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PubMed2003

Sentinel lymph node biopsy followed by delayed mastectomy and reconstruction.

BACKGROUND: The role of sentinel lymph node (SLN) biopsy with total mastectomy is evolving. In patients who desire mastectomy with immediate reconstruction, the final pathologic results of the SLN may create unique problems. Specifically, if the SLN is found to be positive on final pathology, the reconstructed patient would generally require a potentially difficult re-operation on the remaining axillary nodes. The purpose of this study was to review the results of patients who underwent an initial SNL biopsy followed by a planned mastectomy and reconstruction. METHODS: A chart review of patients who underwent staged SLN biopsy with subsequent definitive procedure between 1997 and 2001 was conducted. These were evaluated with regard to type of tumor, status of sentinel node, and design of subsequent operation. RESULTS: There were 40 patients who underwent an initial SLN biopsy followed by a staged mastectomy with reconstruction. Tumors included high-grade carcinoma in situ (n = 4), infiltrating ductal carcinoma (n = 28), invasive lobular carcinoma (n = 4), mucinous carcinoma (n = 1), adenoid cystic carcinoma (n = 1), and mixed ductal and lobular carcinoma (n = 2). Tissue biopsy was obtained by either open (n = 9) or needle (n = 31) technique. Twenty-five patients had a negative SLN biopsy and a delayed total mastectomy with immediate reconstruction. Positive SLNs were identified in 15 patients (37%). Eight patients had macroscopic nodal metastases and underwent a delayed modified radical mastectomy and immediate reconstruction. Seven patients had microscopic nodal metastases and 3 declined further axillary dissection. They proceeded with total mastectomy and immediate reconstruction. CONCLUSIONS: These data suggest that a substantial proportion of patients treated with SLN biopsy, simple mastectomy, and reconstruction will have positive sentinel lymph nodes. Thus, the ideal approach for patients who wish to have reconstruction should involve an initial SLN biopsy as a separate procedure. If the SLN is benign, the patient may undergo a total mastectomy with immediate reconstruction. However, a patient with a positive SLN may proceed to a modified radical mastectomy with immediate reconstruction. This treatment algorithm eliminates a potentially difficult reoperation on the axilla following reconstruction.

Breast Neoplasms↗

PubMed1980

The insertion of prostheses at mastectomy for carcinoma of the breast--a preliminary report.

There has been a move away from radical surgery for carcinoma of the breast to more conservative measures. However, even simple mastectomy causes considerable mutilation and is psychologically very upsetting for most patients. This has led to attempts at reconstruction of the breast and more recently to prostheses being inserted at the time of mastectomy (1). The early results of this procedure in 30 patients--the total experience of a general surgeon--are reported in this paper.

Adult↗

PubMedDate not supplied

The impact of mastectomy on self-concept and social function: a combined cross-sectional and longitudinal study with comparison groups.

Self-concept and social function following radical, modified radical or simple mastectomy for Stage I or II breast cancer, breast biopsy for benign breast disease, cholecystectomy or no operative procedure were measured across a fifteen-month period in a cross-sectional design and across a twelve-month period in a repeated measures design. Women selected for study were without other preexisting mental or physical illness. The degree of disability observed following mastectomy was considerably less than previously reported in uncontrolled studies, with the incidence of actual disturbance extremely small. Women receiving adjuvant therapies following mastectomy, but not women treated by mastectomy alone, reported significantly more body-image dissatisfaction and feminine self-image concerns than the comparison groups. The findings refute previously published impressions of severe psychosocial maladjustments following mastectomy. The study suggests that post-mastectomy women vulnerable to poorer outcome would be those with lower expectations of good quality social support, other present life stressors, other pre-existing chronic diseases, and a disposition to believe in life outcomes as less under their own control.

Adult↗

PubMed1958

The management of cancer of the breast.

Radical mastectomy is excellent only for cases of operable breast cancer in which the tumor is limited to the breast or to the nodes in the axilla. That there is metastasis to the internal mammary lymph nodes in a high proportion of cases has been "overlooked" for many years. Also it is probable that metastasis occurs to the supraclavicular lymph nodes more often than is suspected. Hence the extended radical mastectomy operation leaves much to be desired. There has been no significant improvement in recent years in the mortality rate of mammary cancer. Simple mastectomy and thorough adequate postoperative radiation therapy have much to offer. Treatment of "operable" breast cancer should be a cooperative effort of surgeon, radiation therapist and pathologist.

Axilla↗

PubMed1987

Mastectomies for malignancy: a DRG-based hospital utilization analysis.

The study identified hospital utilization patterns by diagnosis-related group (DRG) produced by mastectomies for malignancy in Sacramento, California, and Syracuse, New York, for the years 1981-1984. A total of 3,449 discharges were included. Total and subtotal mastectomy discharges per capita increased in both areas. The proportion of mastectomy discharges attributed to total mastectomies increased in Sacramento and decreased in Syracuse. Mean stays for mastectomy DRGs declined by 13.72 to 56.38%. In 1984 mean stays ranged from 4.79 to 7.49 days for total mastectomies and 1.88 to 5.44 days for subtotal mastectomies. A major problem identified by the study was the lack of DRG sensitivity to differences in types of procedures. Under DRGs, radical and simple mastectomies are combined in one type of category, while subtotal mastectomies, quadrant resections, and breast biopsies are combined in another.

Breast Neoplasms↗

PubMedDate not supplied

Male breast malignancy in Jos University Teaching Hospital.

BACKGROUND: Male breast malignancies are rare. Cancer of the male breast accounts for about 1% of all breast cancers. Poor level of awareness often results in late presentation and delayed diagnosis in our environment. PATIENTS AND METHODS: A retrospective study of all cases of male breast cancer (MBC) managed in Jos University Teaching Hospital over a 17-year period (January 1987-December 2003.) RESULTS: A total of 302 cases of breast malignancies were managed over the study period. Twenty-six (8.6%) of these were males giving a male:female ratio of 1:10.6. The ages of the 26 MBC cases ranged from 12 years to 85 years, with a mean of 57.9 years and median age of 67 years. The right breast was affected in 15 and the left in 11. Mean duration of symptoms before presentation was 6 months with a range of 3 months to 4 years. All the patients had history of breast lumps, 21 (80.8%) of which were painless. Skin ulceration and axillary node enlargement were present in 19(73.1%) and 24(92.3%) respectively. Five (19.2%) were stage II; 15(57.7%) stage III and 6(23.1%) stage IV. There were 23 (88.5%) carcinomas, 2 (7.7%) fibrosarcomas and a case of Hodgkin's lymphoma. Invasive ductal carcinoma was the most common histological type in 20 (76.9%) of all breast malignancy and 20 (87.0%) of all breast carcinomas. Modified radical mastectomy (mastectomy with axillary clearance with or without division of the pectoralis minor muscle) was done in 10(38.5%) patients. Two of these were fibrosarcomas. Simple mastectomy was done in 13 (50%) as toilet procedures for advanced disease. The only case of Hodgkin's lymphoma had chemotherapy. Bilateral orchidectomy (BO), Tamoxifen, chemotherapy and radiotherapy were offered in 7(26.9%), 13(50%), 17(65.4%) and 7(26.9%) patients respectively. Wound infection was the most common complication in 14(53.8%) patients. There was no case of hospital mortality. CONCLUSION: MBC accounts for 8.6% of all breast cancers in our centre. It affects elderly males. Late presentation with advanced disease and ulceration is a common feature in our environment.

Adolescent↗

PubMed1977

Recurrent operable breast cancer following incomplete mastectomy.

Forty patients have been treated with recurrent operable breast cancer after having undergone procedures less extensive than modified radical mastectomy as a treatment of the primary, with or without radiation therapy. Initial pathology was invasive cancer in 21 patients, and treatment (excision or simple mastectomy, with or without radiation therapy) has been offered as the treatment of choice. Completion of radical mastectomy was done here in 30 patients, extended radical mastectomy in 3, and local excision in 7. Eleven received postoperative radiation therapy. The overall 5-year survival rate from the time of treatment, free of disease, was 40 per cent, and the 10-year survival rate was 20 per cent. If initial treatment included radiation therapy, survival was improved (12/25 vs 4/15 having no radiation therapy). Axillary nodal involvement was extensive, with 13 patients having positive level III nodes. Such patients should be followed closely in order to detect recurrence earlier. Adjuvant radiation therapy and chemotherapy trials post mastectomy should be evaluated in the hope of improving survival.

Adult↗

PubMed1981

Male breast cancer.

This study comprises 27 cases of male breast cancer treated at the University Hospital from 1966 through 1978. Its incidence was 0.53% of all cancer in males and 3.2% of all mammary cancers. Mean age was 52 years old. Lump in the breast was the commonest presenting feature in all patients followed by skin ulceration in 44.4% of cases. The average duration of symptoms was 16 months. Twenty-five patients had infiltrating duct carcinoma and two had papillary carcinoma. Two cases were in stage I, 10 in stage II, 11 in stage III, and 4 in stage IV. Of the 12 patients in stages I and II who underwent radical mastectomy, the axillary lymph nodes were pathologically negative in stage I and positive in stage II. The nodes were clinically involved in stages III and IV. Simple mastectomy followed by radiotherapy were used in stage III cancer and all patients in stage IV cancer had only biopsy and palliative chemotherapy. Bilateral orchidectomy followed by estrogen gave only marginal benefit in terms of survival and objective regression. Only four patients, two each in stages I and II, are alive and well for more than five years. These include two cases of papillary carcinoma. Poor prognosis in this series was exclusively determined by axillary lymph node involvement, although other factors such as shorter span of symptoms, younger age group, higher incidence of skin involvement, and invasive nature of carcinoma also appear to be significant.

Adult↗

PubMed1982

Periareolar abscess in the nonlactating breast.

Periareolar abscesses in nonlactating women are usually accompanied by a sinus tract that communicates with the nipple. This abnormal tract represents the source of the initial invasive infection and, if left unattended, may be the nidus for recurrence. The medical records of 32 patients with periareolar abscess treated at Temple University Hospital from January 1970 through January 1980 were reviewed. Follow-up data were obtained recently for 21 patients, including 1 patient with bilateral disease. Several patients also had an inverted nipple. Nineteen patients denied recurrence after our initial treatment and two required a secondary procedure for cure. Only one patient was dissatisfied with the postoperative appearance of the surgical site. None required partial or simple mastectomy for cure, as reported elsewhere. Excision of the sinus tract and, when present, correction of the inverted nipple as herein described are necessary to prevent reinfection. Simple abscess excision or incision and drainage is usually inadequate therapy.

Abscess↗

PubMed1986

Post mastectomy pain after brachial plexus palsy: metastases or radiation neuritis?

Three patients have been reported who developed metastatic tumour within the neural tissue of the brachial plexus three years, four years and fourteen years respectively after treatment of breast carcinoma by simple mastectomy and postoperative radiotherapy. A fourth patient who developed bilateral upper limb paralysis after radiotherapy for a lymphoma is also reported. At exploration of the brachial plexus extensive fibrosis was present in all cases with metastases only diagnosed through biopsy of neural tissue. The clinical features and the role of surgery are discussed in the light of our experience and a review of available literature.

Adult↗

PubMed1977

Combination of regional chemotherapy and mastectomy in the treatment of carcinoma of the breast. Five-year results.

Thirty-six women with cancer of the breast were treated with infusion of cytotoxic drugs into the first portion of the subclavian artery adjuvant to radical or simple mastectomy. The patients were followed up for five years and the results were compared with a matched group of patients treated by mastectomy alone. There was no difference between the two groups in the overall mortality at the end of the fith year. The survival rates of patients with stage 3 carcinoma receiving adjuvant chemotherapy were in the first three years significantly better than those of the controls. No impairment of the wound healing was observed and the systemic side effects of the cytotoxic drugs were unimportant. In two patients serious neurologic complications developed and one patient died of pulmonary abscess.

Adult↗

PubMed2002

[Current indications for mastectomy in patients with breast cancer].

Recent aggressive changes in the strategy for breast cancer treatment have reduced the frequency of mastectomy as the primary surgery. In addition to the current expanded indications for breast-conserving therapy (BCT), the introduction of preoperative chemotherapy for patients with operable tumors allows BCT to be performed in a larger population of patients. The results of a questionnaire on breast cancer surgery conducted in Japan in 2000 revealed that the frequency of radical modified mastectomy had decreased by 52.2%. However, mastectomy cannot be completely eliminated, since some patients still present with locally advanced tumors and preoperative chemotherapy cannot remove the requirement for mastectomy in all patients. The current standard procedure for mastectomy appears to be the Auchincloss operation. The Halsted radical mastectomy is performed only for patients with cancer involving the pectoralis major muscle or the chest wall, and/or with marked axillary lymph node metastasis and Rotter's node metastasis. Simple mastectomy is selected for wide-spread noninvasive cancer and recently in our department for patients confirmed to be node negative by preoperative sentinely lymph node biopsy. In dealing with the changes in the treatment algorithm, we need to select the appropriate surgical options flexibly.

Algorithms↗

PubMed1983

Adenoid cystic carcinoma of the breast. Report of 11 new cases: review of the literature and discussion of biological behavior.

Eleven new cases of adenoid cystic carcinoma of the breast are added to the 95 previously reported. They were studied for their biological behavior, and an attempt was made to correlate histologic features with prognosis. A comparison was made with analogous tumors in extramammary sites, and possible relationship with carcinoid tumors of the breast explored. The patients in the study followed a biological course very similar to that described by previous studies, i.e., slow progression, local recurrence if inadequately resected, and absence of lymph node metastases. Only one patient developed distant metastases after an interval of ten years following radical mastectomy. If the diagnosis of adenoid cystic carcinoma is reserved for those lesions displaying the distinctive appearance and typical epithelial-stromal relationships which have been described, the authors feel that simple mastectomy with careful follow-up surveillance is the treatment of choice.

Adult↗

PubMed2004

The surgical management of high-grade gynecomastia.

It is now well accepted that low grades of gynecomastia are best treated with liposuction alone. However, the surgical management of the high-grade gynecomastia (Simon's grade III) has remained problematic because both liposuction and conventional subcutaneous mastectomy (without skin excision) have frequently resulted in significant residual skin redundancy, requiring a second operation for skin resection. Our preferred approach to high-grade gynecomastia has been the single-stage subcutaneous mastectomy and circumareolar concentric skin reduction with deepithelialization. However, in the rare case of tubular breast deformity in the male and also in patients with gynecomastia who underwent massive weight loss, simple mastectomy and free nipple graft is performed. Therefore, these 2 groups of patients will be excluded from the current series. Twenty-four consecutive males with high-grade gynecomastia were reviewed. All patients underwent subcutaneous mastectomy with concentric skin resection. There were no major complications such as infection, hematoma, seroma, or nipple-areola complex necrosis. The main disadvantage of the technique was the mild residual skin redundancy, which was noted in all 24 patients. This redundancy, however, was never severe enough to require a secondary procedure, and all patients were satisfied with the final result.

Gynecomastia↗

PubMed1985

Local regional effectiveness of surgery and radiation therapy in the treatment of breast cancer.

Although gross tumor can be controlled with high doses of radiation therapy, control is achieved at the expense of severe radiation sequelae. In order to improve tumor control with minimum complications, the field of treatment should contain only subclinical disease. This article reviews the successful combination of surgery for the removal of gross cancer and radiation of moderate dose for the treatment of subclinical disease in patients with breast cancer. In patients with clinically favorable and operable disease, the combination of a radical or modified radical mastectomy and postoperative radiation therapy of 5000 rad to the peripheral lymphatics and chest wall can secure 90% of the treated areas. For patients with locally and regionally advanced breast cancer, the combination of a simple mastectomy and dissection of the lateral axilla followed by postoperative irradiation of 5000 rad in 5 weeks to the chest wall, axilla, and peripheral lymphatic areas will control more than 85% of the patients treated as compared with approximately 70% control when surgery or radiotherapy alone is used, even with chemotherapy. Yet another clinical application of the subclinical disease concept is the successful combination of conservation surgery (whether segmental mastectomy, quadrantectomy, or wide excision) for gross tumor in the breast and axilla and irradiation for residual microscopic and multiple foci of tumor, yielding more than 90% control of locoregional disease with survival rates equal to those patients treated with radical or modified radical mastectomy. Results of multiple clinical trials and reported series are reviewed.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1998

Assessment of treatment for patients with primary ductal carcinoma in situ in the breast.

BACKGROUND: Current mammographic technology has resulted in increased detection of ductal carcinoma in situ (DCIS). It is necessary to assess which patients presenting with DCIS are good candidates for breast conservation and which of these patients should receive adjuvant radiation. METHODS: We accrued clinical data for 124 patients with a primary diagnosis of DCIS from 1979 through 1994. Primary therapy was a mastectomy for 18 patients, and a lumpectomy for 106 patients. Only 18 of the latter group of patients received adjuvant radiotherapy. For the 88 lumpectomy-alone patients (median follow-up, 5.2 years), we evaluated the effects of clinical (age and initial presentation) and pathologic (nuclear grade, architecture, parenchymal involvement, calcifications, and measured margins) factors on recurrence of DCIS or the development of invasive breast cancer. RESULTS: Patients who underwent lumpectomy with or without adjuvant radiotherapy (median follow-up, 5.0 years) were significantly more likely to have recurrence of DCIS (P=.05) than those who underwent mastectomy (median follow-up, 6.7 years): 18% (19/106) versus 0% (0/18), respectively; lumpectomy-alone patients experienced a 19% (17/88) rate of DCIS recurrence. All recurrent DCIS was ipsilateral. For lumpectomy-alone patients, the factors associated with ipsilateral recurrence of DCIS were extent of involvement of the parenchyma (P=.01, for univariate; P=.07, for multivariate) and initial presentation (P=.05, for univariate; P=.07, for multivariate). Eleven lumpectomy-alone patients developed invasive breast cancer (6 ipsilateral, 5 contralateral); none of the 18 lumpectomy patients who received adjuvant radiation developed invasive disease. None of the factors investigated, including primary surgery and adjuvant radiotherapy, were associated with a significant effect on the development of invasive disease. CONCLUSIONS: Longer follow-up is required to determine if the benefits of either mastectomy or radiotherapy following lumpectomy persist. There is a suggestion that patients under 40 years of age or women who present with nipple discharge might be considered for either adjuvant radiotherapy following lumpectomy or a simple mastectomy.

Adult↗

PubMedDate not supplied

Normal and abnormal US findings at the mastectomy site.

Evaluation of a mastectomy site is more effective with ultrasonography (US) than with either mammography or chest computed tomography because abnormalities are usually small and close to the skin surface. US does not involve the use of ionizing radiation and has a multiplanar scanning capability. The technique is readily available and inexpensive, and it allows real-time monitoring of needle tip placement during biopsy of a lesion. Normal US anatomy of the chest wall after mastectomy usually consists of four layers: skin, subcutaneous fat, pectoral muscles, and rib and intercostal muscle. The axilla is changed in appearance after lymph node dissection, but it remains the same in patients who have undergone simple mastectomy. US can accurately depict benign and malignant conditions in the mastectomy site, including fluid collection, fibrosis, local recurrent tumor, and metastatic lymphadenopathy, and can enable accurate diagnosis based on findings at fine needle aspiration biopsy.

Adult↗

PubMed1988

[Achievements of tumor surgery in tumors of the breast].

Radical mastectomy (Rotter-Halsted) lowered the local and regional recurrence rate from 60% to 6%. Prospective randomized trials showed that there are no differences in overall survival or disease-free survival when a combination of simple mastectomy and lymph node dissection is used; the axillary recurrence rate was 1.8%. Adjuvant radiotherapy is superfluous. Conservative therapy should be reserved for stage I carcinomas in breast cancer.

Breast Neoplasms↗