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Results for “Mastectomy, Modified Radical”

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PubMed1987

Early discharge of the postmastectomy patient: unbundling of hospital services to improve profitability under DRGs.

Cost containment is necessary for health care facilities to remain profitable and, therefore, operable. Thus, newer strategies of providing quality patient care need be developed to achieve this goal. The purpose of this study was to compare the costs and outcome of patients who had modified radical mastectomies, who were discharged home with an indwelling hemovac drain, and whose follow-up was conducted by visiting nurses in contrast to the traditional hospitalization of these patients until the hemovacs were removed. Two groups were compared in a prospective fashion. Twenty patients who had undergone a modified radical mastectomy for stage I or II breast carcinoma and who were discharged home with an indwelling hemovac drain (HWIH) were compared with 20 modified radical mastectomy patients who remained hospitalized with the drains for continuous wall suction (IHWH). Mean length of stay for the HWIH group (2.65 days) was significantly lower than the IHWH group (9.65 days) (P less than .001). Mean total hospital charges (exclusive of physician fees) were significantly lower for the HWIH group ($ 2106) than for the IHWH group ($ 7672) (P less than .001). Under Diagnosis Related Group (DRG) reimbursement allowances, the IHWH group had a loss of $ 355 per patient, whereas the HWIH group had a profit of $ 5211 per patient. One complication in the HWIH group required rehospitalization (a wound infection that was treated with IV antibiotics). This study suggests that significant improvement in efficiency may be accomplished for selected mastectomy patients who are discharged home with the indwelling hemovac drain to be followed as outpatients by both the surgeon and a nurse specialist.

Breast Neoplasms↗

PubMed2004

Breast cancer with nephrotic syndrome: report of two cases.

We report two cases of women found to have breast cancers within a few months of being diagnosed with nephrotic syndrome. Case 1 was a 53-year-old Japanese woman in whom breast cancer was diagnosed 14 months after the onset of nephrotic syndrome. The histological diagnosis was invasive ductal carcinoma with no lymph node metastasis. We performed a modified radical mastectomy, after which the proteinuria and hypoproteinemia resolved almost completely, and the patient has been disease-free for 5 years since. Case 2 was a 61-year-old Japanese woman in whom breast cancer was diagnosed 2 months after the onset of membranous nephropathy. We performed a modified radical mastectomy and the histological diagnosis was invasive ductal carcinoma with marked lymphatic vessel permeation and involvement of five axillary lymph nodes. Proteinuria and hypoproteinemia did not resolve postoperatively and there is a high possibility of remnant or recurrent cancer. To our knowledge, there are only four other reported cases of paraneoplastic membranous nephropathy complicating breast cancer. However, we speculate that the postoperative resolution of nephrotic syndrome might be a measure of cancer control.

Breast Neoplasms↗

PubMed1989

Cancer cell emboli in the pectoral lymphatics of patients with breast cancer.

In order to investigate the possibility of local recurrence in the pectoral muscles of patients who undergo modified radical mastectomies, the cancer cell involvement of the lymphatics associated with the pectoralis major muscle was studied in 39 patients who underwent a standard radical mastectomy for Stage I-III breast cancer. Cancer cell emboli were found in the transpectoral lymphatics of 2 patients (2/39 = 5.1 per cent) and in the pectoral fascial lymphatics of 6 patients (6/39 = 15.4 per cent). Two patients with fascial lymphatic cancer cell emboli were from a group of 14 patients with intramammary lymphatic tumor emboli of a low degree (ly 1). The other 6 patients with cancer cell emboli in either the pectoral fascia or the transpectoral lymphatics were from a group of 11 patients with intramammary lymphatic tumor emboli of a moderate degree (ly 2). There was a significant relationship between the intramammary and the pectoral lymphatic cancer cell emboli (Chi square test: (p less than 0.05). The results of this study therefore indicate that lymphatic cancer cell emboli in the pectoral fascia and muscle are an important risk factor for patients who undergo a modified radical mastectomy.

Adult↗

PubMed1991

Effect of closing dead space on incidence of seroma after mastectomy.

Seromas are a significant cause of morbidity after modified radical mastectomy. The effect of closing dead space by suturing skin flaps to underlying muscle combined with early removal (48 hours postoperatively) of closed suction drains on formation of the seroma was evaluated prospectively in 37 patients. Thirty-three underwent modified radical mastectomy for invasive carcinoma while four underwent total mastectomy with a level 1 axillary dissection for multifocal intraductal carcinoma. Seromas occurred in three, all were minor, two required one aspiration only and one required two aspirations. Two were seromas of the lower flap while one was an axillary seroma. Except for one patient who had a wound hematoma develop, no other instances of morbidity were noted. Closing dead space by suturing skin flaps to underlying muscle combined with early removal of closed suction drains is associated with a low incidence of seroma formation after mastectomy. Use of this technique has important economic and clinical implications for patients who had mastectomy.

Body Fluids↗

PubMed2005

The effect of physiotherapy on shoulder function in patients surgically treated for breast cancer: a randomized study.

The effect of physiotherapy on shoulder function in patients surgically treated for breast cancer was examined through a randomized controlled trial. One hundred and thirty-nine patients with newly diagnosed breast cancer were enrolled in the study. Sixty-two (45%) had Breast Conserving Therapy and 77 (55%) had Modified Radical Mastectomy (Axillary dissection of level I and II was included in both procedures). Enrolled patients were randomized to either group A or group B. Group A was offered, team instructed physiotherapy consisting of 12 sessions of 60 min, two sessions a week. The treatment was instituted between the sixth and eight postoperative week. Group B was also offered team instructed physiotherapy, consisting of 12 sessions of 60 minute two sessions a week, but not until the 26th postoperative week. The patients were seen for follow-up examinations four times during the first postoperative year (after 7, 13, 26 and 56 weeks). Shoulder function was assessed by the Constant Shoulder Score preoperatively and at the four follow-up examinations. Team instructed physiotherapy was found to improve the shoulder function significantly in patients treated surgically for breast cancer. The effect of the treatment was influenced by the type of surgery performed, and in mastectomised patients, also by the application of radiation therapy. Compromised shoulder function is a less frequent and less severe side effect to breast conserving therapy as compared to modified radical mastectomy.

Adult↗

PubMed2003

Preoperative twice-weekly paclitaxel with concurrent radiation therapy followed by surgery and postoperative doxorubicin-based chemotherapy in locally advanced breast cancer: a phase I/II trial.

PURPOSE: Preoperative chemotherapy is the conventional primary treatment in locally advanced breast cancer (LABC). We investigated the safety and efficacy of primary twice-weekly paclitaxel and concurrent radiation (RT) before modified radical mastectomy followed by adjuvant doxorubicin-based chemotherapy. PATIENTS AND METHODS: Stage IIB (T3N0) to III LABC patients were eligible. Primary chemoradiation consisted of paclitaxel, 30 mg/m(2) delivered intravenously for 1 hour twice weekly for a total of 8 to 10 weeks, and concurrent RT (45 Gy at 1.8 Gy/fraction). Modified radical mastectomy was performed at least 2 weeks after completion of chemoradiation or on recovery of skin toxicity. Postoperatively, patients who responded to paclitaxel and RT received four cycles of doxorubicin/paclitaxel, whereas patients who did not respond received doxorubicin/cytoxan. RESULTS: Forty-four patients were accrued. Toxicity from paclitaxel/RT included grade 3 skin desquamation (7%), hypersensitivity (2%), and stomatitis (2%). Postsurgery complications occurred in six patients (14%). The only grade 4 toxicity of postmastectomy chemotherapy was hematologic (10%). Grade 3 toxicities were leukopenia (24%), infection (22%), peripheral neuropathy (17%), arthralgia and pain (17%), stomatitis (12%), fatigue (10%), esophagitis (5%), and nausea (2%). Overall clinical response rate to preoperative paclitaxel and RT was 91%. Thirty-four percent of patients achieved a pathologic response in the mastectomy specimen: 16% pathologic complete responses (clearance of invasive cancer in the breast and axillary contents) and 18% pathologic partial responses (< 10 residual microscopic foci of invasive breast cancer). CONCLUSION: Twice-weekly paclitaxel with concurrent RT is a feasible and effective primary treatment for LABC. Future studies should compare primary chemoradiation to chemotherapy in LABC.

Adult↗

PubMedDate not supplied

Feasibility of postmastectomy radiation therapy after TRAM flap breast reconstruction.

BACKGROUND: Postoperative radiotherapy (PORT) has been shown to decrease locoregional failure rates in high-risk breast cancer patients following modified radical mastectomy. However, there had not been a study evaluating the effect of PORT in patients after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. Therefore, we evaluated flap viability, cosmetic results, and locoregional recurrence in patients who underwent TRAM flap reconstruction and PORT. METHODS: The charts of patients who had undergone modified radical mastectomy with TRAM flap reconstruction and PORT at our institution were reviewed. Patients were examined in the clinic and interviewed by telephone to evaluate their perceptions of the cosmetic result. RESULTS: PORT was delivered to 19 patients with TRAM flaps (3 pedicled and 16 free flaps) between 1988 and 1994. There were no TRAM flap losses as a result of either surgical or radiotherapy complications. Two patients developed fat necrosis, one with a pedicled and one with a free TRAM flap. Patients with pedicled TRAM flaps noted more volume loss in the breast after radiation therapy. Eighty-four percent of patients felt their overall cosmetic result was excellent or good; only one patient reported a poor cosmetic result. Local control was achieved in three of the four patients who received PORT for local recurrence. There was only one local recurrence among the 14 patients who received PORT because they were at high risk of local recurrence. CONCLUSIONS: These results suggest that PORT can be given safely to high-risk patients following TRAM flap breast reconstruction with excellent cosmetic results and good locoregional control.

Adult↗

PubMed2005

Psychosocial effect of mastectomy versus conservative surgery in patients with early breast cancer.

PURPOSE: To compare the quality-of-life (QoL) and psychosocial changes in a group of patients with early breast cancer who underwent conservative surgery (BCS) or modified radical mastectomy(MRM). METHODS: Self-administered questionnaire assessing body image perception, social habits, sexual attraction and self-consciousness with relatives/friends, was randomly assigned to 125 patients (61 BCS, 64 MRM; aged 53 +/- 8 and 50 + 9 years, respectively, p = NS). RESULTS: MRM patients reported a significantly higher frequency of changes in body image perception and other related social behaviour such as avoiding going to the beach or using low-cut clothes, and reticence with friends. Conversely, no differences were found regarding sexuality, denial of the disease by the husband/partner, or concealing the disease from family members. Also, no significant differences were found between patients above and below the age of 50 years, for all variables studied after adjustment for surgical procedure. CONCLUSIONS: Modified radical mastectomy has a negative effect on body image perception and in social behaviour patterns of patients and with a concomitant decrease in QoL. The sexuality of the patient is not significantly affected.

Adult↗

PubMed1994

[Occult breast cancer: 9 cases report and review].

From 1977 to 1994, 9 breast cancer were treated. All patients presented axillary node enlargement as first sign. Six patients were treated by radical or modified radical mastectomy and 3 by axillary node excision. All patients received postoperative adjuvant radiotherapy and chemotherapy. Among the 6 patients treated by radical or modified radical mastectomy, 4 survived over 10 years after surgery, 1 died of heart disease at 8 years, and 1 on chemotherapy is for 4 months. The three patients treated by axillary node excision, all died of the disease at 8-32 months. It is considered that radical or modified radical mastectomy with adjuvant radiotherapy and chemotherapy is a suitable treatment selection for occult breast cancer.

Adult↗

PubMed2000

Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial.

BACKGROUND: Breast-conserving therapy (BCT) has been shown to be as effective as mastectomy in the treatment of tumors 2 cm or smaller. However, evidence of its efficacy, over the long term, in patients with tumors larger than 2 cm is limited. From May 1980 to May 1986, the European Organization for Research and Treatment of Cancer carried out a randomized, multicenter trial comparing BCT with modified radical mastectomy for patients with tumors up to 5 cm. In this analysis, we investigated whether the treatments resulted in different overall survival, time to distant metastasis, or time to locoregional recurrence. METHODS: Of 868 eligible breast cancer patients randomly assigned to the BCT arm or to the modified radical mastectomy arm, 80% had a tumor of 2.1-5 cm. BCT comprised lumpectomy with an attempted margin of 1 cm of healthy tissue and complete axillary clearance, followed by radiotherapy to the breast and a supplementary dose to the tumor bed. The median follow-up was 13.4 years. All P values are two-sided. RESULTS: At 10 years, there was no difference between the two groups in overall survival (66% for the mastectomy patients and 65% for the BCT patients; P =.11) or in their distant metastasis-free rates (66% for the mastectomy patients and 61% for the BCT patients; P =.24). The rate of locoregional recurrence (occurring before or at the same time as distant metastasis) at 10 years did show a statistically significant difference (12% of the mastectomy and 20% of the BCT patients; P =. 01). CONCLUSIONS: BCT and mastectomy demonstrate similar survival rates in a trial in which the great majority of the patients had stage II breast cancer.

Breast Neoplasms↗

PubMed2000

Breast cancer in a 6-year-old child.

A 6-year-old girl presented for a second opinion with a 1-year history of an enlarging soft tissue mass just lateral to the right areola. She had been seen by a pediatric surgeon elsewhere who reassured the parents that the lesion was benign. Ultrasound scan showed a 1.5- x 1.5-cm cystic structure adjacent to the right breast bud. Excisional biopsy results showed secretory ductal adenocarcinoma. Modified radical mastectomy with axillary node dissection was performed. All 11 nodes were negative for metastatic disease. She is now disease free 3 years after diagnosis. Estrogen-progesterone receptors were negative, as was screening for BCR 1 and 2. This is the first report of cytogenetics showing an abnormal cell line with a reciprocal translocation between 12p and 15q. Although breast cancer is extremely rare in children, a history of a painless, enlarging, firm breast mass should raise concern about possible neoplastic disease. Cystic appearance on ultrasound scan caused by the pseudocapsule around the tumor may be a marker for secretory carcinoma. Histological evaluation of all suspicious masses should be obtained. Because of the risk of local recurrence and axillary metastases, the authors recommend modified radical mastectomy with axillary node dissection for children with secretory carcinoma of the breast.

Biopsy, Needle↗

PubMed1997

[Changes in radical surgery of breast carcinoma in the last 20 years].

UNLABELLED: The retrospective analysis of 383 female patients with breast cancer of all tumor stages from the department of surgery (323 patients since 1979) and the department of gynaecology (58 patients since 1993) shows the abandonment of the radical mastectomy according to Rotter-Halsted (116 patients until 1989), acceptance of the modified radical mastectomy (178 patients since 1979) and introduction and rise of the breast conserving operations (67 patients since 1983). In 1992 there was an extension of breast conservation treatment from T1 N0 to T2 N1-2 tumors (tumor diameter till 4 cm). Operation technique: 1. Circular incision above the tumor, 2. tumor excision in histologically healthy tissue, 3. lower axillary dissection (level I and II with > or = 10 lymph nodes), 4. no suture of the gland and drainage without suction, 5. postoperative computerised high energy radiotherapy of the conserved breast (Clinic of radiotherapy of the University of Leipzig). Because of the high operation risk a simple mastectomy without axillary dissection was performed in 22 of 383 patients. RESULTS: 3 of 383 patients died = 0.78% postoperatively due to tumor independent complications. One local tumor recurrence was observed 6 years after breast conserving therapy in 25 patients operated until 1992. In 42 patients operated since 1993 a tumor recurrence did not occur so far. The 5-year-survival-rate in 153 patients of all tumor stages amounted to 64%, in node-negative patients 80.3%, in node positive patients 51.7%. RECOMMENDATIONS: Breast conservation will be always recommended if the relation between tumor diameter and breast volume permits a cosmetic attractive result.

Breast Neoplasms↗

PubMed2005

[Three men with breast cancer].

In three men, aged 81, 66 and 58 years, breast cancer was diagnosed. All three were treated by modified radical mastectomy and axillary-node dissection. They received tamoxifen and the first and the third patient also received radiotherapy. Presentation of these patients is usually delayed, because of the rarity of and unfamiliarity with the disease. Consequently, the disease is often in a more advanced stage at presentation and overall mortality is higher in comparison with women with breast cancer. However, survival of male patients is similar to survival of female patients when matched for age and stage. This stresses the importance of a timely diagnosis. As in women, of the known risk factors for male breast cancer, a positive family history is one of the most important ones. Modified radical mastectomy, combined with sentinel-node biopsy by experienced teams, is the standard treatment. Criteria for adjuvant systemic treatment are identical for men and women, although hormonal therapy (tamoxifen) has a more prominent place in the adjuvant setting because of the high percentage of positive hormone receptors in men.

Aged↗

PubMed2004

Seroma formation after surgery for breast cancer.

BACKGROUND: Seroma formation is the most frequent postoperative complication after breast cancer surgery. We carried out a study to investigate the effect of various demographic, clinical and therapeutic variables on seroma formation. PATIENTS AND METHODS: A retrospective cross sectional study of patients who underwent surgical therapy for breast cancer with either modified radical mastectomy (MRM) or breast preservation (BP) was carried out. The demographic data and clinical information were extracted from case records. Seroma formation was studied in relation to age, type of surgery, tumor size, nodal involvement, preoperative chemotherapy, surgical instrument (electrocautery or scalpel), use of pressure garment, and duration of drainage. The multiple logistic regression analysis was performed to estimate odds ratios. RESULTS: A total of 158 patients with breast cancer were studied. The mean age of the patients was 46.3 years (SD +/- 11.9). Seventy-three percent underwent modified radical mastectomy and the remaining 27% received breast preservation surgery. Seroma occurred in 35% of patients. In multivariate logistic regression analysis an association of postoperative seroma formation was noted with modified radical mastectomy (OR = 2.83, 95% CI 1.01-7.90, P = 0.04). No other factor studied was found to significantly effect the seroma formation after breast cancer surgery. CONCLUSION: The findings suggest that the type of surgery is a predicting factor for seroma formation in breast cancer patients.

Journal Article↗

PubMed1994

Changing practices in the surgical treatment of breast cancer in Japan: a nationwide survey by the Japanese Breast Cancer Society.

A nationwide survey in Japan of the patients with primary breast cancer from 1989 to 1991 revealed marked changes in the surgical treatment of the disease. During this period, there was a significant trend toward fewer instances of radical and extended radical mastectomies, and an increase in modified radical mastectomies and breast-conserving surgery. The percentage of breast-conserving surgery for the early-stage disease increased from 6.8% to 12.7%. Among the types of operations for breast-conserving surgery, quadrantectomy was used for 51.5% of the cases, while either a partial mastectomy or a subcutaneous mastectomy was used for 18.2% and 18.9%, respectively; a lumpectomy was performed in 10.9% of the cases. As for the proportion of patients receiving radiation therapy after breast-conserving surgery, 77% of those undergoing lumpectomy received radiation, in contrast to only 43% of the patients undergoing quadrantectomy. According to the data from 1991, we also found that breast-conserving surgery was performed more often in larger cities and urban areas in Japan. As a result, we found that substantial changes in the treatment of localized breast cancer had taken place from 1989 to 1991. Regarding the details of breast-conserving surgery, however, some variation still remains in spite of the publication of numerous clinical trials.

Breast Neoplasms↗

PubMed1990

Carcinoma of the male breast: a review of 41 cases.

We reviewed the cases of 41 consecutive men treated for breast carcinoma from 1950 through 1987 at Vanderbilt University Affiliated Hospitals to examine controversies in and methods of therapy for this disease. Twenty-two patients (52%) had stage I or II lesions potentially curable by operative therapy. The overall 5-year survival rates were 100% for stage I, 65% for stage II, 56% for stage III, and 0% for stage IV. Radical mastectomy offered no advantage over modified radical mastectomy in terms of survival or rate of recurrence. Diagnosis at an early clinical stage and no finding of disease in axillary lymph nodes were important factors in survival in this series of patients. All tumors evaluated for hormone receptors were positive. Although experience was limited, encouraging results were obtained with the use of tamoxifen citrate in adjuvant as well as palliative roles. With the exception of a predominance of centrally located lesions and a uniquely high frequency of positive hormone receptor status, carcinoma of the male breast appears biologically similar to the disease in women, and treatment should be guided by similar principles.

Actuarial Analysis↗

PubMed1999

[TRAM flap breast reconstruction using a fascia-sparing technique].

Although the TRAM flap has been accepted as one of the most common methods for breast reconstruction utilizing the autologous tissue, its disadvantage is that scarring of the abdominal sheath and muscle may result in postoperative abdominal bulge or hernia. To solve this problem, the authors developed the fascia-sparing technique in TRAM flap breast reconstruction. The technique, in which most of the anterior rectus sheath is preserved, has been applied in 3 patients after radical mastectomy and 7 patients after modified radical mastectomy. With an average follow-up period of 1 year and 2 months, no abdominal bulge or hernia was noted in any patient without the use of prosthetic mesh for the abdominal closure. This fascia sparing technique is particularly effective for TRAM flap reconstruction requiring bilateral rectus abdominis muscle portions and containing only a few minor perforators, for which a DIEP flap is not suitable.

Adult↗

PubMed1983

Breast cancer treatment--current status. 1. Mastectomy, standard surgical approach.

For about three quarters of a century, radical mastectomy was considered standard initial treatment for invasive breast cancer. Within the past 15 years, modified radical mastectomy (total mastectomy with axillary dissection) has replaced radical mastectomy as standard treatment, even though superiority of the former has not been scientifically proven, with the exception of a single study. During the same period, total mastectomy with postoperative irradiation of axillary lymph nodes came into vogue, and debate centered on whether irradiation of nodes was as efficacious as surgical extirpation. Results of several prospective studies indicated that when used prophylactically, neither method enhanced survival but both prevented subsequent nodal disease, and when used therapeutically, both methods controlled cancer growth equally well. Today, modified radical mastectomy is still standard treatment for patients with operable breast cancer, since axillary dissection is now routinely performed for staging purposes, thereby being preferable to irradiation of nodes.

Axilla↗