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PubMed2001

Fibrin sealant reduces the duration and amount of fluid drainage after axillary dissection: a randomized prospective clinical trial.

BACKGROUND: Patients who have axillary dissections during lumpectomy or modified radical mastectomy for breast carcinoma accumulate serosanguinous fluid, potentially resulting in a seroma. Currently accepted practice includes insertion of one or more drains for fluid evacuation. This multicenter, randomized, controlled, phase II study was undertaken to evaluate whether a virally inactivated, investigational fibrin sealant is safe and effective when used as a sealing agent to reduce the duration and volume of serosanguinous fluid drainage and to determine the dose response of this effect. STUDY DESIGN: Patients undergoing lumpectomy or modified radical mastectomy were randomized to treatment with 4, 8, or 16 mL of fibrin sealant or control (no agent) at the axillary dissections site. Patients undergoing modified radical mastectomy also received an additional 4 or 8 mL of fibrin sealant at the skin flap site. Efficacy was evaluated by the number of days required for wound drainage and the volume of fluid drainage compared with control. Safety was confirmed by clinical course, the absence of viral seroconversion, and no major complications attributable to the sealant. RESULTS: The 4-mL axillary dissection dose of fibrin sealant significantly reduced the duration and quantity of fluid drainage from the axilla following lumpectomy (p < or = 0.05). In the modified radical mastectomy patients, a 16-mL axillary dissection dose combined with an 8-mL skin flap dose was significantly effective in reducing the number of days to drain removal (p < or = 0.05) and fluid drainage (p < or = 0.01). There were no fibrin sealant patient viral seroconversions and no major complications attributable to the sealant. A number of wound infections were noted, although this may represent a center-specific effect. CONCLUSIONS: Application of fibrin sealant following axillary dissection at the time of lumpectomy or modified radical mastectomy can significantly decrease the duration and quantity of serosanguinous drainage. The viral safety of the product was also supported.

Axilla↗

PubMed1993

Fibrin adhesive in radical mastectomy.

OBJECTIVE: To find out if fibrin adhesive glue applied locally would reduce the incidence of seroma after modified radical mastectomy for breast cancer. DESIGN: Prospective randomised study. SETTING: City hospital, Sweden. SUBJECTS: 68 women undergoing modified radical mastectomy with axillary clearance for breast cancer. MAIN OUTCOME MEASURES: Amount of postoperative drainage, number of seromas aspirated volumes; length of hospital stay, influence of surgeon operating. RESULTS: Seromas developed in a total of 40/68 patients (59%), 23/36 in the fibrin adhesive group (64%) and 17/32 in the control group (53%); p = 0.5 (95% confidence interval of the difference--0.13 to 0.34). There were no significant differences in the volume of aspirations or in hospital stay. The skill of the surgeon influenced the incidence of seromas, but the differences were not significant (p = 0.5). CONCLUSION: Local application of a fibrin adhesive glue has no effect on the incidence of seroma formation after modified radical mastectomy.

Adult↗

PubMed2002

Surgical management of primary breast sarcoma.

Primary sarcoma constitutes less than one per cent of breast malignancies. A retrospective review of this disease at our institution was undertaken to assess the effect of different treatment modalities on outcome. Over a 24-year period 28 patients were identified. Follow-up ranged from one to 228 months. Partial mastectomy was done in seven patients, whereas ten underwent total mastectomy and nine had modified radical mastectomy. Two refused surgery. All margins of resection were negative. In total ten axillary lymph node dissections were done with no positive nodes identified. Pathologic analysis of tumors revealed a variety of sarcomas including high-grade malignant cystosarcoma phyllodes in 13. Recurrence of disease occurred in two women, both with malignant cystosarcoma phyllodes. One was a local recurrence in a patient who had undergone partial mastectomy. This was successfully treated with a total mastectomy. The second recurrence involved a distant metastasis in a patient treated with modified radical mastectomy that eventually led to her death. For the entire group the disease-free survival was 75 per cent at 10 years whereas overall survival was 87.5 per cent. In conclusion an adequate margin of resection is the single most important determinant of long-term survival. Axillary lymph node dissection is not necessary for the treatment of these tumors.

Adolescent↗

PubMed1990

Bilateral primary breast carcinoma in a man.

The case history is presented of a 56-year-old man, who had a second primary carcinoma in the contralateral breast after 13 years. Both times, he underwent a modified radical mastectomy. The axillary lymph nodes were free from tumour. The incidence in men is about 1 per cent being bilateral in 14 out of 1,000 of these cases. The therapy for men is the same as for women. Because of the smaller breast volume, tumours in men are earlier discovered and show infiltration. If metastases cannot be detected, the first choice of treatment is surgical. Radiotherapy is indicated in case surgical intervention has not been radical.

Breast Neoplasms↗

PubMed1989

Carcinoma of the breast occurring in routine reduction mammaplasty.

We report the case of an 18-year-old female undergoing routine reduction mammaplasty in whom bilateral diffuse intraductal cribriform breast carcinoma was reported upon review of the surgical specimen. This highlights the importance not only of sending specimens for pathologic examination, but also of marking the specimens accurately by location, such as medial, central, and lateral. Treatment with bilateral modified radical mastectomy with lower axillary dissection and immediate reconstruction with autogenous tissue is reported.

Adolescent↗

PubMed1988

Breast cancer--the need for early diagnosis.

A retrospective study was undertaken of 265 women with breast cancer treated at the Department of Surgery, Toa Payoh Hospital, Singapore, during 8 years from 1977 to 1985. The average patient was aged 51.0 years, with a tumour 4.9 cm in diameter, staged at T2aN1bMO (Stage II). In comparison with an earlier series from the same Unit, an increase in the number of younger patients was noted, although overall a larger proportion of 'early' cases (TNM Stage I) was found. In contrast to recent western series, breast cancer in Singapore is diagnosed at a later stage and generally unsuitable for conservative treatment by lumpectomy and radiotherapy. The standard treatment was modified radical mastectomy, or simple mastectomy with axillary clearance, followed by Radiotherapy if ipsilateral axillary lymphnodes were histologically involved.

Age Factors↗

PubMed2005

[Carcinosarcoma of the breast: a tumour with controversial histogenesis].

Carcinosarcoma of the breast is a rare, biphasic, tumour with epithelium and mesenchymal components. Its histogenesis is controversial and, hence, has received various different nomenclatures. At present, all studies indicate that it is a variety of methaplasic tumour and suggest multi-potential myoepithelial cell origin. Clinically, it presents as a tumour of variable size and its diagnosis has been by immunohistochemistry studies, or by electron microscopy. We present, here, a patient with mammary carcinosarcoma a difficult diagnosis. Treatment for the patient was a modified radical mastectomy, and adjuvant therapy.

Antineoplastic Combined Chemotherapy Protocols↗

PubMedDate not supplied

[Reconstruction of a breast following mastectomy].

Breast reconstruction has become an available option for most patients undergoing mastectomy. Breast reconstruction has been shown to lessen the psychological disturbances associated with mastectomy. Reconstruction with a silicone breast prosthesis is selected when the preserved tissues after subcutaneous mastectomy, total mastectomy or modified radical mastectomy, have an adequate quantity and quality for insertion of the prosthesis. Frequently these tissues are quantitatively deficient. In these cases the use of tissue expanders allows the expansion of deficient soft tissues. Anatomically shaped expanders produce breasts with a natural appearance, adequate ptosis and a well-defined submammary fold. When the skin has poor quality or has been irradiated, or when a radical mastectomy has been performed, additional autogenous tissue needs to be brought to the breast area with a flap. The two most commonly used musculocutaneous flaps are the latissimus dorsi and the transverse rectus abdominis flap (TRAM). To get a good result nipple-areola reconstruction is necessary, and it is often necessary to modify the contralateral breast.

English Abstract↗

PubMed1996

Paget's disease of the male breast.

A histopathologically proven case of Paget's disease of the breast in a 47-year-old male induced a review of the 32 cases in the world's literature. Paget's disease usually presents in the 5th and 6th decades of life without any obvious racial predilections. The most frequent presenting signs include ulceration, eczema, nipple discharge, bleeding, and crust formation. At the time of presentation, 50 per cent of the patients have a palpable breast mass, positive lymph nodes, or both. When entertaining the diagnosis of Paget's disease of the breast using morphologic characteristics of the cells, the diagnosis of malignant melanoma and Bowen's disease (intraepithelial squamous cell carcinoma) must be included in the differential diagnosis. Certain differences will be seen between these three entities based on specific cell staining and the uptake of certain tumor markers. There is no evidence that this disease behaves differently in males versus females, but the 5-year survival for males is worse: 20 to 30 per cent in males versus 30 to 50 per cent in females. The treatment of this disease must focus on the pathology of the underlying tumor. Current treatment involves modified radical mastectomy or radical mastectomy for Stage I and II tumors. Adjuvant chemotherapy, radiation, and tamoxifen are also used depending on the nodal and receptor status of the tumor.

Biopsy↗

PubMed1998

Secretory carcinoma of the breast in an elderly woman: report of a case.

We herein report a case of secretory carcinoma of the breast in a 73-year-old woman. Secretory carcinoma is an extremely rare tumor and demonstrates distinctive pathologic characteristics. This tumor frequently occurs in either children or adolescents, and thus has been called juvenile carcinoma. We encountered this rare tumor in an elderly woman. Aspiration biopsy cytology was performed twice, but the cytological diagnosis was not carcinoma. Such pathologic characteristics as mild atypia, the absence of hyperchromasia, and a minimal degree of pleomorphism in the tumor cells can thus lead to a cytological misdiagnosis. An excisional biopsy was performed and secretory carcinoma was finally diagnosed. Consequently, a modified radical mastectomy (Kodama's method) was performed 7 days later. We describe this very rare tumor's clinicopathologic characteristics.

Age Factors↗

PubMed1989

[A case of stromal sarcoma of the breast].

A 28-year-old woman with a stromal sarcoma of the breast is reported. By palpation, she had uncovered a tumor in the upper inner quadrant of the right breast. The subsequent physical examination and echographic findings suggested a phyllodes tumor and an excisional biopsy was performed. A pathologic examination revealed the infiltration of spindle cells with a fascicular pattern, a bizarre mitotic configuration and no epithelial component, thus leading to the diagnosis of a stromal sarcoma. The patient then underwent a modified radical mastectomy. A stomal sarcoma of the breast is very rare, and early diagnosis and a curative resection improves the chances of survival.

Adult↗

PubMed1976

Axillary metastases from an unknown primary source.

The appropriate therapeutic approach is considered in patients who present with carcinomatous metastases in the axillary lymph nodes and in whom the site of the primary tumor remains obscure. Eight patients with axillary lymph node metastases are reported, in five of whom the location of the primary tumor could not be established. In three patients the primary growth was ultimately found to be in the adjacent breast. Early death occurred in only one patient, and in this instance the primary site proved to be in the breast. The remaining seven patients have all shown a relatively good prognosis when compared with those in similar series reported in the literature. The conservative policy of using radiotherapy alone for such cases, and the more aggressive approach of blind radical mastectomy of the adjacent breast, are both rejected. Instead, the more conservative sector mastectomy of the upper outer quadrant of the ipsilateral breast is proposed as a diagnostic procedure. Should this, together with general investigation of the patient, fail to detect the primary tumor, therapeutic axillary block dissection followed by radiotherapy is then advocated. If the primary tumor is found in the breast on sector mastectomy, a modified radical mastectomy of the affected breast should be performed and followed by irradiation.

Adult↗

PubMed2005

A patient with occult breast cancer presenting with an axillary lymph node metastasis and a synchronous contralateral breast cancer.

Detection of a breast mass accompanied by a contralateral axillary lymphadenopathy presents a dilemma because of the possible presence of an occult breast cancer on the same side as the axillary lymphadenopathy. A patient presented with an axillary lymphadenopathy from an occult breast cancer and a synchronous contralateral breast cancer, for which the differential diagnosis was established through a significant difference in estrogen and progesterone receptor levels. The patient was treated with neoadjuvant chemotherapy followed by bilateral modified radical mastectomy, adjuvant chemotherapy, and adjuvant radiation therapy. She is alive and free of disease 1.5 years after the diagnosis.

Axilla↗

PubMedDate not supplied

Feasibility of immediate breast reconstruction for locally advanced breast cancer.

BACKGROUND: Immediate breast reconstruction (IBR) has been considered contraindicated for patients with locally advanced breast cancer (LABC). Our goal was to determine whether IBR resulted in delayed postoperative chemotherapy, increased postoperative complications, or increased risk of recurrent disease. METHODS: A prospective database of 540 modified radical mastectomies performed with IBR between 1990 and 1993 identified 50 patients with LABC. Postoperative management and outcome were compared to that of 72 patients undergoing modified radical mastectomy without IBR treated on a standardized LABC protocol using preoperative chemotherapy, postoperative chemotherapy, and radiotherapy during the same time period. RESULTS: Results were evaluated by chi2 analysis. The median ages for the patients with IBR versus those not undergoing IBR were 44 and 46 years, respectively. The stage distribution for the IBR patients versus patients not undergoing IBR was as follows: IIB, 46% versus 17%; IIIA, 44% versus 39%; and IIIB, 10% versus 44%. The types of IBR were transverse rectus abdominis myocutaneous (TRAM) flap (68%), latissimus dorsi flap (2%), and implants (30%). Chemotherapy was given to all IBR patients: 24% preoperatively and 96% postoperatively. Radiotherapy was used in 40%. Four postoperative complications (8%) necessitated prolongation of hospitalization, including two patients requiring surgical debridement for partial flap loss; there were no complete flap losses. The incidences of major and minor wound complications in the group not undergoing IBR were 7% and 4%, respectively. Of the 15 patients receiving implant reconstruction, 7 (47%) required subsequent implant removal because of contractures or infections. The median interval between surgery and postoperative chemotherapy was 35 days for the IBR patients and 21 days for the patients not undergoing IBR. This difference was marginally significant (P =.05). With a median follow-up of 58.4 months, no significant differences in local or distant relapse rates were detected. CONCLUSIONS: IBR can be performed with low morbidity in patients with LABC. Use of autogenous tissue is preferable because of poor results with implants. IBR is associated with somewhat longer intervals to resumption of postoperative chemotherapy, but this does not appear to be clinically significant-the local and distant relapse rates are similar for LABC patients undergoing modified radical mastectomy with or without IBR.

Adult↗

PubMed1990

Breast cancer: the military's experience at Wilford Hall USAF Medical Center.

We reviewed the experience with breast cancer at Wilford Hall USAF Medical Center for the years 1978 through 1988. A total of 868 cases were identified in the Wilford Hall Tumor Registry; overall 5-year and 10-year survivals were 63% and 39%, respectively. Infiltrating ductal carcinoma represented the principal histologic category. The other predominant variants included invasive lobular carcinoma, lobular carcinoma in situ, and ductal carcinoma in situ. Until recently, most of these patients (90%) had modified radical mastectomy as their definitive surgical therapy, with chemotherapy reserved primarily for patients with advanced disease.

Actuarial Analysis↗

PubMed1988

Primary surgical treatment of breast cancer.

An unexpected rise in breast cancer mortality has been reported for 1984 and 1985 in white women below 50 years of age in the United States. During the preceding 10 years, there had been a progressive drop of approximately 1% in breast cancer mortality for each successive year. This recent increase in mortality occurred despite the increased use of adjuvant chemotherapy; it is most likely a direct result of the current tendency to downgrade the need for adequate primary therapy. Several recent prospective randomized studies that evaluated the relative efficacy of mastectomies of varying extent have shown a direct relationship between local control and long-term survival. They also demonstrated that specific operative procedures were most effective for the appropriate clinicopathological stage of disease. Stage I cancers can be treated effectively by modified mastectomy, but radical mastectomy is superior for control of stage II and stage III disease. Inner-quadrant cancers are most effectively managed by extended radical mastectomy, which includes excision of the internal mammary nodes. Excellent surgical technique was employed in all studies, which included observed follow-up of 10-20 years. Optimal local control and long-term survival were achieved by the appropriate operative procedure.

Breast Neoplasms↗

PubMed1999

Secretory breast carcinoma in a boy.

Secretory breast carcinoma is a very rare condition in boys. An 11-year-old boy with secretory breast carcinoma is presented here. Modified radical mastectomy was performed by irradiation and chemotherapy because of axillary metastasis. There was no local recurrence or distant metastases in the follow-up period of 14 months.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1992

Primary squamous cell carcinoma of the breast.

We have described three patients with primary squamous cell carcinoma of the breast. All three have remained well after modified radical mastectomy. One patient received postoperative radiotherapy. Estrogen receptor status was determined by monoclonal antibody technology in two cases, and the results were negative.

Adult↗