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Results for “Mastectomy, Modified Radical”

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PubMed1999

Radiotherapy following mastectomy: indication and contraindication of chest wall irradiation.

PURPOSE: To determine in which cases radiotherapy of the chest wall following mastectomy is indicated, based on the local recurrent rate in patients with locally advanced breast cancer. METHODS AND MATERIALS: From 1984 until 1994, 105 patients who had four or more histopathologically confirmed axillary nodes metastases, or T3-4Nany, were subjected to mastectomy and were administered radiotherapy postoperatively using the hockey-stick field, which included the ipsilateral supraclavicular fossa and internal mammary nodes, except the chest wall. Median age was 51 years old (range, 23 to 82 years old). Eighty-five patients underwent radical mastectomy, 18 modified radical mastectomy, and 2 extended radical mastectomy. Fraction size was 2 Gy/day, the weekly fraction size was 10 Gy and the total dose ranged from 44 Gy to 54 Gy (median 50 Gy). Seventy-four patients were administered adjuvant chemotherapy, and 61 patients were administered hormone therapy. RESULTS: The 5-year disease-free survival rates of the whole study population were 66%. The 5-year chest wall recurrence rates were 10%. The 5-year chest wall recurrence rates of the patients who had no vascular invasion (n = 19) and the patients who had definite vascular invasion (n = 38) were 0% and 24%, respectively (p = 0.036). All the patients who presented chest wall recurrence had four or more axillary nodes metastases. Nine of the 10 patients who presented chest wall recurrence had definite vascular invasion, while there was no information about vascular invasion for the remaining patient. Factors such as age, pathological subtypes, tumor location, estrogen receptors, extent of resection, chemotherapy, and hormone therapy did not influence the development of chest wall recurrence. CONCLUSION: Among patients with breast cancer who have four or more positive axillary nodes or T3-4Nany, those who have no vascular invasion or less than 4 axillary nodes metastases do not need to be subjected to chest wall irradiation after radical mastectomy.

Adult↗

PubMed1998

Male breast cancer: a 22-year experience.

AIMS: To carry out a retrospective study of male breast cancer over a 22-year experience. METHODS: Data from 121 male patients with breast cancer treated between the years 1972 and 1994 at the Surgical Clinic of Ankara Oncology Hospital were reviewed. Distribution of cases according to stage was: 2.5% stage I, 28.9% stage II, 55.4% stage III and 13.2% stage IV (AJCC staging method). The surgical treatment for 23 of the patients (19%) was Halsted's radical mastectomy or modified radical mastectomy. Seventy-three cases (60.3%) had total mastectomy without axillary node dissection and 25 (20.7%) had local tumour excision only. Seventy-two of 121 patients had adjuvant treatment. RESULTS: In general the prognosis of men with breast cancer was worse than for women. In the analysis of patients in stages I, II and III-A (operable disease group), the 5-year survival rates were 73% in axillary node-negative patients and 77% in those with tumours sized under 5 cm (P<0.001). In these patients, univariate analysis demonstrated that axillary status (relative risk of death in positive status vs. negative=3.6), tumour size (relative risk in T3 vs. T1-2=2), surgical treatment type (relative risk in simple mastectomy vs. radical mastectomy=1.9) and adjuvant chemotherapy (relative risk if no chemotherapy=1.4) were statistically significant factors associated with survival. CONCLUSIONS: Cox's regression model revealed that axillary status, tumour size and type of surgical treatment were the most important independent prognostic factors (P<0.001).

Adult↗

PubMed1992

[Secondary lymphedema of the arm following primary therapy of breast carcinoma].

1107 cases of lymphedema of the ipsilateral arm (27%) were found in 4011 female breast cancer patients suffered from 4101 breast cancer, seen in the Bad Trissl hospital between 1972 and 1990. The right arm was affected in 47.5%, the left in 52.5%. Primary treatment had consisted of operation alone in 1630 patients with a consecutive rate of edema of 20.3%. Additional irradiation increased this rate up to 31.4% (n = 2471). The rate of edema after radical mastectomy (n = 731), modified radical mastectomy (n = 3149) and breast preserving operation (n = 221) were 39.2% and 9.5% respectively. Adjuvant radiotherapy increased the edema rate of each the surgical procedures (radical mastectomy alone 22.7%, with irradiation 44.7%, modified radical mastectomy alone 19.9%, with irradiation 29.3%, breast preserving operation alone 6.9%, with irradiation 10.4%). During the observation time from 1972 to 1990, the edema rate was reduced from 38% to 18%, reflecting the change of the chosen therapy modalities (radical surgery and conventional irradiation from the 50th's to the early 70th's, breast preserving techniques with modern megavoltage irradiation in the late 80th's). A further reduction of the lymphedema rates by minimization of the aggressiveness of the treatment seems to be possible and should be taken into account for preserving an optimal quality of life.

Arm↗

PubMed1986

Breast cancer: presentation and prognosis in the community hospital.

A retrospective analysis of all breast cancer primarily treated at this institution during the ten-year period from 1967 to 1977 revealed 336 cases; in 308 of these cases, complete follow-up of five or more years was available. Clinical staging using the TNM system (tumor, node, metastasis) showed stage I disease in 60 patients, stage II in 94, stage III in 105, and stage IV in 49. Pathologic classification of these 308 cases showed a high incidence of infiltrating ductal carcinoma (88%). Early in the study operative treatment consisted of radical mastectomy, with modified radical mastectomy being more common in the later years. Simple mastectomy was occasionally done palliatively. Adjuvant treatment using cyclophosphamide (Cytoxan), methotrexate, 5-fluorouracil, radiation, and/or hormonal manipulation was then given according to a set protocol. In general, five- and ten-year survival improved with this combined treatment. The mortality among patients with stage I infiltrating ductal carcinoma not given adjuvant therapy suggests the need for proper selection of patients in this group who should receive adjuvant chemotherapy because they are at increased risk.

Adenocarcinoma, Mucinous↗

PubMed1983

Postoperative lymphoedema after treatment of breast cancer.

A clinical study was made of the occurrence of lymphoedema of the arm following radical mastectomy and modified radical mastectomy for curable breast cancer. The relation between this incidence and the occurrence of axillary node metastases and subsequent radiation to the axilla was examined. Both radical surgery and radiation increased the risk of postoperative arm lymphoedema. By changing the surgical approach towards less extensive operations this risk has been substantially reduced while radiation therapy still implies a high risk for persistent lymphoedema.

Arm↗

PubMed1993

[Treatment of male breast cancer: an analysis of 41 cases].

41 male patients with breast cancer confirmed pathologically were treated. Of these, 35 were treated by radical mastectomy and 6 by modified radical mastectomy. The patients with axillary lymphatic metastasis were treated by postoperative radiotherapy, chemotherapy. The overall 5-, 10- and 15-year survival rates were 67.6%, 53.3% and 55.0%, respectively. The 15 year survival rates of TNM stage I-II and III patients were 55% and 50% respectively. We conclude that radical or modified radical mastectomy is the rational therapy for male breast cancer. The patients in stage III will benefit from postoperative adjuvant therapy in terms of improving prognosis.

Adenocarcinoma↗

PubMed1998

Preoperative chemotherapy for locally advanced breast carcinoma at Charity Hospital, New Orleans, Louisiana.

Despite increased screening and public education efforts, there continues to be a subset of patients with breast carcinoma who do not seek medical attention until their lesions are locally advanced. Recently, there has been increasing interest in administering preoperative chemotherapy to these patients. The purpose of this study was to evaluate the Charity Hospital experience with preoperative chemotherapy for locally advanced breast carcinoma. Thirty-three poor urban women with T3 or T4 breast lesions were treated with preoperative chemotherapy before surgical resection, between 1987 and 1995. Their charts and pathology were reviewed and analyzed. Local treatment was in the form of radical mastectomy (n = 3), modified radical mastectomy (n = 26), or lumpectomy with axillary dissection (n = 4). After preoperative chemotherapy, 4 patients had a complete histologic response (12%), 19 had a partial response (58%), and 10 had no response (30%). After a mean follow-up of 40.6 months, stage IIIA (n = 16) and stage IIIB (n = 12) patients were found to have 5-year survival rates of 50.2 and 26.7 per cent, respectively. Stage IV (n = 5) patients had a median survival of 23.1 months with no survivors at 3 years. Patients who had a complete or partial response to chemotherapy had a median survival of 43.0 months versus 23.1 months for the nonresponders. We conclude that our response rate, for poor urban women with locally advanced breast carcinoma, to preoperative chemotherapy, is comparable with that found in the literature. Furthermore, the initial response to this chemotherapy may be an important indicator of ultimate prognosis.

Adult↗

PubMed1994

Malignant cystosarcoma phyllodes.

UNLABELLED: This study reviewed 26 women who had resection of a malignant cystosarcoma phyllodes. Clinical presentations were palpable mass, 25; pain, 11; and ulceration, 2. Definitive surgical therapy was radical mastectomy (RM), 2; modified radical mastectomy (MRM), 14; total mastectomy (TM), 4; and partial mastectomy (PM), 6. Tumors ranged in size from 1-20 cm (median, 7 cm). Eight patients developed recurrent disease after 10-45 months. Local recurrence was more likely after TM and PM than after MRM and RM (P < 0.05). Patients who developed local recurrence only were treated by wide re-excision, and all such patients are alive with no evidence of disease at 5-25 years. Only one of 16 patients undergoing axillary dissection had involved lymph nodes. Four patients whose tumors ranged from 5-8 cm and who underwent one RM and three MRM developed systemic recurrence; all died of their disease after 15-48 months. CONCLUSION: 1) Although there is a higher local recurrence after PM and TM as compared with MRM and RM for malignant cystosarcoma phyllodes, the local recurrence can be treated with wide excision without affecting long-term survival; 2) systemic recurrence was not related to size or extent of resection; 3) axillary dissection does not predict for or prevent recurrence.

Adult↗

PubMed1989

[Treatment selection for stage I breast cancer--report of 412 cases].

From 1958 to 1982, 412 Stage I breast cancer patients treated by simple operation, operation plus radiotherapy and/or chemotherapy are reported. Of them, 312 were treated by radical mastectomy (R), 43 by simple mastectomy (S), 31 by modified radical mastectomy (M), 20 by tumorectomy (T) and 6 by extended radical mastectomy (E). The results showed that M and T with radiotherapy and/or chemotherapy were similar to R in terms of survival and recurrence rates. There were no differences between R, S, M, E groups and combined treatment group in recurrence rate, but there was a significant difference between T group and combined treatment group (P less than 0.01). Recurrence rate of patients with positive axillary lymph nodes was similar to that of patients with negative nodes, because 91.5% of the former patients received combined treatment, but only 54.3% of the latter patients did (P less than 0.01). Six cases in T group recurred and 4 (67%) of them were retreated by salvage surgery. Three cases survived for 15 years, giving a better result than radical mastectomy. It is indicated that modified radical mastectomy and tumorectomy plus combined treatment are advisable for Stage I breast cancer. Prospective randomized clinical trials for assessment of different treatment modalities are needed.

Adolescent↗

PubMed1996

Factors influencing the distribution of metastases and survival in metastatic breast carcinoma.

A total of 370 patients with metastatic breast, carcinoma who had been followed at Hacettepe Oncology Department between 1980 and 1991 were retrospectively analyzed for the factors influencing the distribution of metastases and survival. Median age was 47 years. Radical or modified radical mastectomies were performed in 199 (53.8%). Infiltrative ductal carcinoma was the most common pathologic subtype (69.4%). In 191 patients who were evaluated for estrogen receptor (ER) status, 101 (52.9%) were positive and 90 (47.1%) were negative. The distribution of first metastases did not differ between the soft tissue, bone, and visceral sites. The second, third, and fourth metastases were more common in visceral sites (p < 0.05). ER and menopausal status did not affect distribution. Mortality rate was significantly lower in the group having the first metastasis to the bone (p < 0.05). Of interest, first metastases were predominantly found in visceral sites in patients having radical or modified radical mastectomies (p < 0.05). Response to therapy, presence of initial metastases, axillary status, and age were the important factors influencing the overall survival in univariate analysis, whereas response to therapy, ER status, age, and presence of initial metastases were the important factors according to the multivariate analysis.

Adult↗

PubMed1977

[Prognosis of local primary breast carcinoma under current therapy].

A retrospective study is presented on 225 selected patients with local primary carcinoma of the breast treated from 1963 to 1973 at the Surgical Clinic of the Cantonal Hospital, St. Gallen, Switzerland. All patients were under 70 years old. The results are compared of our two therapies, namely radical mastectomy of Halsted and a modified radical mastectomy consisting of mastectomy with dissection of the axilla but without removing the pectoral muscle. Both operations were followed by postoperative irradiation. In view of the short postoperative interval after modified radical mastectomy (from 1969), a five-year diseasefree survival is indicated. There was no statistically significant difference between the two therapies. Depending on age, patients with histologically negative lymph nodes of the axilla had a probability of 45-60% for 5-year diseasefree survival, against only 15-40% for those with positive axillary lymph nodes. The quality of survival is deemed important, and the authors therefore recommend the modified radical mastectomy, which disfigures a woman less than the Halsted operation.

Adult↗

PubMed1984

[Lymphedema and function of the arm after mastectomy for breast cancer].

We made an investigation of lymphedema and function of the arm in 1,115 patients after mastectomy. Slight edema was observed in 26.7 per cent, moderate edema in 3.9 per cent and severe in 0.9 per cent. Lymphedema is dependent upon the extensiveness of surgical operation. The incidence of moderate and severe edema is 2.5 per cent for 637 patients with modified radical mastectomy, 7.7 per cent for 440 patients with standard radical mastectomy and 10.5 per cent for 38 patients with extended radical mastectomy. The development of edema is more frequent in irradiated patients than in those without irradiation. No difference of the incidence of arm movement limitation is observed between modified radical mastectomy and standard radical mastectomy. Modified radical mastectomy, especially Auchincloss operation, offers a much cosmetic appearance.

Arm↗

PubMed1986

Needle-guided breast biopsy for mammographic abnormalities in 561 patients.

Between 1977 and 1983, 561 consecutive patients underwent 595 surgical biopsies for suspicious mammographic lesions with negative clinical correlation. The procedure consisted of preoperative needle localization, with or without immediate radiologic examination of the biopsy specimen, depending on the presence or absence of microcalcifications in the mammographic lesion. Eighty-four carcinomas were found. Of these, 60 (71%) were infiltrating carcinoma and 24 (29%) were noninvasive carcinoma. The carcinoma yield was 24.2% in the patients with lesions involving foci of microcalcifications and 9% in those lesions without calcifications. Surgical treatment of infiltrating carcinoma consisted of 39 modified radical mastectomies, 10 (25.6%) of which were associated with positive nodes, 16 partial mastectomies with axillary dissection, 3 (18.7%) of which were associated with positive nodes, and 5 wedge resections. Treatment of noninvasive carcinoma consisted of 19 partial mastectomies with axillary dissection and 5 modified radical mastectomies. None of these were associated with positive nodes. Modified radical mastectomy was used with decreasing frequency. Of the 10 patients with infiltrating carcinoma and positive axillary nodes treated by modified radical mastectomy, 7 had one to three involved nodes and 3 had four or more; of those with positive nodes treated by partial mastectomy, 1 had one to three involved nodes and 2 had four or more. These results confirm the correlation between suspicious mammographic non-clinical lesions and breast carcinoma.

Biopsy, Needle↗

PubMed1992

The management of breast cancer with immediate or delayed reconstruction.

In patients with stage I and stage II disease who are candidates for a mastectomy, either immediate or delayed reconstruction can be accomplished with remarkably good cosmetic results. Age is not a specific contraindication to reconstruction, but, in my experience, the majority of women over 55 years of age are not interested. Mastectomy or modified radical mastectomy should be performed in these patients using a technique that facilitates delayed reconstruction. The patient may or may not elect to have the reconstruction eventually. Immediate or delayed reconstruction is appealing to a significant number of women under 55 years of age. They should see a plastic surgeon in consultation and the advantages and disadvantages of a subpectoral silicone implant vs. a myocutaneous flap (usually a transverse rectus abdominis musculocutaneous flap) should be discussed in detail. The patient's acceptance of the cosmetic result is better if she has an opportunity preoperatively to review photographs of reconstructed breasts and to discuss the results with women who have undergone a similar procedure. The timing of the reconstruction is a matter of clinical judgment; no prospective clinical trials have been performed. Immediate reconstruction is feasible if the skin flaps will accept the slight tension produced by either a subpectoral implant or a transposed muscle flap. A subpectoral silicone implant produces a satisfactory cosmetic result in the majority of patients, particularly if both breasts are supported by a properly fitting brassiere. In long-term follow-up, infection, contracture, and displacement requiring removal and reinsertion occur in approximately 15% of patients. Reconstruction by a myocutaneous flap is a technically more difficult operation. The operating time is prolonged significantly and blood loss is increased. In my opinion, a myocutaneous flap probably is not worth the risk of a heterologous transfusion. The long-term cosmetic results, however, are considerably better in comparison to a subpectoral silicone implant. The reconstructed breast is much more mobile, making it a more realistic replacement of the original breast. In most cases, it is better to perform this type of reconstruction with a myocutaneous flap as a delayed procedure. In experienced hands, however, immediate reconstruction, with the transverse rectus abdominis musculocutaneous flap harvested while the modified radical mastectomy is being performed, is perfectly feasible. Nipple/areolar reconstruction is available. However, the cosmetic results are only fair to good, and the patient should be aware of this before undergoing the procedure. The problem of symmetry between the breasts requires a good deal of judgment.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1990

[Therapy and prognosis of small breast cancers. Comparison of subcutaneous mastectomy procedures with ablatio mammae].

A retrospective clinical study included 1283 patients with breast cancer. 307 of 762 tumours with known diameter (mm) were classified as stage pT1 (TNM, 70). Four groups were formed to compare the prognosis in subgroups of pT1 cancers: 0-5 mm (n = 22), 6-9 mm (n = 22), 10 mm (n = 53) and 11-20 mm (n = 210). A comparison of three types of surgery was made: Radical subcutaneous mastectomy (12), bilateral modified subcutaneous mastectomy (10, 11), and modified radical mastectomy (Auchincloss, 3). Both forms of subcutaneous mastectomy were combined with adjuvant postoperative radiotherapy to the side of the tumour. In this trial, patients were younger at diagnosis than usually stated in the literature. Small breast cancers had the same localisation and histology as large ones. Axillary lymph node metastases were identified from a tumour diameter of 6 mm upwards. Bilateral tumours were seen in 2 of 22 patients with tumours less than or equal to 5 mm. Multifocal growth was observed also in the same size range. Histologically different simultaneous invasive unilateral cancers were seen starting at a diameter of 8 mm of the larger tumour. Systemic metastases were observed in tumours of 10 mm in diameter. Local recurrences occurred in breast cancers with a diameter of 2 mm and more. There were no recurrences in the area of the nipple or areola in pT1 cancers. Small breast cancers did not appear to be biologically different from larger lesions. No prognostic subgroups of pT1 were evident beyond the established TNM staging. Disease-free survival was not significantly different between the three surgical approaches. Local recurrence was significantly less frequent after breast-conserving surgery. A negative influence of local recurrence on the prognosis was observed to a similar extent irrespective of the type of surgery. The concept of "minimal breast cancer" suggesting ablative surgery for a heterogeneous group of preinvasive and small invasive lesions is outdated. The different forms of subcutaneous mastectomy are a therapeutic alternative in the context of breast-conserving surgery of small infiltrating breast cancers. Especially the modified subcutaneous mastectomy (Beller) combines a good cosmetic result without prognostic impairment and with a potential reduction of the risc of contralateral breast cancer. Further potential applications include prophylactic treatment of high-risk patients with preinvasive lesions.

Breast Neoplasms↗

PubMed1998

Determinants of surgical site infection after breast surgery.

BACKGROUND: Surgical site infection (SSI) after breast procedures may result in significant morbidity, psychologic trauma, and additional cost, SSI rates in patients at the Cleveland Clinic Foundation having biopsy, partial mastectomy, or modified radical mastectomy were higher during April and May 1995 than during the previous 12 months (8 infections for 74 procedures [10.8%] vs 10 for 378 [2.6%]; p < 0.006). Since 1993 one surgeon has performed most of these procedures, with no change in operative technique, skin preparation, or surgical team. A case-control study was performed to identify risk factors for infection. METHODS: A case patient was defined as any patient having a breast procedure from April 1994 through May 1995 with culture of a pathogen from surgical site drainage or aspiration or with erythema or presence of cellulitis treated by incision and drainage and/or antibiotic therapy. Randomly selected control patients were matched by time and procedure. There were 18 case patients and 37 control patients. RESULTS: Factors associated with SSI were obesity (78% of cases vs 40% of controls; p = 0.02) and older age (mean 66 years in cases vs 56 years in controls; p = 0.005). After introduction of cefazolin sodium prophylaxis, SSI rate was reduced to 0.9% (3 infections for 332 procedures). CONCLUSIONS: Host factors may contribute to SSI in breast procedures. Cefazolin sodium prophylaxis was useful in preventing SSI after breast surgery.

Age Distribution↗

PubMed1990

Immediate breast reconstruction following mastectomy is as safe as mastectomy alone.

We evaluated wound complications and potential risk factors after mastectomy with immediate breast reconstruction and compared them with similar data after modified radical mastectomy. The incidences of infection, seroma, hematoma, and epidermolysis were compared among 395 patients (305 with modified radical mastectomies and 90 with mastectomy with immediate breast reconstruction) from Virginia Mason Medical Center, Seattle, Wash, between 1983 and 1989. Obesity, age (60 years or older), smoking, antibiotics, and wound drainage were examined as possible risk factors. There were more wound complications in the modified radical mastectomy group (48% vs 31%), and specifically, more seromas (30% vs 13%). In the modified radical mastectomy group, age of 60 years or older was associated with seroma and infection, drainage greater than 30 mL per day (at time of drain removal) with seroma, and smoking with epidermolysis. In the mastectomy with immediate breast reconstruction group, obesity was associated with seroma and epidermolysis. We conclude that mastectomy with immediate breast reconstruction appears to be as safe as modified radical mastectomy alone with respect to wound complications.

Age Factors↗

PubMed1997

Long-term follow-up of axillary node-positive breast cancer patients receiving adjuvant systemic therapy alone: patterns of recurrence.

PURPOSE: Prognostic factors for locoregional failure have been poorly documented. The purpose of this retrospective review is to examine the patterns of failure of 320 patients with Stage II or III axillary node-positive breast cancer who received adjuvant chemotherapy without locoregional radiation. METHODS AND MATERIALS: The records of 735 patients who were referred to the London Regional Cancer Centre between 1980 and 1989 with a diagnosis of Stage II or III breast cancer were reviewed. Three hundred and twenty patients were identified who underwent segmental mastectomy with axillary dissection or modified radical mastectomy and adjuvant chemotherapy without adjuvant locoregional radiation. Seventy-one percent of these patients had undergone a modified radical mastectomy, 40% had T1 tumors, 49% T2, and 11% T3. Resection margins were positive in 13 patients. The median number of axillary nodes removed was 11. Fifty-four percent had one to three positive axillary nodes, 27% had four to seven positive nodes, and 19% had in excess of seven positive nodes. RESULTS: Median follow-up for the 320 patients was 77 months. One hundred and fourteen patients developed a locoregional recurrence as the site of first relapse (31 in the intact breast, 29 on the chest wall, 21 in the axilla, 22 in the supraclavicular fossa, 1 in the internal mammary chain, and 10 in multiple sites). Thirty-three percent of segmental mastectomy patients and 13% of modified radical mastectomy patients developed local recurrence. Seven percent of patients recurred in axillary or supraclavicular nodes each. Factors with regard to locoregional recurrence which on univariate analysis were significant included type of mastectomy (i.e., segmental vs. modified radical), size of primary tumor, positive resection margins, and percentage of ideal chemotherapy dose intensity (< 66% vs. > or = 66%). After multivariate analysis, only type of mastectomy, size of primary tumor, and percentage of ideal chemotherapy dose intensity retained significance. The number of positive axillary nodes was not a significant factor. Number of positive axillary nodes plus the above four clinical factors were analyzed in terms of regional recurrence specifically. By univariate and multivariate analysis, only size of primary tumor retained significance. Again, the number of positive axillary nodes was not a relevant factor. CONCLUSION: Patients receiving adjuvant chemotherapy who are at high risk of locoregional recurrence include those who undergo segmental mastectomy and those with larger tumors (> 5 cm in diameter). Breast or chest wall radiation is recommended for these groups. Supraclavicular radiation is recommended for patients with tumors larger than 5 cm in diameter. Axillary recurrences were relatively infrequent in patients who had undergone an adequate Level I and II axillary dissection, and therefore, axillary radiation was not recommended.

Adult↗