a one-stage procedure gives an aesthetically acceptable result. The role of ductal-glandular mastectomy as prophylaxis for invasive carcinoma warrants future prospective trials.
Adult↗
Breast reconstruction with submuscular prosthesis after modified radical or simple mastectomy. Surgical technique and early complications.
A series of 100 women who underwent breast reconstruction is reviewed. They had previously been treated for breast cancer with modified radical or simple mastectomy. The technique and early results of reconstruction are presented. The same surgeon performed all these operations and the technique was not varied. Emotional need for reconstruction was the main factor in patient selection. The interval between mastectomy and reconstruction was as a rule at least one year after removal of stage I cancer and 2-5 years in stage II cases. Scar correction was required significantly more often after oblique than after horizontal mastectomy incision. A submuscular pocket was created to accommodate the prosthesis and a muscle and fascia flap was used to add tissue and contour. No major early complications occurred. The submuscular implantation of prosthesis facilitated clinical follow-up. In a background population of breast cancer patients, the overall frequency of breast reconstruction was 4%. The figure for premenopausal patients with stage I breast cancer treated with modified radical mastectomy was 18%.
Adult↗
The prediction of local or regional recurrence after simple mastectomy for operable breast cancer.
Both the histological grade of the primary tumour and lymph node status have been found to contribute significantly towards the development of a local or regional recurrence after simple mastectomy for operable breast cancer. No other factor, from a series of seven studied, has been found to be of independent significance. A small group of patients with grade III tumours, lymph node positive at mastectomy, has been identified in whom more than 40 per cent of all symptomatic local or regional recurrences occurred. The chance a patient in this group has of developing a local or regional recurrence requiring treatment within 4 years approaches 50 per cent.
Breast Neoplasms↗
Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction.
The aim of this study was to assess and compare the psychological outcome and satisfaction of patients whom underwent wide local excision, mastectomy alone and mastectomy with breast reconstruction. A total of 577 patients had different types of operations for primary breast cancer (254 (44%) had wide local excision, 202 (35%) had simple mastectomy and 121 (21%) had breast reconstruction). Psychosocial morbidity and satisfaction were studied retrospectively using self-evaluation questionnaires. The three different surgical groups were cross-matched into four different age group. Significant statistical differences existed between the three procedures regarding satisfaction and psychosocial morbidity (anxiety, depression, body image, sexuality and self-esteem) in favour of wide local excision followed by breast reconstruction. Greatest morbidity was seen in the mastectomy group. Patient satisfaction of cosmetic outcome and psychosocial aspects was greater with wide local excision than with breast reconstruction or mastectomy. However, since wide local excision is indicated in only a group of patients, breast reconstruction should be an option available to patients requiring mastectomy.
Anxiety↗
Subcutaneous mastectomy and immediate prosthetic implantation as an alternative to simple mastectomy.
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Adult↗