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PubMed1986

Is modified radical mastectomy really equivalent to radical mastectomy in treatment of carcinoma of the breast?

Evaluation of any therapeutic modality for carcinoma of the breast requires prolonged follow-up. Between 1965 and 1968, 870 women with primary unilateral breast cancer were treated surgically at our institution. To achieve a study group that could be meaningfully analyzed, the authors identified and excluded all patients with pre-existing life-threatening disease, incomplete (palliative) operation, multiple lesions, or fixed lesions. There remained 530 patients (322 treated with radical and 208 treated with modified radical mastectomy). No overall statistical difference in 5-year survival to death from breast cancer was noted between the radical (82.1%) and the modified radical (87.0%) mastectomy group. Recently, the authors updated that series, now with 10 to 16 years of follow-up (minimum, 10 years). Two hundred eighty-one patients were alive at 10 years. The 10-year survival from breast cancer after radical (74.5%) and modified radical (74.2%) mastectomy was almost identical. The 10-year node-negative survival was 86.0% and the node-positive survival was 56.3% (P = 0.0001). Results were compared according to age, tumor site, absolute number of involved nodes, histologic features, grade, size, and adjuvant treatment. A numeric combination of these variables was constructed and used as a prognostic score. These results suggest that, with equal long-term efficacy in the treatment of breast cancer, the cosmetically and functionally superior modified radical mastectomy should remain the procedure of choice in the surgical treatment of carcinoma of the breast.

Adult↗
PubMed1994

Mastectomy only versus radical mastectomy and postoperative radiotherapy in node negative, resectable breast cancer. A randomized trial.

Patients with clinically node negative resectable breast cancer were randomized to either mastectomy only or radical mastectomy and radiotherapy, and followed for 15-20 years. During follow-up axillary metastases occurred with the same frequency after mastectomy as was initially observed in the group that underwent axillary dissection. There was no significant survival difference between the two groups. When adjusting the treatment effect for differences in age, tumour size, lymph node metastases, and histology, the outcome after radical mastectomy plus irradiation was significantly inferior. Comedo carcinoma proved also in this study to carry a poor prognosis.

Breast Neoplasms↗
PubMed1987

Overview of randomized trials comparing radical mastectomy without radiotherapy against simple mastectomy with radiotherapy in breast cancer.

An overview of mortality in the mature randomized trials comparing radical mastectomy without radiotherapy against simple mastectomy with radiotherapy has been conducted. These trials mark a transitional period between radical mastectomy and simple mastectomy as the generally preferred surgical treatment and as such are not strictly trials assessing the value of postoperative adjuvant radiotherapy. All known mature trials have been included and these four trials have entered a total of 3236 patients, in whom 1678 deaths have been recorded. Overall, no significant difference in survival was seen, but there was a nonsignificant trend for patients given radiotherapy to do worse after 15 years of follow-up.

Breast Neoplasms↗
PubMed2005

Nipple-sparing mastectomy in association with intra operative radiotherapy (ELIOT): A new type of mastectomy for breast cancer treatment.

BACKGROUND: Breast-conserving surgery has become the standard approach for about 80% of patients treated for primary breast cancer in most centres. However, mastectomy is still required in case of multicentric and/or large tumours or where recurrences occur after conservative treatment. When a total mastectomy is performed, the removal of the nipple areola complex (NAC) is a strongly debated issue. In fact, although removal of the NAC greatly increases the patient's sensation of mutilation, and the risk of tumor involvement of the areola is reported as a very variable percentage, NAC excision still remains the standard treatment. PATIENTS AND METHODS: From March 2002 to September 2003, 106 nipple sparing mastectomies (NSM) were peformed in 102 patients, 63% of whom had invasive carcinoma and 37% of whom had in situ carcinoma. Four patients underwent bilateral surgery. In all cases, a large or multicentric tumour and/or diffuse microcalcifications, clinically distant from the NAC, were present. During surgery, the tissue under the areola was routinely sampled to exclude the presence of tumor. If disease-free at the frozen sections, the NAC was spared and a NSM was performed. Additionally, a total dose of 16 Gy of radiotherapy (ELIOT) was delivered intraoperatively in the region of the NAC. All the patients underwent an immediate plastic breast reconstruction. RESULTS: In eleven patients (10.4%), the breast tissue under the areola resulted infiltrated at the definitive histological examination: in 10 cases a single or multiple foci of in situ carcinoma and in one case an invasive component were present. Eleven patients (10.4%) developed a superficial skin areolar slough followed by spontaneous healing, and 5 patients (4.7%) lost their NAC due to total necrosis. Among these, one patient had a poor cosmetic result on the NAC with asymmetrical location and required further surgical removal and reconstruction with tattoo and local flap in a better position. When rating the results from 0 (bad) to 10 (excellent), on average, the colour of the areola was rated 9/10, the sensitivity of nipple 3/10, the overall aesthetic result was rated 8/10 by both the surgeon and the patients. Early radiodystrophy (pigmentation) was observed in eight cases (7.5%). After an average follow up of 13 months, one local recurrence, located under the clavicula, far from the NAC, was observed. The preliminary results of the psychological study show a very high satisfaction with the preservation of the nipple (97.6 %), with younger women expressing a higher satisfaction than older counterparts. CONCLUSIONS: In selected cases, NSM with ELIOT of NAC has so far permitted good local control of the disease and satisfactory cosmetic results. Wider surgical experience is required to minimise the risk of leaving tumor cells in the region of the spared NAC and a longer follow up is necessary to evaluate the long term tumor recurrence rate at the NAC.

Breast Neoplasms↗
PubMed2000

Contralateral prophylactic mastectomy improves the outcome of selected patients undergoing mastectomy for breast cancer.

BACKGROUND: Risk factors for contralateral breast cancer (CBC) may indicate a benefit for contralateral prophylactic mastectomy (CPM) at the time of unilateral mastectomy for breast cancer. The purpose of this study is to evaluate the efficacy of CPM in preventing CBC. METHODS: sixty-four patients undergoing CPM and a control group of 182 patients not undergoing CPM and matched for age, stage, surgery, chemotherapy, and hormonal therapy were retrospectively compared for CBC rate, disease-free survival, and overall survival. RESULTS: Thirty-six CBCs occurred in the control group. In the CPM group, 3 CBCs were found at the time of prophylactic mastectomy, but none occurred subsequently (P = 0.005). Disease-free survival at 15 years in the CPM group was 55% (95% confidence interval [CI] 38% to 69%) versus 28% (95% CI 19% to 36%) in the control group (P = 0.01). Overall survival at 15 years was 64% (95% CI 45% to 78%) CPM versus 48% (95% CI 39% to 58%) in controls (P = 0.26). CONCLUSION: CPM prevented CBC and significantly prolonged disease-free survival. Future studies will need to address risk assessment and contralateral breast cancer prevention in patients treated for early breast cancer.

Adult↗
PubMed1978

Total glandular mastectomy. Modifications of the subcutaneous mastectomy for use in premalignant disease of the breast.

We describe two modifications of the original subcutaneous mastectomy, in which we remove the nipple en bloc with the breast, and we believe they are as suitable as other mastectomies for the removal of microcarcinomas and premalignant diseases of the breast. We do not advocate them for macroscopic malignancy. We are using the term "total glandular mastectomy" to designate these two modifications.

Breast Neoplasms↗
PubMed2005

Satisfaction after contralateral prophylactic mastectomy: the significance of mastectomy type, reconstructive complications, and body appearance.

PURPOSE: Contralateral prophylactic mastectomy (CPM) is one option for reducing the risk of a second breast cancer in women with a personal and family history of breast cancer. Few data are available regarding satisfaction, psychological, and social function after CPM. The purpose of this research is to evaluate women's long-term satisfaction with CPM, factors influencing satisfaction, and psychological and social function after CPM. PATIENTS AND METHODS: This was a descriptive study of all women with a family history of breast cancer, known to be alive, who elected CPM at Mayo Clinic (Rochester, MN) between 1960 and 1993 (n = 621). Ninety-four percent of the women (n = 583) completed a study-specific questionnaire. RESULTS: A mean of 10.3 years after the procedure, the majority of women (83%) were satisfied with their CPM. A smaller number were neutral (8%) or dissatisfied (9%). Women who had a subcutaneous mastectomy had more problems with reconstruction, and fewer of these women were satisfied than women with simple mastectomy. Decreased satisfaction with CPM was associated with decreased satisfaction with appearance, complications with reconstruction, reconstruction after CPM, and increased level of stress in life. The majority of women experienced no change or favorable effects in self-esteem (83%), level of stress in life (83%), and emotional stability (88%). Satisfaction with body appearance, feelings of femininity, and sexual relationships were the most adversely affected with 33%, 26%, and 23% of the women responding negatively. CONCLUSION: Although most women are satisfied with CPM, each woman should weigh the benefits alongside the potential adverse effects.

Adaptation, Psychological↗
PubMed1990

Simple mastectomy with postoperative irradiation versus extended radical mastectomy in breast cancer. A twenty-five-year follow-up of a randomized trial.

From November 1951 to December 1957, all patients with untreated breast cancer admitted to the Radium Centre in Copenhagen were randomized before their operability was evaluated into two groups, if the patients were operable, viz. simple mastectomy with postoperative x-ray treatment or extended radical mastectomy. Twenty-five-year results are presented, showing no difference in survival or recurrence-free survival of the operable patients. Histological grading was performed in nearly all cases. Patients with grade 1 tumours had a better survival than grades 2 and 3, but there was no difference in survival between the two treatment groups, when histological grading was taken into account. Histological node positive patients had more grades 2 and 3, tumours, whereas node negative patients had more grade 1 than grades 2 and 3 tumours. Premenopausal women had a significantly better survival than postmenopausal in all stages.

Age Factors↗
PubMedDate not supplied

A multivariate analysis of en bloc extended radical mastectomy versus conventional radical mastectomy in operable breast cancer.

We made clinical trials of en bloc extended radical mastectomy (EXT) of a new type in 118 patients from 1980 through 1985. A variety of conventional radical mastectomies (RDL) were also performed in 105 patients from 1973 through 1985. A multivariate analysis was performed of the results to compare EXT and RDL. The result showed the 5-year survival rates of 91 +/- 2.6% and 83 +/- 3.7% were achieved for the EXT and RDL groups, respectively (Cox P value for comparison of survival curves = 0.16). Adjusted Cox regression analysis revealed a significantly favourable result of EXT (P = 0.05). This difference was most remarkable in patients with one to three metastatic axillary lymph nodes, although it was not statistically significant because of too small a number of patients available (P = 0.18). The results are thus not definite, but suggest that EXT may be advantageous over RDL especially in patients with a few metastatic axillary lymph nodes.

Aged↗
PubMed1989

Treatment of breast cancer with segmental mastectomy alone or segmental mastectomy plus radiation.

A retrospective review of the outcome of treatment for primary, Stage I and II breast cancer with segmental mastectomy (SGM) alone or segmental mastectomy plus postoperative irradiation (SGM + RT) at four Rochester, New York, city hospitals is reported. Between January 1971 and March 1984, 99 women were treated with SGM and 146 with SGM + RT. Groups were similar regarding significant clinical and histologic prognostic factors; they differed, however, in that the SGM group was considerably older (means = 72) than the SGM + RT group (means = 56). Among SGM patients, local and total locoregional failure was 26.44 and 35.2%, respectively. Local and total locoregional failure (7.6 and 12.4%, respectively) was significantly reduced among patients treated with SGM + RT (p less than 0.0001). Among SGM patients, there was scant advantage in enlarging the extent of resection from local excision (29.5% local failure) to wide local excision (27.3%) to quadrantectomy (22.2%). Among women receiving SGM + RT, similar rates of local failure occurred among patients receiving local excision (15.5%) and wide local excision (12.5%). By contrast, only 2.8% of those receiving quadrantectomy failed. Results are viewed as supportive of findings of NSABP-B06. Findings suggest that SGM constitutes inadequate treatment of Stage I and II breast cancer. Locoregional failure rates of 30-40% may be reduced to around 10% with postoperative irradiation.

Adult↗
PubMed1989

Immediate and long-term phantom breast syndrome after mastectomy: incidence, clinical characteristics and relationship to pre-mastectomy breast pain.

Phantom breast syndrome (PBS) following mastectomy has already been reported by other authors. The temporal course, character and extent of these phenomena, however, have not yet been elucidated. In a prospective study, we investigated the incidence, clinical picture and the temporal course of PBS. One hundred and twenty women who, during a 1 year period, embarked consecutively on post-operative control or treatment at the department, were interviewed by a standard questionnaire 3 weeks after the operation. One year later 110 patients were interviewed again. The median age at the first interview was 54 years (Q1 = 45 years; Q3 = 62 years). The incidence of PBS was 25.8% at the first interview and 24.5% at the second. The incidence of phantom pain and non-painful phantom sensations was 13.3% and 15.0%, respectively, 3 weeks after mastectomy and 12.7% and 11.8%, respectively after 1 year. We found significant relationships between pre-operative pain and PBS, but no significant relation between age and the occurrence of PBS. Neither post-operative sequelae nor cancer treatment including radiotherapy seemed to affect the occurrence of PBS. Exteroceptive-like pain emerged as the most predominant type of pain from both interviews. At the time of the first interview, 35.0% of the patients experienced cicatrix pain which was clearly distinguishable from phantom pain; after 1 year, 22.7% of the patients had persistent cicatrix pain. The present incidence of PBS is close to the incidence reported by others. Persistent phantom pain may, however, be more common than usually expected. Also persistence of cicatrix pain seems to be more common than generally expected.

Breast Neoplasms↗
PubMed1988

Treatment of breast cancer among elderly women with segmental mastectomy or segmental mastectomy plus postoperative radiotherapy.

Elderly women with cancer are often treated non-aggressively. Between January 1972 and March 1984, 128 women greater than 60 years were treated for Stage I or II breast cancer with segmental mastectomy (SGM) plus/minus postoperative radiation at one of our four area hospitals. Whereas 82% of similar patients less than 60 years were referred for postop radiation, only 39.8% of patients greater than 60 were so referred. Referral rates progressively diminished with increasing patient age above 60. Thus, we reviewed the outcome of 77 elderly women treated with SGM and 51 treated with SGM+RT. Treatment groups were similar with regard to prognostic clinical and histologic parameters. Mean follow-up is 51.4 months. Among SGM patients, 45.5% of patients between 60-70 years, 37.9% of those greater than 70, and 20% of those greater than 80 years experienced loco/regional failure prior to death. Conversely, only two local failures occurred among all elderly women treated with SGM+RT. Distant failure was approximately 11% and was unaffected by treatment. Complications of SGM+RT were modest. These data suggest that SGM+RT can be safely and effectively applied to the elderly. Moreover, the data suggests that postop radiation may be more beneficial when extended to elderly patients post segmental mastectomy than among younger women. Referring surgeons should focus upon their patients' physiologic and not chronologic age as a basis for treatment allocation decisions.

Age Factors↗
PubMed1990

[A multivariate analysis of en bloc extended radical mastectomy versus conventional radical mastectomy in operable breast cancer].

We made clinical trials of en bloc extended radical mastectomy (EXT) of a new type in 118 patients from 1980 through 1985. Conventional radical mastectomies (RDL) were also performed in 105 patients from 1973 through 1985. A multivariate analysis was performed to compare the results of EXT and RDL. As the result, the 5-year survival rates of 91 +/- 2.6% and 83 +/- 3.7% were achieved for the EXT and RDL groups, respectively (Cox P value for comparison of survival curves = 0.16). Adjusted Cox regression analysis revealed a significantly favorable result of EXT (P = 0.03). This difference was most remarkable in patients with one to three metastatic axillary lymph nodes, although it was not statistically significant because of too small number of patients available (P = 0.18). The results are thus not definite, but suggest that EXT may be advantageous over RDL especially in patients with a few metastatic axillary lymph nodes.

Adult↗
PubMed1977

Total mastectomy with axillary dissection. A modified radical mastectomy.

A technic for total mastectomy with complete axillary dissection has been described. The procedure utilizes division of the pectoralis major muscle between its clavicular and sternal portions, perservation of its innervation, and reconstruction after completion of the dissection. The pectoralis minor muscle is resected. This modification facilitates a thorough axillary dissection, particularly at the apex, while preserving the cosmetic and functional benefits of the Patey operation.

Axilla↗
PubMed1988

[Subcutaneous mastectomy: surgical indications and pathologico-anatomic findings in the mastectomy specimen].

This is a report on the histological findings in subcutaneous mastectomy (scM) specimens of 250 patients, who underwent surgery at the Gynaecological Department of the University Hospital Heidelberg between 1978 and 1987. These operations were indicated either because of diagnostic problems (n = 111), a carcinoma of the contralateral breast (n = 41), a histologically proven mastopathy with epithelial atypia (n = 30), non-invasive lobular carcinoma (n = 28) or non-invasive ductal carcinoma (n = 40). In the group of patients with diagnostic problems, a large number of occult carcinoma and precancerous lesions (36%) could only be found where the glandular tissue could be evaluated neither clinically nor radiologically. In cases with preoperatively diagnosed proliferative mastopathies with epithelial atypia, we found occult carcinoma ipsilaterally in 27%, in cases with a preoperative carcinoma lobulare in situ (Clis) in 28% and with a preoperative diagnosed carcinoma ductale in situ (Cdis) in 57%. The percentage of occult carcinoma in the corresponding contralateral breasts was 6%, 25% and 30% respectively. In women with a previously known contralateral carcinoma, occult invasive or non-invasive carcinoma were diagnosed in 20%. There was a correlation between the incidence rate of carcinoma and genetic risk. On the basis of these results the acceptable indications for a scM are: 1. clinical and radiological diagnostic problems with an additional genetic risk, 2. proliferative mastopathy with epithelial atypia in addition to limited mammographic assessment and familial risk, 3. contralateral carcinoma with radiologic dysplasia or high genetic risk, 4. Clis, when there are radiological diagnostic problems, 5. Cdis less than 2 cm.

Breast↗