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PubMed1979

"Apple coring" the nipple in subcutaneous mastectomy.

A simple technique is described for removing the ductal tissue from the nipple in a subcutaneous mastectomy. We believe that complete removal of all the ductal tissue is desirable in this operation, and that it will also decrease the incidence of subsequent infection. The operative technique, the problems, the advantages, and the disadvantages of the procedure are described.

Adenofibroma↗
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↗
PubMed1991

Modified skin incisions for mastectomy: the need for plastic surgical input in preoperative planning.

Skin-sparing mastectomy by definition describes the procedure of mastectomy, either simple or modified radical, with a minimum amount of skin excision. The surgical skin excision must: (1) include the nipple-areola complex, (2) include the biopsy site, and (3) allow for access to the axilla for possible dissection. In 27 mastectomies, the senior author has had direct input in the preoperative skin planning. All patients underwent immediate breast reconstruction. In large-breasted women, the mastectomy was performed to a Wise-type pattern. In small-breasted women, the mastectomy involved minimal skin excision followed by reconstruction. Non-continuous incisions were frequently used in small-breasted women, thereby minimizing breast scarring. When appropriately applied, skin-sparing mastectomy can greatly improve the final aesthetic result of the breast.

Adult↗
PubMed1995

[Conservative treatment of sub-clinical noninfiltrating cancers of the breast (102 EOA in situ, TONO)].

102 patients with sub-clinical intra ductal non invasive breast cancer (T0N0) treated by limited surgery and curative radiation therapy. Follow-up ranged from 2 to 10 years with a median follow-up of 59 months. The long term survival rate of this therapeutic approach, consisting of simple excision without any adjuvant treatment and radical mastectomy was close to 100%. The actuarial local recurrence rate was only 8.6% at 10 years (confidence interval: 4.6 to 12.6%), which strongly suggests that radiation therapy is active on multicentric foci. Salvage surgery could be performed in every case of local recurrence. The survival rate of in situ breast cancer (T0N0) treated by conservative radio-surgery is comparable to that of radical mastectomy, while cosmetic results and psychological impact appear to be better for the conservative technique (breast preservation rate = 91 to 96%).

Breast Neoplasms↗
PubMed1987

[Paget's disease of the nipple without any associated mammary tumor clinically or radiologically detectable. Apropos of 51 cases treated at the Curie Institute].

Between 1960 and 1984, 51 patients with Paget's disease of the nipple, with no concomitant palpable or radiological breast tumour, were treated at the Institut Curie. The diagnosis was made in all cases through a simple biopsy of the nipple and/or the areola. All slides were reviewed for the present study. 20/51 patients were treated conservatively, with external radiotherapy alone (17/20 pts), or limited surgery and radiotherapy (3/20 pts). The mean age was 54 years (range 40 to 80). The median follow-up was 7.5 years. No patients died of breast disease. Three local recurrences occurred and were treated by mastectomy. All were located in the nipple or areola and were Paget's disease without intraduct or invasive carcinoma. The actuarial probability of living 4.5 years free of disease when the breast is preserved with a good cosmetic result is 81%. 31/51 patients underwent mastectomy; 30 a modified mastectomy, 1 a simple mastectomy. The mean age was 66 years (range 55 to 90). Associated intraduct carcinoma was found in 30/31 microscopic examinations. No axillary node invasion was found after dissection of the axilla. In the group treated by surgery, the median follow-up was 5 years. No patient died of breast disease. No chest wall recurrence occurred. The 5 years disease-free survival rate was 87%. This retrospective non randomized study of 51 patients treated for Paget's disease of the nipple suggests that radiotherapy is a valuable alternative to mastectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Pathobiology of breast cancer--treatment implications.

In most patients (approximately 85%), breast cancer at the time of diagnosis is already a systemic disease. Multicentricity (20-40%) and synchronous (5-10%) and metachronous (15-30%) bilaterality are indicative of etiologically similar noxae. Ductal and lobular carcinoma in situ become invasive in approximately 50% of patients. Whereas ductal carcinoma in situ is mainly diagnosed clinically (lumpiness, tissue irregularity), lobular carcinoma in situ, a small, nonpalpable lesion, is usually discovered accidentally following biopsy for fibrocystic disease and/or suspicious mammography. Treatment of in situ and minimal (small invasive) breast cancer (less than or equal to 5 mm in diameter) is controversial, ranging from observation (lobular carcinoma in situ) over segmental excision to simple or radical mastectomy with or without lymphadenectomy and contralateral "mirror-image" biopsies. Long-term survival rates (90-95%) appear similar for patients with treated or untreated lobular carcinoma in situ. Patients with minimal breast cancer have as good a prognosis as those with ductal carcinoma in situ (long-term survival, 80-90%). Presently, a trend from radical to conservative surgery (lumpectomy, segmentectomy) is observed. Especially for in situ carcinoma, modified radical or even simple mastectomy may be considered overtreatment. For invasive carcinomas, lumpectomy and radiotherapy provide as good a chance of survival as radical mastectomy. Such equal survival indicates that although in 25% to 45% of patients with invasive carcinoma multifocal disease (in situ and invasive carcinoma) is left behind, subsequent radiotherapy is effective. Accordingly, patients with carcinoma in situ may be spared mutilating surgery in favor of radiotherapy. Because many patients at extraordinarily high risk of breast cancer cannot accept prophylactic mastectomy, thorough follow-up by clinical examination, mammography, sonography and biopsy is essential.

Breast Neoplasms↗
PubMed1991

Cancer of the breast: a study of 1520 consecutive patients operated on between 1960 and 1980.

A retrospective study was carried out of 1520 consecutive patients with breast cancer operated on at the Hôpital Notre-Dame in Montreal between 1960 and 1980. Age and hormonal status of the patient, and duration, size, location, histologic type and stage of the tumour were studied. The authors grouped the patients according to four types of surgical treatment: radical (487 patients), modified radical (497 patients) and simple (220 patients) mastectomies and conservative procedures (316 patients). Adjuvant treatments included radiotherapy in 60%, hormone therapy in 4.7% and chemotherapy in 6.7% of patients. Overall survival at 5, 10 and 15 years was 71.3%, 58.7% and 51.1%; in patients with stage I disease, survival rates were, respectively, 86%, 78% and 72%; rates for patients with stage II disease were 74%, 62% and 53%. The population characteristics and survival rates were similar to those reported by others. The four types of treatment did not produce significantly different survival rates in patients with stage I lesions. However, this was not the case in patients with stage II and III lesions in whom simple mastectomy (McWhirter procedure) was associated with significantly worse results. Finally, this study confirmed the prognostic importance of stage, size of the tumour and degree of axillary lymph-node involvement.

Adult↗
PubMed1989

[Treatment selection for stage I breast cancer--report of 412 cases].

From 1958 to 1982, 412 Stage I breast cancer patients treated by simple operation, operation plus radiotherapy and/or chemotherapy are reported. Of them, 312 were treated by radical mastectomy (R), 43 by simple mastectomy (S), 31 by modified radical mastectomy (M), 20 by tumorectomy (T) and 6 by extended radical mastectomy (E). The results showed that M and T with radiotherapy and/or chemotherapy were similar to R in terms of survival and recurrence rates. There were no differences between R, S, M, E groups and combined treatment group in recurrence rate, but there was a significant difference between T group and combined treatment group (P less than 0.01). Recurrence rate of patients with positive axillary lymph nodes was similar to that of patients with negative nodes, because 91.5% of the former patients received combined treatment, but only 54.3% of the latter patients did (P less than 0.01). Six cases in T group recurred and 4 (67%) of them were retreated by salvage surgery. Three cases survived for 15 years, giving a better result than radical mastectomy. It is indicated that modified radical mastectomy and tumorectomy plus combined treatment are advisable for Stage I breast cancer. Prospective randomized clinical trials for assessment of different treatment modalities are needed.

Adolescent↗
PubMed1975

Lymphedema of the upper limb after surgery for breast cancer.

Radical mastectomy is followed by swelling of the arm, and although the number of surgeons employing the operation is decreasing, postmastectomy lymphedema continues to be a serious complication. In the present report based on 158 women who underwent modified radical (126) or simple (32) mastectomy and occasionally radiation for histologically proved adenocarcinoma of the breast, the pathogenesis and treatment of postmastectomy lymphedema are discussed. The following conclusions can be drawn: (1) The occurrence of postmastectomy lymphedema diminishes the less extensive the operation. (2) Mild lymphedema that develops early postoperatively tends to subside. (3) Conservative treatment in the majority of cases is effective in controlling postmastectomy lymphedema of a mild to moderate degree. (4) Modified radical mastectomy, which is as radical as Halsted's operation, is rarely followed by lymphedema.

Adult↗
PubMed2002

Adenoid cystic carcinoma of the breast: molecular markers, treatment, and clinical outcome.

BACKGROUND: The objective of this study was to comprehensively characterize the clinical and biologic features of adenoid cystic carcinoma (ACC) and to assess the implications for management in a large cohort of patients. METHODS: From a database of 50,000 patients, 28 were identified with ACC for which clinical follow-up and biologic information was available. The biologic features examined included estrogen receptor and progesterone receptor status, DNA ploidy, and S-phase fraction. Median follow-up was 83 months with a range of 29 to 144 months. Overall survival and disease free survival curves were drawn using Kaplan and Meier estimates and were compared by the log-rank test. RESULTS: All but one patient were postmenopausal with a median age at diagnosis of 66 years (range, 40-96 years). One patient had macroscopic metastatic disease at diagnosis. Median tumor size was 1.9 cm (range, 0.5-7.0 cm). Axillary lymph node dissection was performed in 23 patients. Only 1 patient (4%) had histologic positive lymph nodes (2 of 10), and no recurrence was detected for this patient. Forty-six percent were ER positive (median, 16 fmol/mg protein; range, 5-1017 fmol/mg), and 35% were PgR positive (median, 61 fmol/mg protein; range, 6-854 fmol/mg). S-phase fraction and DNA ploidy were assessable in 24 cases. Ninety percent of tumors had low S-phase (median, 3.3%; range, 0.1-34.2%), and 92% were diploid. Simple or modified radical mastectomy was performed in 22 patients, and 6 patients were treated by lumpectomy. Five of these six patients also received radiation therapy after lumpectomy. Despite the different surgical approaches, there were no local recurrences. The 5-year disease free survival rate was 100%, and the 5-year overall survival rate was 85% (95% confidence interval, 71.7-98.6%). CONCLUSIONS: Adenoid cystic carcinomas of the breast have very favorable biologic characteristics and, consistent with this, an excellent prognosis. Good local control can be achieved by lumpectomy with radiation or by simple mastectomy. Axillary lymph node dissection is not helpful in clinical management.

Adult↗
PubMed1979

Reconstruction of the breast without additional skin or muscle flaps.

After mastectomy (usually simple or modified radical) many breasts may be reconstructed without additional tissue. However, in any patient in whom the skin flaps are very thin and/or tight, especially if the flaps have been irradiated, we urge use of the thoracoepigastric flap, latissimus dorsi muscle, or myocutaneous flap to achieve a pleasing result.

Adult↗