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PubMed1992

[Reconstructive measures in local recurrence after breast saving therapy of breast cancer].

Local recurrence after breast preserving treatment of breast cancer will usually be treated by simple mastectomy. Safe immediate reconstruction is only possible by use of a musculocutaneous flap, the latissimus dorsi flap or better by the rectus abdominis musculocutaneous flap in it's vertical (VRAM) or transverse (TRAM) variation. As a sequel of the irradiation, one stage reconstruction with a simple submuscular implant or an expander prosthesis has a higher complication rate. Personal experience with 42 rectus flaps is reported. The rate of total necrosis was 5%, in one patient a late desmoid tumor was found in the donor area.

Adult↗

PubMed1975

[Early histological findings of carcinoma of the breast (author's transl)].

Histologically the early histological findings of the carcinoma of the breast enclose lobular and intraductal carcinoma in situ, and atypical epithelial proliferation. Without mastectomy a considerable percentage of these cases will develop invasive carcinoma. In order to detect these early forms of carcinoma mammography should be carried out. Following this procedure a more precisely located histological examination can be performed. The treatment consists of simple mastectomy.

Breast Neoplasms↗

PubMed1984

Subcutaneous mastectomy for primary operable breast cancer.

Subcutaneous mastectomy has been performed on 98 patients with primary breast cancer. Eighty-four have undergone breast reconstruction using a silicone prosthesis. The overall complication rate has been low. The rates of local recurrence and survival are similar to those in patients undergoing simple mastectomy.

Breast↗

PubMed1997

[Angiosarcoma of the breast. Apropos of 8 cases and review of the literature].

The 8 cases of primary breast angiosarcoma which were diagnosed, treated and had their follow-up at the Gustave-Roussy Institute between 1954 and 1995 are reported. The age at presentation ranged from 32 to 68 years. In 4 patients the vascular nature of their mammary lesion was conspicuous by a violaceous discolorations of the overlying skin. No patient had enlarged ipsilateral axillary lymph nodes. One patient had metastases. In 2 out of 5 patients who had a partial surgical or fine-needle biopsy before treatment, the diagnosis was missed, and adequate treatment was unduly delayed. The tumor most often presents as an ill defined area made of dense endothelium-lined papillae. A remarkable picture of "soap bubbles" has been identified in 4 cases. The "meshes" of fatty areas appear to be reinforced as they are infiltrated by tumor cells. This appearance may be specific of mammary angiosarcoma. By the French Cancer Centers' grading system for soft tissue sarcomas in general, grade is III in 3 tumors, II in 2 tumors, I in 3 tumors. Five tumors were treated by total mastectomy only. In 3 cases a total mastectomy was followed by radiation therapy to the chest wall. At diagnosis a chemotherapy was administered only to the patient who had metastases. Median disease-free survival was 9 months. Median overall survival was 13 months. From a review of the literature a simple mastectomy appears to be necessary as well as enough for local treatment. Patients with a grade III angiosarcoma of the breast should be included into a therapeutical trial of adjuvant chemotherapy for soft tissue sarcomas in general.

Adult↗

PubMed2000

c-erbB-4 protein expression in human breast cancer.

The Type 1 family of growth factor receptors includes epidermal growth factor receptor (EGFR), c-erbB-2, c-erbB-3 and c-erbB-4. Overexpression of the first two members is associated with poorer prognosis in patients with breast carcinoma. In this study we examined the expression of c-erbB-4 protein using the monoclonal antibody HFR-1. A total of 127 consecutive cases of primary operable invasive breast carcinoma presenting between 1975 and 1977 were studied. All patients were managed by simple mastectomy or conservation surgery with radiotherapy and no adjuvant therapy given. Long-term follow-up was maintained. Routine, formalin-fixed, paraffin-embedded tumour samples were used and sections were stained immunohistochemically using the Duet StreptABC method. Immunoreactivity was classified using a simple semi-quantitative scoring method. Protein expression was generally low but definite positive cytoplasmic, membranous and nuclear reactivity was identified in 58%, 41% and 25% of cases respectively. Expression at all three sites demonstrated significant inverse associations were histological grade. In addition, membrane accentuation correlated inversely with the Nottingham Prognostic Index (NPI), while cytoplasmic reactivity showed a positive association with c-erbB-3 expression. No significant associations were found with disease-free interval or survival. The results of this study demonstrate that higher levels of c-erbB-4 protein expression are associated with a more differentiated histological phenotype in contrast to the other members of the Type 1 family. Larger series with extended follow-up will be required to ascertain definitively the prognostic value of c-erbB-4 expression in breast carcinoma.

Adult↗

PubMed1992

Breast cancer in the elderly: treatment of operable disease.

Between 1976 and 1985 122 elderly patients aged 70 years and over, were treated for 'operable' invasive breast cancer (UICC stage I-IIB). A tendency towards less aggressive investigation and treatment was noted in the elderly. Of 117 patients undergoing surgery, 79 (68%) had 'full' conventional treatment, either mastectomy with axillary clearance, sampling or radiotherapy, or local excision with radiotherapy. In 38 patients (32%) management of the breast or axilla was considered to have been less complete than the usual practice for younger patients ('limited' treatment group), either local excision without radiotherapy or simple mastectomy alone. The 'limited' treatment group were significantly older than the 'full' treatment group but were comparable for tumour size, clinical nodal status and oestrogen and progesterone receptor levels. Although there was no survival difference between the groups, those in the 'limited' treatment group were more likely to develop locoregional recurrence (chi 1(2) = 9.2, P = 0.002, log rank test). In practice, management of the elderly often appears to be influenced by chronological age rather than clinical or biological factors. It is suggested that elderly patients sufficiently fit to undergo surgery should be treated along the lines applicable to younger patients.

Age Factors↗

PubMed2006

Mammary Paget's disease occurring after mastectomy.

BACKGROUND: Mammary Paget's disease and extramammary Paget's disease are neoplastic conditions, in which there is intraepithelial (usually intraepidermal) infiltration by neoplastic cells showing glandular differentiation. Mammary Paget's disease occurs exclusively on the nipple/areola complex from where it may spread to the surrounding skin. CASE PRESENTATION: We here describe a case of Paget's disease occurring on the thoracic wall site of a previous simple mastectomy, and also briefly summarise the most important aspects leading to a diagnosis of mammary Paget's disease. CONCLUSION: To the best of our knowledge, this is the first reported case of mammary Paget's disease occurring after mastectomy. The absence of the nipple/areola complex obviously raised some questions concerning whether it was mammary or extra-mammary Paget's disease, and how it could occur in the absence of the nipple/areola complex.

Journal Article↗

PubMed1985

Radiation therapy and breast cancer. Past, present, and future.

After radical mastectomy, postoperative irradiation unquestionably diminishes the incidence of local-regional failures, and there are series in which the survival rates are improved for a subset of patients. The comparative survival rates shown in Table 6 suggest that adjuvant postoperative irradiation produces survival benefits. For more advanced tumors, simple mastectomy and axillary dissection with chemotherapy and irradiation is effective, with the optimal sequence still to be determined. In selected patients, tumorectomy and irradiation produce survival rates equivalent to radical mastectomy with very satisfactory cosmetic results. In all situations, gross masses in the breast and axilla should be removed leaving for irradiation only subclinical disease that is controlled with doses that do not produce significant sequelae.

Axilla↗

PubMed1989

[Psychosocial aspects of bilateral subcutaneous reduction mastectomy in breast cancer].

The authors administered a questionnaire to 56 women with breast cancer who had bilateral subcutaneous mastectomies after Stroembeck/Beller since 1985. In this study, psychological aspects were investigated. There was no change in social behavior; isolation was not noticed. The negative effects on the body image were well accepted and discussed with relatives and friends. Psychological or emotional suffering was rare compared to patients with simple mastectomy. No change in sexual behavior was reported. The sexual function of the mamillae was significantly reduced. Although some cosmetic deformities were obvious, most patients would again choose the subcutaneous reduction mastectomy as operation of choice.

Adaptation, Psychological↗

PubMed1977

Radiotherapy in the postoperative treatment of operable cancer of the breast. Part I. Critique of the clinical and biometric aspects of the trials.

A statistical assessment of several "randomized" clinical trials was carried out and the following conclusions were noted. 1. There is no statistically significant evidence that radiation to the peripheral lymphatics and/or chest wall following radical mastectomy affects survival. 2. There is significant evidence that postoperative irradiation to the peripheral lymphatics and/or chest wall does decrease local recurrence rate. 3. There is reliable evidence that the treatment of local recurrence, once it develops, is successful in only 50% of the cases. 4. There is evidence that radiation plus simple mastectomy is as effective in the treatment of breast cancer as radical mastectomy alone. It is our considered opinion that radiation remains a useful adjuvant and complementary agent in the treatment of breast cancer, is not harmful vis a vis survival and should be used when and where indicated.

Adult↗

PubMed1987

Clinical experience in breast cancer--20 years after radical mastectomy.

From 1958 to 1982, 1,035 radical mastectomies have been performed in our institute in cases of breast cancer. A total of 804 cases have been followed up for 5 years or more after the operation, the follow-up rate being 100%. Routine radical operations were performed in 695 cases, whereas the other 109 cases were treated with simple mastectomy, modified radical mastectomy, and extended radical mastectomy. The 5-, 10-, 15-, and 20-year survival rates of these 804 cases were 71.8%, 58.2%, 48.8%, and 41.8%, respectively. According to the tumor-node-metastases (TNM) classification, the 5-, 10-, 15-, and 20-year survival rates for stage I were 85.4%, 77.0%, 58.3%, and 75.0%; for stage II, 72.8%, 57.4%, 53.5%, and 58.8%; and for stage III, 55.3%, 44.7%, 36.5%, and 8.0%, respectively.

Adult↗

PubMed1977

Physical and psychologic readjustment after mastectomy: an evaluation of Memorial Hospitals' PMRG program.

Memorial Hospital in New York City, the clinical section of the Memorial Sloan-Kettering Cancer Center, has developed a Post-Mastectomy Rehabilitation Group (PMRG) Program. The PMRG Program is comprised of a series of structured exercise, information, discussion, and group therapy sessions conducted by a social worker, nurse, physical therapist, and a volunteer from Reach to Recovery. The specific purposes of the program are to help a patient to begin to regain functional use of her arm and shoulder on the affected side, and to adapt functionally, psychologically, and emotionally to the loss of her breast and to the diagnosis of cancer in the shortest time possible. Approximately 1,700 women who underwent mastectomy participated in the program between 1970 and 1974. Some results and conclusions are: the patient's age and type of operation are related to physical recovery, resumption of normal activities, return to work, and emotional stress; 84% (661 of 790 patients) resumed normal activities within the four-month postoperative period; 74% (237 of 317 patients) returned to work (full time) within three months of their mastectomies; 13% (52 of 406 patients) experienced moderate or severe emotional stress; activity per se (any activity, doing something, keeping busy) affects readjustment; the apparent disadvantage of greater trauma with more extensive surgery may be more than compensated for by the relatively young age of that population, and the relatively less physical trauma and injury, resulting from simple mastectomies may be overshadowed by the patient's age and general physical condition; 98% (284 of 291 patients) reported the PMRG program helpful.

Activities of Daily Living↗

PubMed1979

Alternatives to subcutaneous mastectomy.

It is our belief that subcutaneous mastectomy often leads to complications, with poor results. In addition, because a considerable amount of breast tissue may be left behind, its value as a prophylactic operation must be questioned. Two alternatives are presented. In our experience, these lead to fewer complications with a more thorough removal of the mammary gland, and achieve a better appearance. The alternatives are (1) simple mastectomy with secondary reconstruction; (2) the type of mastectomy described by Spira--with primary reconstruction using a subpectoral silicone prosthesis covered by muscle and an inferiorly-based dermal flap.

Adenofibroma↗

PubMed1990

Breast cancer.

Breast cancer will affect 1 out of 10 women in the United States and cause 27 deaths per 100,000 women per year. The etiology remains unknown, but the incidence correlates with genetic as well as environmental factors. Screening programs have been shown to prolong the survival by early detection compared with control populations but remain underutilized by physicians and patients. Breast disease can be evaluated by physical examination and mammography and a definitive diagnosis made by needle aspiration, needle biopsy, or excisional biopsy. This allows the patient to participate in the decision regarding mastectomy vs. conservative surgery plus radiation therapy. These two approaches have equivalent survival in selected patients. Patients with locally advanced, nonmetastatic disease benefit from a multidisciplinary approach using preoperative chemotherapy and postoperative radiation therapy. This approach has allowed less disfiguring surgery and improved survival. Preinvasive carcinoma is diagnosed more frequently with the increased use of screening mammography. Local therapy options include simple mastectomy, local excision plus radiation, or local excision alone. The natural history and results of therapy in preinvasive disease are evolving as more data are accumulated. Systemic adjuvant therapy is recommended for all node-positive patients and most node-negative patients with invasive cancer. The specific modality (hormonal or cytotoxic) varies with the subgroup involved. Treatment of metastatic disease to palliate symptoms and prolong survival includes the use of local therapies (surgery and radiation) and hormonal and cytotoxic agents. Most patients benefit, but cure has been unobtainable. Newer approaches utilizing high-dose chemotherapy and bone marrow support with growth factors or autologous transplantation are currently being explored.

Breast Neoplasms↗

PubMed1980

The curative value of irradiation in the treatment of nondisseminated breast cancer.

Data are now available from two randomized trials showing that adjuvant irradiation of the internal mammary and supraclavicular nodes following a radical or modified radical mastectomy results in increased survival rates. A retrospective analysis of 1111 patients treated at M. D. Anderson Hospital with radical mastectomies with and without irradiation to the peripheral lymphatic areas shows equal ten-year survival rates in irradiated and unirradiated patients in spite of the fact that the irradiated patients had a much higher incidence of histologically positive nodes. There is a significant percentage of patients surviving ten-years in 353 patients with locally or regionally advanced tumors treated with simple mastectomy and irradiation without chemotherapy. Radiation of gross local and regional recurrences has a high risk of failure and radiation sequelae.

Breast Neoplasms↗

PubMed1996

Nipple-areolar preservation during breast-conserving therapy for subareolar breast carcinomas.

OBJECTIVE: To determine if women with subareolar breast carcinoma can be successfully treated by breast-conserving therapy consisting of segmental mastectomy that preserves the nipple-areolar complex, axillary lymph node dissection, and postoperative irradiation. DESIGN: Prospective study. SETTING: Tertiary care cancer center. PATIENTS: Twenty-five patients; median age, 56 years; median tumor diameter, 1.4 cm; and median follow-up, 48 months. INTERVENTION: Breast-conserving therapy for subareolar primary breast carcinoma. RESULTS: Two patients had positive surgical margins of resection, and another patient underwent simple mastectomy after developing a local recurrence. Nipple-areolar distortion was the most common cosmetic deformity after breast-conserving therapy, but overall cosmesis was good. At the most recent follow-up, all patients were free of disease. CONCLUSION: Patients who have small subareolar primary breast carcinomas without evidence of nipple involvement are candidates for breast-conserving therapy with nipple-areolar preservation.

Adult↗

PubMed1992

[Surgical procedure in an extensive un-operable decaying breast cancer].

The article indicates necessity of palliative surgical treatment of ulcerating and decaying breast cancers. Ulceration and decay of tumour of the breast make worse the quality of life of the afflicted. The operation like simple mastectomy liquidates the threat of haemorrhage and prevent intoxication from decaying tumour. In the period from 1977 to 1991 year the group of 1075 women with breast cancer were operated. In this number there were 44 women with decaying breast cancer. Sometimes there are difficulties in closing of the operative wound, when women with very extensive tumour ulceration are treated and then reconstructive methods are needed (transposition of a simple skin flap from the opposite breast, a latissimus dorsi myocutaneous flap or omental transposition from the abdomen to the chest wall). All these operated women survived the operation and left surgical ward.

Breast Neoplasms↗

PubMed1992

Phyllodes tumor: clinicopathologic review of 60 patients and flow cytometric analysis in 30 patients.

We reviewed 66 phyllodes tumors of the breast from 60 patients. Our patients included 59 women and one man ranging in age from 16 to 72 years. Fifty patients presented for primary treatment of newly diagnosed breast masses, nine presented with recurrent tumors, and one presented with soft tissue metastases 9 years after bilateral subcutaneous mastectomies and multiple chest wall recurrences of phyllodes tumor. After 0.3 to 53.2 years (mean, 15.5 years) of follow-up, 26 (43.3%) patients are free of disease without recurrence, 26 (43.3%) patients are dead of other (17 patients) or unknown (nine patients) causes, four (6.7%) patients had locally recurrent tumor 0.7 to 2.9 years after lumpectomy and are free of disease 3 months to 12 years after re-excision or simple mastectomy, two (3.3%) patients are lost to follow-up, and two (3.3%) patients died with metastatic disease 1.8 and 7 years after diagnosis. Histologic features and flow cytometric analysis showed no correlation with outcome. Fifty-six breast tumors were biphasic and nine were purely stromal tumors. Twenty-six (47%) biphasic tumors showed stromal overgrowth. Tumor margins were pushing in 20 (39%) and infiltrative in 29 (61%) of 49 evaluable cases. Twenty-one tumors were highly cellular and 17 showed cytologic atypia. Necrosis was identified in 16 tumors. Mitotic rates ranged from 0/10 high-power fields to 48/10 high-power fields. Twenty-four diploid, six aneuploid, three tetraploid, and one polyploid tumor were identified by flow cytometry. S-phase fractions tended to be higher in nondiploid tumors. Neither DNA content nor S-phase fraction correlated with outcome. Our results indicate that most mammary phyllodes tumors, including purely stromal tumors, behave as low-grade, nonmetastasizing neoplasms. Neither histologic evaluation nor DNA content provides reliable clues concerning the natural history of an individual tumor.

Adolescent↗