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PubMed1986

Early discharge after modified radical mastectomy.

Thirty-nine patients underwent modified radical mastectomy and were discharged with their suction drains and sutures in place after a mean postoperative stay of 4.7 days. Drains and sutures were removed at the first office visit. There were no infections, and late seromas developed in only 21 percent of the patients. Another group of patients were hospitalized until drainage effluent from their tubes was less than 30 ml/day, at which time the drains were removed and the patients discharged. This group had a mean postoperative stay of 9.5 days, and an incidence of late seroma of 43 percent. These data suggest it is both safe and effective to discharge patients 3 to 5 days after mastectomy at considerable potential cost savings due to the reduced hospital stay.

Adult↗

PubMed1976

Contour restoration following simple or modified radical mastectomy.

With the increasing performance of modified radical mastectomy in the treatment of female breast cancer, satisfactory restoration of contour can be performed by a relatively simple procedure. In a large number of patients, this constitutes the optimal rehabilitation in the appropriate circumstances. It is hoped that with an increasing awareness of the possibility of this type of restoration, the procedure will be more widely applied.

Adult↗

PubMed2005

[Immediate breast reconstruction with DIEP flap following modified radical mastectomy].

OBJECTIVE: To review the experience in immediate breast reconstruction with DIEP flap following modified radical mastectomy. METHODS: From 2003 to 2005, eight patients with breast cancer have undergone modified radical mastectomy and immediate breast reconstruction with deep inferior epigastric perforator flap. Six patients had stage I disease and 2 patients had stage II disease. RESULTS: The flaps in all the cases survived. Two occurred minor complications. A small part of venous congestion occurred in one flap. One patient had hematoma under the flap. Follow up more than 6 months, no evidence of recurrence and metastasis occurs. Postoperative abdominal wall examination didn't reveal and hernia and bulging. Patient satisfaction with the reconstructed breast was rated high. The reconstructed breast achieved good results in shape, colour and symmetry. CONCLUSION: The procedure introduced is an ideal method for breast reconstruction after modified radical mastectomy.

Adult↗

PubMed1975

Modified radical mastectomy.

This report describes our experience with a technique of modified radical mastectomy involving incision of the lower lateral fibers of the pectoralis major muscle and detachment of the origins of the pectoralis minor muscle. These maneuvers enable sufficient retraction of these muscles to provide excellent axillary exposure while minimizing the danger of traction injury to the neurovascular structures supplying these muscles. The operation has been performed in 20 patients; statistical analysis demonstrates at least as many nodes in these specimens compared to retrospective analysis of nodes recovered from 223 radical mastectomy specimens done during the previous 5 years. The final cosmetic results are superior to those obtained with standard radical mastectomy. These results suggest that this method of modified radical mastectomy should be considered, unless the proximity of the disease to the pectoralis muscles endangers the adequacy of the surgical margins.

Breast Neoplasms↗

PubMed1982

Modified radical mastectomy for carcinoma of the breast.

The technique of modified radical mastectomy (total mastectomy and axillary dissection) as carried out by members of the Breast Service at Memorial Sloan-Kettering Cancer Center is presented. As described by Patey, the pectoralis minor muscle is removed to facilitate dissection of the upper levels of the axilla. Care is taken to preserve the principal neurovascular bundle to the pectoralis major muscle. Indications for and complications of the procedure are indicated, with particular emphasis given to selection of patients for modified radical mastectomy or radical mastectomy.

Axilla↗

PubMed1975

Is modified radical mastectomy adequate for axillary lymph node dissection?

The effectiveness of axillary dissection by modified radical mastectomy was assessed by a comparison of the total axillary nodes removed by this operation to that by radical mastectomy. In a series of 121 consecutive radical mastectomies performed during the period of 1964 to 1969, we found that the number of axillary nodes removed ranged from 3 to 63 with a median of 22 and a mean of 23.4 per patient. In a subsequent series of 111 consecutive modified radical mastectomies performed between 1969 and 1973, the total axillary nodes removed ranged from 6 to 77 with a median of 24 and mean of 25.7 nodes in each mastectomy specimen. These results strongly suggest that axillary dissection in modified radical mastectomy is as complete as that in the Halsted radical mastectomy.

Axilla↗

PubMed2004

[Comparative clinical evaluation of the effectiveness of modified radical mastectomy and organ-preserving therapy in localized breast cancer (pT1-2N0M0)].

The outcome of 320 patients with breast tumors was followed. Modified total mastectomy with subsequent irradiation, chemo- and/or hormone therapy was given to 164 patients. Limb-saving surgery was performed in 156. Incidence of locally advanced recurrences did not differ significantly in the two groups--3.7 and 5.5%, respectively. Nor did 5-year overall (90 +/- 1.4% and 88.4% +/- 1.6%, respectively) and relapse-free survival (88.4 +/- 1.2% and 83.5 +/- 1.4%, respectively) (p < 0.05). Hence, mastectomy is not worth more than sparing treatment.

Breast Neoplasms↗

PubMed2000

Factors influencing a woman's choice to undergo breast-conserving surgery versus modified radical mastectomy.

BACKGROUND: The use of breast-conserving surgery (BCS) rather than modified radical mastectomy (MRM) for the treatment of breast carcinoma is an option for the majority of women (75%) with early stage breast cancer, but only 20% to 50% choose to undergo this procedure nationwide. The objective of this study was to identify factors influencing a woman's choice between BCS and MRM, and specifically, the surgeon's influence on this choice. METHODS: A total of 134 women eligible for BCS were sent a survey. Data obtained included demographics, influential factors in treatment choice, and satisfaction with preoperative discussion and postoperative results. RESULTS: Ninety-six women completed the questionnaire. Mean patient age was 62 years. Most women surveyed felt their treatment options were satisfactorily explained to them. BCS, MRM with reconstruction (MRM-R), and MRM without reconstruction (MRM-NR) were performed in 45%, 15%, and 40% of patients, respectively. Overall, the most influential factor was the fear of cancer. Women choosing BCS indicated that the surgeon, cosmetic result, and psychological aspects were more influential in their decision than in women undergoing MRM-NR (P <0.02). Fear of cancer was the most important factor affecting the choice to undergo MRM-NR. In comparing MRM-R with MRM-NR, there was a similar fear of cancer; however, MRM-R had much greater concern with cosmesis (P = 0.0002). CONCLUSION: The surgeon's input is important in a woman's choice to undergo BCS or MRM-R. However, it appears that if a woman wants to have MRM-NR, even when she is a candidate for BCS, the surgeon's input is overshadowed by the patient's fear of cancer.

Adult↗

PubMed1997

The National Cancer Data Base report on the results of a large nonrandomized comparison of breast preservation and modified radical mastectomy.

BACKGROUND: Although the conclusions reached in the National Surgical Adjuvant Bowel and Breast Protocol B-06 trial and other clinical trials appear to remain intact, questions persist regarding the equivalency of breast preservation compared with modified radical mastectomy for patients with invasive carcinoma. Documentation and assessment of comparative survival rates in a large cohort of nonrandomized breast carcinoma patients was undertaken to understand better these outcome patterns. METHODS: Information gathered from the medical records of 96,030 women diagnosed with early stage carcinoma of the breast between 1985 and 1988 was reviewed to determine the age at diagnosis; tumor stage, grade, dimension; treatment; and disease status. RESULTS: Of these 96,030 Stage I and II (based on the American Joint Committee on Cancer staging system) patients, 8583 (8.9%) were treated with segmental mastectomy, axillary lymph node dissection, and radiotherapy without systemic treatment. Three thousand seven hundred and ninety-seven patients (4.0%) were treated with segmental mastectomy, axillary lymph node dissection, radiotherapy, and systemic therapy. Forty-four thousand two hundred and forty-nine patients (46.0%) were treated with modified radical mastectomy without systemic therapy, and 18,322 patients (19.1%) were treated with modified radical mastectomy with systemic therapy. Within each stage, reported survival was equal to or more favorable for patients managed with breast preservation compared with those treated with modified radical mastectomy. This comparability was observed in all subsets analyzed including those defined by age at diagnosis, histologic grade, and tumor dimension. CONCLUSIONS: These findings are consistent with the hypothesis that AJCC Stage I and II patients treated with breast preservation appear to have survival rates equivalent to those treated with modified radical mastectomy.

Adolescent↗

PubMedDate not supplied

Single-stage subcutaneous breast-prosthesis implantation and modified radical mastectomy for invasive carcinoma.

In eighteen patients modified radical mastectomy for invasive carcinoma was immediately followed by breast reconstruction. The prosthesis was placed subcutaneously. There were no infections and no definitively lost prostheses. One prosthesis had to be replaced subpectorally after 55 days due to a small skin necrosis occurring after radiotherapy. One hematoma had to be evacuated and one small skin necrosis was excised and sutured per primam. There were no local recurrences but the follow-up is short (3 years and 4 months). Postoperative radio- and chemotherapy were not affected by the reconstruction.

Adult↗

PubMed1997

Delayed shoulder exercises in reducing seroma frequency after modified radical mastectomy: a prospective randomized study.

BACKGROUND: Seromas and impaired shoulder function are well-known complications after modified radical mastectomy for breast cancer. Early postoperative physiotherapy is a common treatment to avoid shoulder dysfunction. The aim of this study was to evaluate if the frequency of postoperative seromas could be reduced, without increasing shoulder dysfunction, by delayed postoperative shoulder exercises. METHODS: In a prospective study 163 patients with breast cancer undergoing modified radical mastectomy were randomized to physiotherapy starting on postoperative day 1 or day 7. Patients were seen by the surgeons and the physiotherapists during hospital stay and in the outpatient department. Seromas and other complications were registered by the surgeons. The physiotherapists instructed the patients pre- and postoperatively and assessed shoulder function. RESULTS: There was a significantly higher incidence of postoperative seromas in the group of patients that started physiotherapy postoperative day 1 (38%) compared to the group that started physiotherapy postoperative day 7 (22%) (p < 0.05). There was no significant difference between the groups in the late outcome of shoulder function. CONCLUSION: The incidence of seromas after modified radical mastectomy for breast cancer is reduced by delaying shoulder exercises one week postoperatively. Earlier postoperative physiotherapy is not necessary to avoid impaired shoulder function.

Aged↗

PubMed1992

[A role of interpectoral (Rotter's) lymph node dissection in modified radical mastectomy for breast cancer].

To study the influence of interpectoral lymph node (IPN) dissection on the prognosis of patients who underwent modified radical mastectomy, IPN was carefully dissected and studied pathologically on 168 cases of our breast cancer patients operated with modified radical mastectomy. There were 1.2 lymph nodes on an average in the interpectoral region, and they were almost 1-2mm in diameter. IPN metastases were found in 10 cases. (Tis: 0%, Stage I: 4.9%, Stage II: 5.7%, Stage III: 13%). Tumors located in outer quadrant in almost all these cases. Positive IPN were found in 6 (16%) of n1 alpha group, 1 (10%) of n1 beta group, and in 3 (50%) of n2 group. All these 3 cases of n2 died of distant metastasis and local recurrence. Two (1.7%) of axillary node (1a, 1b) negative patients had microinvolvement of cancer only in IPN, and are currently disease-free. These data suggest that IPN metastasis may occur even in the early breast cancer patients, and that may be controllable by lymph node excision. Therefore, routine and careful dissection of IPN through wide opening of sulcus interpectoralis is necessary for modified radical mastectomy and even for breast preserving operation.

Adult↗

PubMed1976

Evaluation of dissection of the axilla in modified radical mastectomy.

Fifty consecutive unselected patients with infiltrating carcinoma of the breast underwent radical mastectomy in two consecutive stages. The initial operation was a modified radical mastectomy, with preservation of the pectoral muscles, and the second stage, a procedure to transform the initial operation into a standard radical mastectomy. An analysis of the location and the number of the lymph nodes recovered in the two stage operation shows that a so-called modified radical mastectomy is inadequate to ensure the clearing of the axilla. Lymph nodes were recovered at the second stage of the operation in 36 patients, and seven of these patients had metastasis. Modified radical mastectomy was effective in erradicating the lymph nodes of the lower part of the axilla but inadequate for lymph nodes at levels II and III and, especially, the interpectoral lymph nodes.

Adult↗

PubMed2005

Half versus full vacuum suction drainage after modified radical mastectomy for breast cancer- a prospective randomized clinical trial[ISRCTN24484328].

BACKGROUND: Suction drains are routinely used after modified radical mastectomy and are an important factor contributing to increased hospital stay as the patients are often discharged only after their removal. Amongst various factors that influence the amount of postoperative drainage, the negative suction pressure applied to the drain has been reported to be of great significance. While a high negative suction pressure is expected to drain the collection and reduce the dead space promptly, it may also prevent the leaking lymphatics from closing and lead to increased drainage from the wound. Against this background a prospective randomized clinical study was conducted to compare the amount and duration of drainage between a half negative suction and full vacuum suction drainage in patients following modified radical mastectomy. The associated postoperative morbidity was also compared between the two groups. METHODS: 85 FNAC (fine needle aspiration cytology) proven cases of locally advanced breast cancer were randomized. (Using randomly ordered sealed envelops, which were opened immediately before the closure of the wound) in to 50 patients with full vacuum suction (pressure = 700 g/m2) and 35 cases in to half vacuum suction drainage (pressure = 350 g/m2) groups. The two groups were comparable in respect of age, weight, and technique of operation and extent of axillary dissection. Surgery was performed by the same surgical team comprising of five surgeons (two senior and three resident surgeons) using a standardized technique with electrocautery. External compression dressing was provided over the axilla for first 48 hrs and following that patients were encouraged to do active and passive shoulder exercises. The outcomes measured were postoperative morbidity and the length of hospital stay. Statistical methods used: Descriptive studies were performed with SPSS version 10 and group characteristics were compared using student t-test. RESULTS: Half vacuum suction drains were removed earlier than the full suction vacuum suction drains. There was no significant difference in the incidence of seroma formation in the two groups and there was a significant reduction in the total hospital stay in patients with half vacuum suction drainage systems as compared to the full suction drainage group (p < 0.001) without any added morbidity. CONCLUSIONS: Half negative suction drains provide an effective compromise between no suction and full or high suction drainage after modified radical mastectomy by reducing the hospital stay and the post operative morbidity including post operative seromas.

Adult↗

PubMed1998

Seroma with fibrous capsule formation requiring a surgical resection after a modified radical mastectomy: report of a case.

Seroma formation is the most common complication of a modified radical mastectomy for breast cancer. Although various management or risk factors for seroma formation have been previously reported, little has been published concerning seromas with fibrous capsule formation which ultimately require a surgical resection. We herein present a case who developed a seroma with a fibrous capsule after a modified radical mastectomy for breast cancer, in spite of an uneventful intraoperative and postoperative course. The seroma was refractory to all conventional treatments, and thus finally required a surgical resection.

Axilla↗

PubMed1989

A new method of modified radical mastectomy for breast cancer.

We have developed a new type of modified radical mastectomy, the method and clinical results of which are reported herein. In this operation, axillary dissection is performed by the following two approaches. Firstly, the axillary contents are dissected from the highest possible subclavicular point to the pectoralis minor muscle, after partially cutting the sternocostal origin of the pectoralis major muscle. The second approach is from the posterior aspect of the pectoralis minor muscle to the lateral portion of the latissimus dorsi muscle. Parasternal dissection can also be performed for stage II and IIIa cancers with a central or medial tumor. After lymph node dissection, the detached edge of the sternocostal origin of the pectoralis major muscle is resutured to cover the parasternal region. Thus, complete dissection of the axillary nodes is performed whilst preserving the pectoralis major and pectoralis minor muscles. Good clinical results were achieved with respect to radicality, cosmetic effects and function in 28 patients with stage I, II, and IIIa breast cancers who were followed up for between 5 to 8 years. This new operation may therefore be adopted for the majority of patients with Stage I, II, or IIIa cancers, unless massive infiltration into the pectoralis major muscle has occurred. Preservation of both the pectoralis major and pectoralis minor muscles results in a good cosmetic appearance, good functioning of the arm and easy reconstruction of the breast following mastectomy.

Adult↗

PubMed1999

Preincisional dextromethorphan decreases postoperative pain and opioid requirement after modified radical mastectomy.

PURPOSE: To examine whether preincisional dextromethorphan (DM) improved analgesia after modified radical mastectomy (MRM). METHODS: Sixty patients (ASA I-II) scheduled for MRM were included and randomly allocated into two groups. Patients in the treatment group (DM) received 40 mg DM and 20 mg chlorpheniramine maleate (CPM) i.m., and those in the control group received 20 mg CPM i.m. alone 30 min before skin incision. Meperidine, 1 mg x kg(-1) i.m., was given for postoperative pain relief as required. The time to first meperidine injection, total meperidine consumption, worst pain score, bed-rest time, and side effects were recorded every 24 hr for 48 hr after surgery by a resident anesthesiologist on a double-blind basis. RESULTS: A longer time to first meperidine injection (19.2 +/- 1.6 vs 1.5 +/- 0.23 hr, P < 0.001) and lower meperidine consumption (0[10] vs 75[50] mg, median [interquartile range], P < 0.001) were observed in the DM group than in the control group. The bed-rest time was shorter in the DM than in the control group (18.0[4] vs 23.0[19] hr, P < 0.001). No difference was noted in worst VAS pain score. Meperidine-related side effects (nausea, vomiting, pruritus, dizziness, headache) were more frequent in the control (10/30) than in the DM group (3/30, P < 0.05). The number of patients who required meperidine injection for pain relief was lower in the DM (7/30) than in the control group (25/30, P < 0.005). No DM- or CPM-associated side effects were observed. CONCLUSION: Preincisional IM. DM treatment decreased postoperative pain and opioid requirement after MRM surgery.

Analgesics, Opioid↗

PubMed2006

[Bilateral breast reconstruction with deep inferior epigastric perforator flap following modified radical mastectomy].

OBJECTIVE: To present a method for bilateral breast reconstruction with deep inferior epigastric perforator (DIEP) flap following modified radical mastectomy. METHODS: From 2004 to 2005, three patients with bilateral modified radical mastectomy have undergone delayed bilateral breast reconstruction with deep inferior epigastric perforator flap. RESULT: The flaps in all the cases survived. Follow-up more than 3 months, postoperative abdominal wall examination didn't reveal hernia and bulging. The bilateral reconstructed breast achieved good results in shape and symmetry. Bilateral reconstructed breasts are symmetry. CONCLUSION: The procedure introduced is a reliable method for bilateral breast reconstruction.

Adult↗