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Results for “Mastectomy, Modified Radical”

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PubMed1989

[Breast carcinoma: breast-preserving therapy and cosmetic results].

Conservative surgery and radiation therapy for breast cancer is now a well accepted alternative to modified radical mastectomy but the esthetic results are not always satisfactory and often inferior to mastectomy and reconstruction of the breast. The different problems are discussed. A list of selective criteria for limited surgery is established. The author warns against the routine use of conservative surgery and radiation. He gives an overview of the different breast reconstruction techniques.

Adult↗

PubMed2005

[Application of endoscopy-assistant operation in surgical treatment of breast diseases].

OBJECTIVE: To explore the technique and problems of endoscope-assistant breast surgery. METHODS: Five patients with breast cancer underwent endoscope-assistant modified radical mastectomy, 30 patients with breast cancer underwent endoscope-assistant modified radical mastectomy with small incision, and 13 patients with breast cancer underwent endoscope-assistant resection of breast cancer with retained breast plus axillary lymph node dissection. Two patients with fibroadenoma and 2 patients with fibrocystic disease breast with atypical hyperplasia were treated with endoscope-assistant subcutaneous total mastectomy and breast reconstruction by one-stage silica gel filling operation. Seven patients with fibrocystic disease with atypical hyperplasia and 16 patients with gynecomastia were treated with endoscope-assistant subcutaneous total mastectomy. One 10-month-old infant with huge chest lymphangioma was treated with endoscope-assistant tumor resection via axilla. RESULTS: All operations were performed smoothly. The duration of operation was 180 approximately 360 min. The frozen sections of skin and breast tissue at the incision margin resected during operation endoscope-assistant modified radical mastectomy with small incision and endoscope-assistant conservative surgery were all negative There were 2 cases of postoperative incisional bleeding, 1 case of skin margin necrosis of axillary incision, 1 case of skin margin incisional necrosis after endoscope-assistant resection of breast cancer with retained breast plus axillary lymph node dissection, 4 cases of epidermal necrosis of nipple, and one case of full thickness skin necrosis of nipple surface. CONCLUSION: Endoscope-assistant breast surgery has changed the routine method in breast operation and manifests the cosmetic effects that cannot be achieved by routine surgery.

Adolescent↗

PubMed1991

Breast biopsy techniques and adequacy of margins.

The change toward breast-conserving surgery for cancer has altered the role of the initial biopsy. We retrospectively analyzed two methods, traditional excisional biopsy (n = 47) and lumpectomy (n = 44) to evaluate their usefulness as the initial procedure for breast-conserving surgery. Lumpectomy required more time (mean +/- SEM, 53 +/- 3 minutes) than traditional biopsy (37 +/- 2 minutes). Margins were verified by microscopic examination to be clear in 73% of the patients in the lumpectomy group and in only 17% of patients in the traditional biopsy group. Patients in the lumpectomy group subsequently underwent more axillary dissections than patients in the traditional biopsy group (31% vs 4%, respectively) and fewer modified radical mastectomies (49% vs 71%, respectively). A correlation between extensive intraductal components and positive margins was found in the lumpectomy group. These data suggest that as the initial biopsy method, lumpectomy more often provides adequate margins and may decrease the number of subsequent procedures on the breast for breast-conserving surgery.

Adult↗

PubMedDate not supplied

Arm morbidity following treatment of breast cancer with total axillary dissection: a multivariated approach.

In order to clarify the factors that mainly influence arm morbidity following treatment of breast cancer with the full axillary dissection protocol, we evaluated, in a model of multiple regression analysis, parameters such as the type of breast surgery, adjuvant radiotherapy, time of irradiation, age, number of dissected nodes and axillary nodal status. A total of 104 women were studied. Late arm edema was observed in 17% of the patients and was more frequent when (1) irradiation was given immediately after the operation than if it was given 6 months later (p = 0.009) and (2) the number of removed nodes exceeded 40 (p = 0.037). Upper limb pain was reported by 16% of the patients and was reported more frequently from patients over 60 years of age (p = 0.036), as well as from patients who underwent modified radical mastectomy (p = 0.044) and those in whom 30-40 nodes were dissected (p = 0.025). Shoulder joint mobility was impaired in 17% of the patients, and it was not affected by any of the examined factors. It seems that conservative breast surgery or adjuvant breast radiotherapy 6 months after the operation might reduce independently the likelihood of arm morbidity by 25%.

Age Factors↗

PubMedDate not supplied

How breast cancer patients choose a treatment method.

This paper discusses two treatment options for early stage breast cancer--modified radical mastectomy and lumpectomy plus radiation therapy--and examines the reasons why women choose one method of treatment over the other. In examining how women make their treatment decision, the paper reviews the literature regarding how psychological, emotional and psychosocial factors play a role in determining a method of treatment. It also discusses coping methods during breast cancer treatment, why women choose to undergo breast reconstruction and to whom they look for information when making health decisions.

Breast Neoplasms↗

PubMed1993

Definitive surgery for breast cancer performed on an outpatient basis.

OBJECTIVE: More than 160,000 women will develop breast cancer in the United States during the next year. Traditionally, their definitive surgery has been performed on an inpatient basis, with postoperative hospital stays ranging from 1 to 7 days. DESIGN: Retrospective review of cases and results. PATIENTS: Two hundred twenty-one patients underwent 223 definitive surgical procedures for carcinoma of the breast, entirely on an outpatient basis, between September 1990 and June 1992. Operations included 31 modified radical mastectomies, 101 partial mastectomies with radical axillary node dissections, 11 total mastectomies, 69 partial mastectomies, and 11 radical axillary dissections. RESULTS: There were no deaths, and no serious complications. No patient required hospitalization for any reason. There were no wound infections. Patient satisfaction was high, and compliance was excellent. CONCLUSIONS: Most operations for carcinoma of the breast can be performed on an outpatient basis, without increasing the risk of complications.

Adult↗

PubMed1989

Psychological factors in the choice of treatment for breast cancer.

For several years women with an early diagnosis of breast cancer have been able to choose between two equally effective treatments: modified radical mastectomy and the breast-conserving treatment of lumpectomy plus radiation therapy. This study investigated the psychological factors that become involved when a woman chooses between treatments. Many more anticipatory concerns about body image, disfigurement, femininity, and the ability (or inability) to handle emotionally a mastectomy were expressed by lumpectomy/radiation therapy patients than by mastectomy patients. Those lumpectomy-radiation therapy patients who chose the treatment against medical advice were also found to be more concerned than the others about treatment effects on sexuality.

Adaptation, Psychological↗

PubMed1991

[Surgical and adjuvant therapy of breast cancer].

This is a report on 512 patients operated on for primary breast cancer in 1988 and 1989 at the Central Institute of Cancer Research in Berlin-Buch. Most patients were postmenopausal (52%), 17.7% were aged 45 to 49 years. The average duration of the symptoms was 6.1 months. 45.4% of all the tumours were located in the upper outer quadrant, 47.3% in the right and 52.7% in the left breast. Clinical evaluation and mammography had a sensitivity of 89%, 93.7% respectively. Invasive ductal carcinomas were histologically proven in 319 cases, less frequently (n = 118) invasive lobular tumours. Predominant surgical procedures were the quadrantectomy with axillary dissection (33%) and the modified radical mastectomy according to Auchincloss-Madden (25.5%). In the case of medially/centrally located tumours and axillary lymph node involvement greater than or equal to 4 nodes independent of the tumour site we performed the IMN-biopsy in 129 patients. The majority of the premenopausal node positive patients received adjuvant chemotherapy (94.4%), postmenopausal node positive patients with positive ER received adjuvant tamoxifen. Postoperative irradiation indicated was applied in 25 patients.

Adult↗

PubMed1998

Changes in the treatment outcome of node-positive breast cancer stratified by menopausal status: comparison of patients treated in 1965-75 versus those treated in 1976-86.

OBJECTIVE: The objective of this study was to examine whether and to what extent the outcome of treatment for lymph-node positive breast cancer patients improved between the periods 1965-75 and 1976-86. METHODS: The subjects were 1595 patients with breast cancer positive for lymph node metastasis who were treated at the National Cancer Center Hospital between 1965 and 1986. In order to analyze background factors and treatment outcome, we classified the patients into four groups stratified by the time of initial surgery (1965-75/1976-86) and menopausal status (premenopause/postmenopause). RESULTS: With respect to the clinicopathological background factors, significant changes between the periods 1965-75 and 1976-86 were more frequent use of modified radical mastectomy and postoperative adjuvant chemoendocrine therapy and less frequent use of postoperative radiotherapy in both pre- and postmenopausal patients. The 10-year disease-free and overall survival rates improved by approximately 15-20% between 1965-75 and 1976-86 in this group of patients, regardless of menopausal status. CONCLUSION: The patients with node-positive disease treated at our hospital showed an increase in both disease-free and overall survival from 1965 to 1986.

Adult↗

PubMed1992

Intramammary lymph nodes.

AIMS: To determine the prevalence and pathology of intramammary lymph nodes in breast specimens. METHODS: All breast specimens examined by a single pathologist over 70 months in a large teaching hospital were studied retrospectively. All the surgical pathology reports were reviewed. Relevant glass slides from cases in which intramammary lymph nodes were identified were also reexamined. RESULTS: Breast specimens (n = 682) were examined. Seven lymph nodes were found in five patients. The specimens comprised 533 biopsy specimens, 29 segmental resections, 22 reduction mammoplasties, 77 modified radical mastectomies and 20 gynecomastia mastectomies. No clinically relevant microscopical abnormalities were found in four lymph nodes and slight sinus histiocytosis was seen in two nodes. One node contained metastatic adenocarcinoma and benign glandular epithelial inclusions. CONCLUSION: Although rare, intramammary lymph nodes may be detected by careful gross examination of breast specimens even in the absence of clinical identification. They can occur in any quadrant of the breast and can display a variety of pathological conditions. Pathologists should be alert to the existence and potential importance of these lymph nodes.

Adenocarcinoma↗

PubMed2003

Synchronous bilateral breast cancer with Paget's disease and invasive ductal carcinoma: report of a case.

We report a case of synchronous bilateral breast cancer with Paget's disease and invasive ductal carcinoma. A 60-year-old Japanese woman presented with an 8-month history of discharge from the left nipple with eczema and itching. Mammography showed grouped fine calcification in the right breast, which was highly suggestive of right breast carcinoma with an intraductal component. Ultrasonography did not reveal any mass lesions in the bilateral breasts, and computed tomography and bone scintigraphy showed no site of distant metastasis. We performed a modified radical mastectomy for Paget's disease in the left breast and breast-conserving surgery for ductal carcinoma in the right breast. The histological diagnosis was Paget's disease in the left breast and invasive ductal carcinoma with a predominant intraductal component in the right breast. There was no metastasis in any of the 24 left axillary lymph nodes resected. We also gave her postoperative adjuvant chemoendocrine therapy, comprised of tamoxifen (20 mg) and UFT (uracil/tegafur) (400 mg)daily. The patient has been disease-free for 4 years since her operation.

Breast Neoplasms↗

PubMed1990

Breast cancer in situ: a retrospective review of 23 cases with a minimum of 10-year followup.

Twenty-three cases of breast carcinoma in situ (12 with intraductal carcinoma and 11 with lobular carcinoma in situ) seen at Charleston Area Medical Center between 1957 and 1977 were reviewed. The mean age diagnosis was 50 years (age range: 30-86 years). An asymptomatic breast mass was the initial symptom in 19 patients (82 per cent). Mammography, performed in seven patients, was abnormal in five. A simple or modified radical mastectomy was performed in 20 women and wedge resection in three. Twenty-two women underwent ipsilateral axillary nodal dissection, and all but one had histologically-negative nodes. Only one patient in this series died with metastatic breast cancer. Six other patients died from non-malignant causes. Sixteen patients are still alive with no evidence of disease from 11.5 to 26.5 years after the initial diagnosis. The role of simple excision with or without radiotherapy in breast carcinoma in situ remains to be determined.

Adult↗

PubMed2000

Breast cancer surgery: comparing surgical groups and determining individual differences in postoperative sexuality and body change stress.

Women diagnosed and surgically treated for regional breast cancer (N = 190) were studied to determine the sexual and body change sequelae for women receiving modified radical mastectomy (MRM) with breast reconstruction in comparison with the sequelae for women receiving breast-conserving therapy (BCT) or MRM without breast reconstruction. The sexuality pattern for women receiving reconstructive surgery was one that was significantly different--with lower rates of activity and fewer signs of sexual responsiveness--than that for women in either of the other groups. Significantly higher levels of traumatic stress and situational distress regarding the breast changes were reported by the women receiving an MRM in contrast to the women treated with BCT. Using a model to predict sexual morbidity, regression analyses revealed that individual differences in sexual self-schema were related to both sexual and body change stress outcomes.

Adult↗

PubMed1993

Psychosocial and functional status of breast cancer patients. The influence of diagnosis and treatment choice.

This exploratory study examined breast cancer patients' psychosocial and functional status at the time of diagnosis and during the initial phase of treatment. The purpose was to better understand the impact of diagnosis and treatment on patients' physical state and psychosocial well-being. A convenience sample was drawn from a population of newly diagnosed stage 1 and 2 breast cancer patients undergoing either modified radical mastectomy or lumpectomy with radiation. Subjects completed instruments designed to measure uncertainty, quality of life, functional status, and reaction to diagnosis on two separate occasions: at the time of diagnosis, but before treatment selection and then approximately 8 weeks after surgery. Data obtained from 52 subjects indicated that patients' perceptual uncertainty and various aspects of their functional status declined over the initial course of treatment, but that quality of life was unaffected. The results also showed no relationship between type of breast cancer treatment and patients' uncertainty, quality of life, and functional status. Mastectomy and lumpectomy patients also responded in similar ways to the cancer diagnosis. Both groups experienced the same amount of distress and used conformational coping strategies to similar degrees. Clinical implications are discussed and recommendations are made for future research.

Activities of Daily Living↗

PubMed1998

Current issues in the surgical treatment of early stage breast cancer.

Surgery remains the primary treatment for early stage breast cancer. Modified radical mastectomy and lumpectomy with axillary dissection continue to be the two procedures most commonly performed. Changes in the healthcare system and advances in medical research in cancer treatment affect the nursing care of these patients. The introduction of the sentinel node biopsy may change certain aspects of surgical treatment, as some patients may not require an axillary dissection. The challenge for nurses is to provide quality care and maintain established standards for patients with breast cancer as their hospitalizations are shortened to same day or overnight stays. The purpose of this article is to review the standard surgical treatments and related nursing care and discuss the impact of the sentinel node biopsy and the impact of changes in the length of hospital stay on the care of women with breast cancer.

Breast Neoplasms↗

PubMedDate not supplied

[Lacking effect of timing of surgery in relation to the menstrual cycle on prognosis of breast cancer in premenopausal women].

The influence of timing of surgery in relation to menstrual period on survival of breast cancer patients has been both advanced advocated and disputed. A meta-analysis on published series showed a statistically significant overall odds reduction when surgery is performed in the luteal phase. The records of 165 premenopausal M- breast cancer women, not on hormonal therapies, consecutively operated on from 1977 to 1991 were reviewed. All patients underwent modified radical mastectomies or quadrantectomies plus operative radiotherapy, Node-positive patients received standard adjuvant chemotherapy. Cox regression analysis was used to estimate the relative risk (RR) of death in three models including timing of surgery, age, histology, pathological T and N. In each model, patients were divided into two groups according to the criteria proposed by Badwe, Hrushesky, and Senie. Multivariate analysis showed a significant association between pT and pN and survival, whereas no association with survival was observed for timing of surgery according to Badwe or Hrushesky or Senie criteria (RR = 1.26, RR = 0.91, and RR = 0.88 respectively). Up-to-date agreement on the menstrual phase and relative expected better prognosis is still lacking.

Adult↗

PubMedDate not supplied

Conservative surgery for the management of invasive and noninvasive carcinoma of the breast: NSABP trials. National Surgical Adjuvant Breast and Bowel Project.

In 1976 the National Surgical Adjuvant Breast and Bowel Project (NSABP) initiated a randomized trial (B-06) to evaluate the worth of lumpectomy in the treatment of patients with stages I and II breast cancer. This report presents, for the first time, findings from that trial through 10 years of follow-up relative to ipsilateral breast tumor recurrence (IBTR), distant disease-free survival, and survival of patients who were treated by modified radical mastectomy, lumpectomy, or lumpectomy followed by breast irradiation. The report indicates that the incidence of IBTR observed in the B-06 trial is decreased by effective systemic therapy as well. Also commented on are a number of issues regarding the use of lumpectomy that are of concern to clinicians. They relate to the need for tumor specimen margins, the size of tumors amenable to lumpectomy, treatment of breast tumor recurrence, lumpectomy in older women, and other concerns. No patient or tumor characteristics have been identified that preclude the use of lumpectomy and radiation therapy. All evidence continues to justify the use of lumpectomy and breast irradiation for the treatment of invasive breast cancer. In addition, we have noted findings that indicate the propriety of lumpectomy and breast irradiation for treatment of localized ductal carcinoma in situ.

Breast Neoplasms↗

PubMed2005

Patient demographics and treatment for early breast cancer: an observational study.

This study aims to examine relationships between demographic factors and treatment choice for early breast cancer (T2/N<1). Two hundred and two patients were offered modified radical mastectomy (MRM), breast conserving therapy (BCT) or MRM and reconstruction and interviewed at a University Hospital and oncology centre in South Wales. Median age at treatment was 57 (32-90) years. Seventy-one patients (35%) choose MRM, 10 (5%) MRM and reconstruction and 121 (60%) BCT. Median age of women choosing MRM was 61 and 55 for BC (P<0.0001). Single women (P=0.009) and those with no family history of breast cancer (P=0.02) were more likely to choose MRM. There was no difference between treatment choice and method of cancer detection and the age at which the patient left education (P=0.065). Mean histological tumour diameter was smaller for women choosing BC (15 mm) than for women choosing mastectomy (17 mm; P=0.014). There was no association between tumour grade and treatment choice.

Adult↗