SEARCH · PubMed Health

Results for “Mastectomy, Modified Radical”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 523 records · Page 29Linked to original sources

PubMed2003

A systematic overview of radiation therapy effects in breast cancer.

A systematic review of radiation therapy trials in several tumour types was performed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures for evaluation of the scientific literature are described separately (Acta Oncol 2003; 42: 357-365). This synthesis of the literature on radiation therapy for breast cancer is based on data from 29 randomized trials, 6 meta-analyses and 5 retrospective studies. In total, 40 scientific articles are included, involving 41 204 patients. The results were compared with those of a similar overview from 1996 including 285 982 patients. The conclusions reached can be summarized as follows: There is strong evidence for a substantial reduction in locoregional recurrence rate following postmastectomy radiation therapy to the chest wall and the regional nodal areas. There is strong evidence that postmastectomy radiation therapy increases the disease-free survival rate. There are conflicting data regarding the impact of postmastectomy radiotherapy upon overall survival. There is strong evidence that breast cancer specific survival is improved by postmastectomy radiotherapy. There is strong evidence for a decrease in non-breast cancer specific survival after postmastectomy radiotherapy. There is some evidence that overall survival is increased by optimal postmastectomy radiation therapy. There is strong evidence that postmastectomy radiotherapy in addition to surgery and systemic therapy in mainly node-positive patients decreases local recurrence rate and improves survival. There is moderate evidence that the decrease in non-breast cancer specific survival is attributed to cardiovascular disease in irradiated patients. There are conflicting data whether breast conservation surgery plus radiotherapy is comparable to modified radical mastectomy alone in terms of local recurrence rate. There is strong evidence that breast conservation surgery plus radiotherapy is comparable to modified radical mastectomy alone in terms of disease-free survival and overall survival. There is strong evidence that postoperative radiotherapy to the breast following breast conservation surgery results in a statistically and clinically significant reduction of ipsilateral breast recurrences followed by diminished need for salvage mastectomies. There is strong evidence that the omission of postoperative radiotherapy to the breast following breast conservation surgery has no impact on overall survival. In one meta-analysis including three randomized studies a survival advantage is demonstrated by Bayesian statistics. There is strong evidence that the addition of a radiation boost after conventional radiotherapy to the tumour bed after breast conservation surgery significantly decreases the risk of ipsilateral breast recurrences but has no impact on overall survival after short follow-up. There is strong evidence for the use of postoperative radiotherapy to the breast following breast conservation surgery for DCIS (ductal breast cancer in situ). Radiotherapy leads to a clinically and statistically significant reduction of both non-invasive and invasive ipsilateral breast recurrences. There is insufficient evidence to define the optimal integration of systemic adjuvant therapy and postoperative radiotherapy. There are limited data on radiotherapy-related morbidity in breast cancer. No conclusions can be drawn.

Adult↗

PubMed1997

Adjuvant radiotherapy and chemotherapy in node-positive premenopausal women with breast cancer.

BACKGROUND: Radiotherapy after mastectomy to treat early breast cancer has been known since the 1940s to reduce rates of local relapse. However, the routine use of postoperative radiotherapy began to decline in the 1980s because it failed to improve overall survival. We prospectively tested the efficacy of combining radiotherapy with chemotherapy. METHODS: From 1978 through 1986, 318 premenopausal women with node-positive breast cancer were randomly assigned, after modified radical mastectomy, to receive chemotherapy plus radiotherapy or chemotherapy alone. Radiotherapy was given to the chest wall and locoregional lymph nodes between the fourth and fifth cycles of cyclophosphamide, methotrexate, and fluorouracil. RESULTS: After 15 years of follow-up, the women assigned to chemotherapy plus radiotherapy had a 33 percent reduction in the rate of recurrence (relative risk, 0.67; 95 percent confidence interval, 0.50 to 0.90) and a 29 percent reduction in mortality from breast cancer (relative risk, 0.71; 95 percent confidence interval, 0.51 to 0.99), as compared with the women treated with chemotherapy alone. CONCLUSIONS: Radiotherapy combined with chemotherapy after modified radical mastectomy decreases rates of locoregional and systemic relapse and reduces mortality from breast cancer.

Adult↗

PubMed1987

Who still prefers aggressive surgery for breast cancer? Implications for the clinical applications of clinical trials.

Conservative breast surgery and modified radical mastectomy may, according to recent reports, yield equivalent survival. Analysis of a 1985 Canada-wide study (N = 228) compared surgeons and oncologists still recommending modified radical mastectomy (30%) with those recommending less aggressive surgery (69%) for a hypothetical stage I patient. The groups did not differ significantly in most physician characteristics, estimated survival and cure probabilities, importance of most treatment goals, uncertainty about treatment choice, or most attitudinal responses. Although equally involved with and cognizant of the value of clinical trials, the modified radical group expressed more skepticism about the ability of trial results to be transferred to practice and to take sufficient account of patient uniqueness, indicating greater focus on variation than mean results. Trial results might be more readily adopted if they are reported in accessible data-bases, incorporating patient characteristics potentially relevant to treatment choice. This would allow clinicians to individualize treatment by analyzing patient subsets of their own choosing.

Attitude of Health Personnel↗

PubMed1985

Results of conservative operations for breast cancer.

The results of conservative operations for breast cancer in 1,593 patients treated at the Cleveland Clinic between 1957 through 1975 are reported. During this period, we individualized our treatment of breast cancer depending on tumor size, location in the breast, and clinical stage of the disease. The following three principal operations were performed: modified radical mastectomy in 592 patients (37%), simple (total) mastectomy in 442 patients (28%), and partial (segmental) mastectomy in 291 patients (18%). Survival results at 5, 10, and 15 years are reported. Factors important in long-term survival included stage of the disease, number of lymph node metastases, delay in therapy, size of the tumor, histologic type, and estrogen receptor status; type of operation was not a significant factor. In this series, partial (segmental) mastectomy without radiation therapy provided five- to 15-year survival rates equal to modified radical mastectomy and simple (total) mastectomy.

Adenocarcinoma, Mucinous↗

PubMed1991

Experience with 50 free TRAM flap breast reconstructions.

The data from the first 50 patients undergoing free TRAM flap breast reconstruction in two units were examined. Average patient age was 42 years, and average weight was 62 kg. Forty percent of patients were chronic smokers, and 26 percent had low abdominal scars. Twelve percent exercised their abdominal muscles regularly. Eighteen percent had undergone radical mastectomy, whereas 76 percent had undergone modified radical mastectomy and 6 percent had undergone subcutaneous mastectomy. Postoperative radiotherapy had been given in 16 percent of patients, and 54 percent had received postoperative chemotherapy. The average time from mastectomy was 32 months, whereas six breasts were reconstructed immediately. Average operating time was 5.6 hours, and average blood loss was 2.4 units. Average hospital stay was 11.2 days. Complications included three total flap losses (6 percent) and two partial flap losses (4 percent). Abdominal hernia occurred in two patients (4 percent).

Adult↗

PubMed1989

[Recent trends in breast cancer surgery in Japan].

In the past ten years, extended or conventional radical mastectomies have decreased, being replaced by modified radical mastectomies (muscle-preserving mastectomies) such as Auchinoloss' operation and Patey's operation. Furthermore, limited surgeries for early cases such as partial mastectomy, lumpectomy etc. also have increased in the recent three years. The indications for these operations, the surgical techniques, postoperative functional and cosmetic problems were presented. And future problems as to partial mastectomy were also discussed. In contrast, aggressive surgery such as extensive resection of the chest wall for locally advanced breast cancer is useful as one of the therapeutic measures in the recent multidisciplinary treatments for breast cancer, in order to prolong the patient's survival and improve the quality of life. The techniques including the reconstruction using musculocutaneous flaps were also presented.

Breast↗

PubMed1995

[Treatment of breast cancer with ipsilateral supraclavicular node metastases].

During 1954-1977, among 2803 cases of breast cancer 99 (3.5%) had ipsilateral supraclavicular node mestastases. The results of treatment are reported, based on follow-up for more than 10 years. According to the treatment modality, the patients were divided into 4 groups: I. surgery with postoperative adjuvant chemotherapy and radiation therapy; II. radiation and chemotherapy; III. chemotherapy; IV. no treatment. In group I, surgical procedures consisted of segmental mastectomy in 6; simple mastectomy in 7; modified radical mastectomy in 16; standard radical mastectomy in 12, and extended radical mastectomy in 3. The over-all five-year survival rate was 9%. It was 18% (8/44) in group I, but only 5% (1/21) in group II. None survived for 5 years in group III and group IV. The results seem to indicate that more aggressive multi-modality treatment of breast cancer with ipsilateral supraclavicular lymph node metastases is indicated to expect better survival.

Adult↗

PubMed1998

Beyond body image: the experience of breast cancer.

PURPOSE/OBJECTIVES: To describe the mental and emotional impact of treatment for breast cancer with a focus on the ways the body is experienced. DESIGN: Phenomenologic, descriptive, and interpretive. SETTING: An outpatient treatment area of a comprehensive cancer center in the southwestern United States. SAMPLE: 20 women, ages 20-68 (mean = 50 years), who had mastectomies (including both modified radical mastectomies and lumpectomies, with some having reconstruction) for breast cancer. METHODS: Content analysis of verbatim transcriptions of open-ended interviews using hermeneutic phenomenology and descriptive and interpretive presentation of a paradigm case. MAIN RESEARCH VARIABLES: Reaction to breast cancer and its treatment. FINDINGS: Informants' descriptions demonstrate that the body can be viewed as having three aspects: (a) the body as symbol or social expression (i.e., how bodies make a social statement and tell others who you are); (b) the body as a way of being in the world, including sensations and symptoms such as nausea, fatigue, and pain; and (c) the existential sense that one needs a body to be in the world (i.e., the body expresses existence), which led to more awareness of the possibility of death. CONCLUSIONS: Women treated for breast cancer view their bodies in ways that go beyond what is suggested by the literature on body image and breast cancer, encompassing a wide range of responses. IMPLICATIONS FOR NURSING PRACTICE: The contribution of this study is the documentation of the complexity of the meaning of "body" for women with breast cancer. Appropriate interventions differ for each aspect of the body: for the body as social symbol, programs such as Look Good ... Feel Better or image centers; for the body's sensations and symptoms, information about what to expect and about symptom prevention and management; for the existential body, active listening to fears and concerns and providing assistance as needed.

Adaptation, Psychological↗

PubMed2000

[Skin sparing mastectomy with autologous immediate reconstruction: oncological risks and aesthetic results].

OBJECTIVE: Is the oncological safety of skin sparing mastectomy (SSM) with immediate autologous reconstruction and improved aesthetic results comparable to postoperative findings in patients treated with modified radical mastectomy (MRM)? MATERIAL AND METHODS: Sixty patients with T1-2 breast carcinomas and contraindications for breast conserving therapy were treated by SSM and compared to 81 patients of the same age groups and MRM with regard to oncological and aesthetic data. In 33 (55%) patients the nipple areola complex (NAC) could be spared. For autologous tissue TRAM- and Latissimus dorsi-flaps were used. The mean follow-up was 40 (range 20-71) months. RESULTS: The observed local recurrence rates were not significantly different (p = 0.443) after SSM (n = 3; 5.0%) or MRM (n = 5; 6.2%). Distant metastases and death were seen in 26.7% and 15.0% (SSM), respectively, and in 25.9% and 13.5% (MRM), respectively. Body mass index, operation time and postoperative haemoglobin concentration differed between both groups significantly (p < 0.001) but not the rate of complications (p = 0.232). Aesthetic results of SSM were judged as excellent or good in 90.0% of patients and in 83.4% of surgeons. Nine patients (11.1%) underwent a secondary breast reconstruction after MRM. Furthermore, 12 (14.8%) patients with MRM would prefer a SSM with immediate reconstruction in a similar situation. CONCLUSION: Skin-sparing mastectomy improves aesthetic results to a high degree without increasing of local or distant recurrence rates. Skin-sparing mastectomy should be offered to selected patients with breast cancer as an alternative to modified radical mastectomy.

Adult↗

PubMed1998

Axillary lymphadenectomy prepared by fat and lymph node suction in breast cancer.

AIMS: To describe a new technique of axillary dissection and evaluate the results. METHODS: Axillary lymphadenectomy prepared by fat and lymph node suction was performed on 43 patients with breast cancer and uninvolved axilla on physical examination. The mean follow-up was 18 months (range 12-27). After lipolysis and liposuction of the axilla, lymph node dissection was performed by axilloscopy in patients treated with conservative surgery. For patients undergoing modified radical mastectomy, a mastectomy with open axillary dissection was carried out. The axillary space was drained until less than 20 ml of lymphorrhea was being produced per day. Seventeen modified radical mastectomies (group M) and 26 lumpectomies (group L) were performed. RESULTS: No injury of muscles, vessels or nerves was observed. An average of 13.6 lymph nodes (8-31) were removed. In group L, the mean number of lymph nodes removed by liposuction, axilloscopy and control incision was 2.5, 5.4 and 4.2, respectively. In group M, the mean number of lymph nodes removed was 14. None of the 589 lymph nodes examined showed any pathological trauma. Fourteen patients (32%) had more than one histologically positive node. The mean quantity of lymphorrhea was 390 ml in group M and 275 ml in group L. The mean duration of drainage was 6 days in group M and 5 days in group L. Four patients had seromas which required punctures. Two patients had shoulder restriction (movements < 90 degrees) at 12 months. No arm oedema was seen. CONCLUSIONS: Axillary lymphadenectomy prepared by fat and lymph node suction is a reliable and effective procedure. However, it does not appear to be better than standard dissection as regards post-operative complications, except for arm oedema, but this must be confirmed by further studies.

Adult↗

PubMed1991

Double-pedicle TRAM flap for unilateral breast reconstruction.

Autogenous breast reconstruction with the pedicled TRAM flap has been employed in 500 patients in our series. We have developed and refined indications for use of the single-pedicle TRAM flap and double-pedicle TRAM flap in unilateral breast reconstruction. In our experience with 341 unilateral breast reconstructions, we used a double-pedicle TRAM flap 19 percent of the time; however, in our most recent 50 unilateral modified radical mastectomy reconstructions, the double-pedicle technique has been employed 60 percent of the time. In general, when a TRAM flap is chosen for unilateral reconstruction of a modified radical mastectomy defect, we feel the single-pedicle TRAM flap is the procedure of choice. Carefully selected patients will benefit from the added safety of a double-pedicle TRAM procedure. The indications for the double-pedicle TRAM flap, the technique, and our results are described in detail.

Abdominal Muscles↗

PubMed1997

[The surgical treatment of nonpalpable breast lesions].

Non-palpable breast lesions may be defined as suspected lesions for "occult" tumours and diagnosed during the course of screening or, occasionally, in asymptomatic women. Mammography is the main diagnostic instrument owing to its high sensitivity and specificity, although an increasingly important complementary role is played by ultrasound scan. The comparison of findings obtained provides elements for further evaluation. Moreover, mammography can be used to make a dynamic study of the breast over time in order to evaluate doubtful lesions that might change, especially in women of a child-bearing age and during the various phases of the menstrual cycle. The use of the metal repere allows the lesion to be identified and surgically removed. A total of 135 operations for breast pathologies were examined from 1 January 1994 to 30 April 1996, subdivided into 26 operations for benign pathologies and 109 for malignant pathologies. Of the latter 52 (47.7%) were modified radical mastectomies, 50 (45.9%) were quadrantectomies with axillary lymphadenectomy, 1 (0.9%) quadrantectomy, and 5 (5.5%) simple mastectomies. A total of 16 needle biopsies were performed of which 8 were benign and 8 malignant. The latter were treated using 2 modified radical mastectomies owing to the presence of an extensive intraductal component, 5 quadrantectomies with lymphadenectomy, and 1 simple quadrantectomy for a lobular carcinoma in situ. Kopans needle was also used as a repere and the stiffening cannula was used for an accurate, effective but economical exeresis. One of the 8 benign cases was complicated by an hematoma (12.5%). Neither the mammary gland nor the subcutis were sutured to avoid unsightly scars and uncertain images at later mammographic controls.

Biopsy, Needle↗

PubMed2003

Late local recurrences in a randomised trial comparing conservative treatment with total mastectomy in early breast cancer patients.

BACKGROUND: A randomised trial was conducted comparing wide lumpectomy and breast irradiation with modified radical mastectomy. As the follow-up was long (mean duration 22 years), we analysed the variation in the effect of treatment over time. PATIENTS AND METHODS: The trial included 179 patients with a breast cancer measuring </=2 cm at macroscopic examination. Eighty-eight patients had breast-conserving surgery and radiotherapy, and 91 underwent mastectomy. All patients had axillary dissection. The analyses were based on Cox models with time-dependent treatment effects. RESULTS: The effect of treatment on death or metastasis did not vary with time. The risk of local recurrence was lower during the first 5 years for the breast-conserving surgery group as compared with the mastectomy group, but higher after 5 years (P = 10(-4) for a different treatment effect over time). Similar results were found in a database including 1847 patients with small breast tumours at diagnosis. In this analysis, late breast recurrences were also more frequent in the breast-conserving surgery group and this treatment effect was greater among younger patients (</=40 years at the time of diagnosis). CONCLUSIONS: Late breast recurrences were more frequently observed in younger patients treated with breast-conserving treatment compared with those submitted to mastectomy. These results require confirmation in other randomised studies so that younger patients with early breast cancer can receive adequate counselling and so that a more stringent long-term follow-up policy can be adopted when breast-conserving treatment is planned.

Adult↗

PubMed1984

Breast-conserving treatment for breast cancer in Stockholm, Sweden, 1977 to 1981.

Since 1977 patients living in Stockholm with Stage I breast cancer fulfilling specific criteria are offered breast-conserving treatment. The treatment includes a partial mastectomy and a low-axillary dissection followed by radiotherapy, 5000 rad, to the remaining breast. Between 1977 and 1981, 262 patients underwent the breast conserving therapy. One hundred eighty-six patients had pathologic Stage I tumors. Radiotherapy was given to 158 of those patients. During the follow-up time (6 months to 5 years), 4 of 186 patients had recurrence to the breast. Two of those had not received radiotherapy. Recurrent tumor in regional lymph nodes occurred in 4/186, and distant metastases in 10/186 patients. Six patients have died of their disease. The cosmetic results were favorable overall, but often impaired when surgical complications occurred. A comparison between these results and those obtained in similar patients treated with modified radical mastectomy with a low-axillar dissection followed by radiotherapy to the remaining breast seems to be an alternative treatment to modified radical mastectomy. Longer follow-up time is needed before final conclusions can be drawn.

Adult↗

PubMed1987

Surgery as part of a combined modality approach for inflammatory breast carcinoma.

From November 1977 to February 1984 21 patients with inflammatory breast carcinoma (IBC) were treated in a prospective, nonrandomized study with initial chemotherapy, consisting of a combination of chlorambucil, methotrexate, 5-fluorouracil, and doxorubicin. Modified radical mastectomy was performed after three courses of chemotherapy followed by another six courses of the same chemotherapy. Locoregional radiotherapy concluded the treatment program. All patients responded clinically to the initial chemotherapy. Modified radical mastectomy provided a direct histologic control of the effectiveness of the treatment and, in case of tumor persistence, allowed cytoreduction. No scarring problems were observed and postoperative chemotherapy could be administered without any delay. Radiotherapy was decisive for locoregional tumor control which was obtained in all patients who were treated strictly according to the protocol. Dermal lymphatic involvement represented in this series of clinical inflammatory breast carcinoma no pejorative feature and positive hormone receptors failed to be of predictive value for response to treatment. Considerably variable tumor persistence after initial chemotherapy and the results relative to local tumor control advocate surgery as part of a combined modality approach for inflammatory breast carcinoma.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1998

Gamma-probe-guided resection of the sentinel lymph node in breast cancer.

Regional lymph node metastases in patients with breast cancer have fundamental staging, prognostic, and treatment implications. Classically, axillary lymph node sampling requires a dissection under general anesthesia. The concept that a primary, or sentinel, lymph node is the first node to receive drainage from a tumor has been established in patients with malignant melanomas using radiolabeled tracers and vital dyes. This study proposed two hypotheses: (1) radiolabeled sentinel lymph nodes can be identified in most patients with breast cancer, and (2) radiolabeled sentinel lymph node biopsy accurately predicts axillary lymph node metastases in those patients. Patients with operable breast cancer had Tc-99 sulphur colloid injected around their breast tumors 1-6 hours preoperatively. Patients underwent gamma probe identification of sentinel lymph nodes that were biopsied. All patients underwent axillary lymphadenectomy in conjunction with lumpectomy or mastectomy. Fifty female patients ages 26 to 90 years underwent lumpectomies with axillary dissections (40 patients) or modified radical mastectomies (10 patients). Sentinel lymph nodes were identified in 42 of 50 patients (84%). Eight patients (16%) had metastases to the axillary lymph nodes. In 7 patients, sentinel lymph nodes correctly predicted the status of the axillary nodes. There was one false negative result. A total of 550 lymph nodes were resected for an average of 11.2 nodes per patient. Sentinel lymph node scintigraphy and biopsy accurately predicted the axillary lymph node status in 41 of 42 patients (98%). Scintigraphy can identify sentinel lymph nodes in a large majority of patients. Sentinel lymph node biopsy is an accurate predictor of axillary lymphatic metastases.

Adult↗

PubMed2006

Ipsilateral breast tumor reappearance in patients treated with conservative surgery after primary chemotherapy. The role of surgical margins on outcome.

BACKGROUND AND OBJECTIVES: To evaluate the ipsilateral breast tumor reappearance (IBTR) rate after breast conservative surgery (BCS) following primary chemotherapy (PC) and to assess whether positive margins affects IBTR rate and overall survival (OS). METHODS: Three hundred nine women candidates for mastectomy received PC before surgery. One hundred ninety-five patients (63.1%) underwent BCS and 114 patients (36.9%) a modified radical mastectomy. RESULTS: After a median follow-up of 41 months (range 7-90), 13 patients of the 195 treated with BCS had an IBTR (6.7%), 6 patients had a regional relapse (3.1%), 28 women had distant metastases (14.4%). Twenty-three patients died of breast cancer (11.8%). Twenty-four patients treated with BCS had positive margins (12.3%). At 3 years, the crude cumulative incidence of local recurrence was 4.7% in women with negative margins, and 13.3% in women with positive margins (P=0.05). Cumulative incidence of distant metastases was similar in patients with positive and negative margins (P=0.16) and there was no significant difference in terms of OS according to the margin status (P=0.577). CONCLUSIONS: BCS after PC has an acceptable rate of IBTR. After a short follow-up, the presence of positive margins does not affect OS.

Adult↗

PubMed1993

[Immediate reconstruction after radical mastectomy for breast carcinoma with a Becker-type expander prosthesis].

In recent years, the breast has won importance from the female psychology point of view. After ablative surgery for cancer, the loss of the breast gives rise in the woman to a feeling of refusal of her new body shape. Reconstruction produces positive feelings in the patient. The best-used surgical technique for operable breast cancer is modified radical mastectomy. An immediate reconstruction of the missing breast is considered when the following conditions are fulfilled: desire for reconstruction, age of the patient, clinical and pathologic evaluation (tumor size-tumor grade-lymph-node status). After modified radical mastectomy with "en bloc" removal of axillary lymph nodes, an immediate reconstruction is performed by lining the surfaces with human fibrin glue (Tissucol) followed by the insertion of a prosthesis of appropriate size (Becker Expander Mammary Prosthesis-Type 1) in the subserratus-subpectoral position. Human fibrin lining reduces the incidence of capsular contracture and effusion production. A suction drain is placed in the axillary area and is removed after 5 days. The use of expanding-type prostheses means that the patient must return for further expanding. When the pathologic features are negative, the delayed nipple areola reconstruction is possible with the full-thickness skin grafts in the groin or in pre-existent appendectomy incision. By this procedure, adjuvant chemotherapy or radiation therapy can be performed if required. From 1987 to 1991 the procedure has been performed in 35 cases of mammary neoplasm (mean age 40 years) at INRCA Department of Surgery of Ancona). No evidence of adverse effect on the natural course of the breast disease for have been seen.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗