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PubMed1986

Breast reconstruction: current state of the art.

The current state of the art makes breast reconstruction possible in any patient who has undergone mastectomy, whether simple, modified radical, or radical. Indications for reconstruction are a strong desire on the part of the patient and a reasonable life expectancy. Methods of reconstruction include the simple placement of a breast prosthesis alone (submuscularly when possible) or in combination with advancement of upper abdominal skin or rotation flaps. Expander implants are useful in patients with limited skin and musculature. For the patient with serious muscle and skin deficits, more complex reconstructive procedures with use of transverse rectus abdominis or latissimus dorsi myocutaneous flaps may be performed, with or without an implant. Several methods of reconstruction of the nipple and areola are also possible. Treatment of the opposite breast is often necessary if symmetry is to be achieved. When appropriate, augmentation, mastopexy, reduction, or subcutaneous mastectomy may be performed. There is no single preferred method of reconstruction. The approach should be tailored for each patient.

Breast Neoplasms↗
PubMed1985

Characteristics of breast cancer in women over 80 years of age.

The records of 198 women over 80 years of age with breast cancer were reviewed to identify characteristics of breast cancer and to determine the effect of age in management of the disease in elderly women. Twenty percent of the patients were not staged at diagnosis. Axillary lymph node status was undetermined in 40 percent of the patients because operation was limited to lumpectomy or mastectomy (either simple or total). Complications were related to the operative wound. Breast cancer and cardiovascular disease accounted for 115 of 146 deaths and the 5 year survival rate was 35.6 percent. We have concluded that breast cancer in elderly women can be treated with appropriate surgical therapy and should not be limited because of age.

Adenocarcinoma↗
PubMed1989

Residual tumour after biopsy for non-palpable ductal carcinoma in situ of the breast.

In a group of 40 patients with non-palpable ductal carcinoma in situ (DCIS) of the breast, 41 breast specimens were available for studying residual tumour after biopsy. In one group of ten patients seen before 1977, simple histological examination revealed a 9 per cent incidence of residual tumour. However, after thorough examination residual foci of DCIS were found in 77 per cent of a subsequent group of 30 patients. This means that the majority of patients would have had to undergo reoperation if a breast-saving procedure had been performed. This fact must be taken into account when planning treatment of patients with non-palpable DCIS.

Adult↗
PubMed1992

[Esthetic results of breast reconstruction after amputation for cancer. 323 cases].

323 reconstructions of the breast were carried out at the Gustave-Roussy Institute and were analysed in order to assess the aesthetic results and the sequelae of these reconstruction operations. The majority of the patients were operated on between 1984 and 1989 with a median follow-up of 3.5 years (1 to 9 years). Three types of reconstruction were carried out: simple prosthesis behind the muscle (P, 69% of this population), latissimus dorsi flap (G.D., 11%), or transverse rectus abdominis flap (TRAM, 20%). These reconstructions were either carried out immediately (RMI, 23.5%) or later (RMD, 76.5%). The unanimous enthusiasm of the patients for reconstruction was the greatest encouragement for us to continue in this way. From the aesthetic point of view the transverse rectus abdominis flap (TRAM) proved to be superior to the others. Scar and functional sequelae of the latissimus dorsi flap (GD) were by no means nil in this series (table 9) in contrast with other studies that have been carried out. All the same the majority of these sequelae were larger scars. The functional poor sequelae were minor. TRAM sequelae were less frequent and usually mainly in the abdominal wall. A more accurate technique should lower the incidence. As far as the timing of surgery is concerned, immediate reconstruction did not alter the quality of results which were better (but not significantly statistically). This has already been published. On the other hand patients were more satisfied with RMD (p less than 10(-4)). The analysis of this unexpected result show the great significance of psychological factors in interpreting these results.(ABSTRACT TRUNCATED AT 250 WORDS)

Academies and Institutes↗
PubMed1982

Current surgical management of in situ cancer of the female breast.

Surgical procedures for breast cancer were compared in 468 cases with in-situ and 4,967 cases with invasive lesions. The cases were obtained from the Michigan Cancer Foundation Registry, a Surveillance, Epidemiology, and End Results (SEER) participant, and were incident-resident cases diagnosed from 1973-1978. For single, primary in situ or invasive cancer, the preferred mastectomy was modified radical. Partial and simple resections were used more often than radical procedures for non-infiltrating, especially lobular lesions. For cases with bilateral primates, with at least one in situ, the mastectomy of choice was the simple procedure for the in situ malignancy and modified radical for the invasive cancer. The change in preferred surgery for in situ lesions, from modified radical to simple mastectomy, was not due to any change in strategy for treatment of bilateral invasive disease, which remained modified radical resection.

Adult↗
PubMed2005

A population-based study of bilateral prophylactic mastectomy efficacy in women at elevated risk for breast cancer in community practices.

BACKGROUND: Findings from several studies suggest that bilateral prophylactic mastectomy reduces breast cancer incidence by 90% or more, but the studies used highly selected patients from referral centers, and the comparison groups were not population based. We studied the efficacy of bilateral prophylactic mastectomy in women with elevated breast cancer risk cared for in community practices. METHODS: We conducted a retrospective case-cohort study of women aged 18 to 80 years with 1 or more breast cancer risk factors (family history of breast cancer, history of atypical hyperplasia, or > or =1 breast biopsies with benign findings). Using computerized data and medical records, we identified 276 women with bilateral prophylactic mastectomy and a stratified random sample of 196 women representing an underlying cohort of 666 800 women with elevated breast cancer risk without prophylactic mastectomy, and then we determined who developed breast cancer. RESULTS: Breast cancer developed in 1 woman (0.4%) after bilateral prophylactic mastectomy vs 26 800 women (4.0%) without prophylactic mastectomy. Stratifying by birth year, the hazard ratio for breast cancer occurrence after bilateral prophylactic mastectomy was 0.005 (95% confidence interval, 0.001-0.044). No woman with bilateral prophylactic mastectomy died of breast cancer vs a calculated 0.2% of women without prophylactic mastectomy. CONCLUSIONS: Bilateral prophylactic mastectomy reduced breast cancer incidence in women at elevated risk for breast cancer cared for in community-based practices. However, the absolute risk of breast cancer incidence and death in women who did not undergo the procedure in these settings was relatively low.

Adolescent↗
PubMed1993

Prognosis of patients with breast cancer related to the timing of operation.

Whether the timing of mastectomy during the menstrual cycle influences the prognosis of premenopausal women with breast cancer is controversial. We retrospectively reviewed the cases of 97 regularly menstruating women treated for operable stages of breast cancer. At operation, 55 women were in the perimenstrual phase of the menstrual cycle (days 0 through 6 and days 21 through 36) and 42 were in the periovulatory phase (days 7 through 20). No relationship could be identified between the timing of surgical treatment and subsequent recurrence or survival. The timing of biopsy was also not associated with prognosis. We conclude that no delay of surgical treatment for breast cancer need be based on the phase of the menstrual cycle of premenopausal women.

Adult↗
PubMed1993

Definitive surgery for breast cancer performed on an outpatient basis.

OBJECTIVE: More than 160,000 women will develop breast cancer in the United States during the next year. Traditionally, their definitive surgery has been performed on an inpatient basis, with postoperative hospital stays ranging from 1 to 7 days. DESIGN: Retrospective review of cases and results. PATIENTS: Two hundred twenty-one patients underwent 223 definitive surgical procedures for carcinoma of the breast, entirely on an outpatient basis, between September 1990 and June 1992. Operations included 31 modified radical mastectomies, 101 partial mastectomies with radical axillary node dissections, 11 total mastectomies, 69 partial mastectomies, and 11 radical axillary dissections. RESULTS: There were no deaths, and no serious complications. No patient required hospitalization for any reason. There were no wound infections. Patient satisfaction was high, and compliance was excellent. CONCLUSIONS: Most operations for carcinoma of the breast can be performed on an outpatient basis, without increasing the risk of complications.

Adult↗
PubMed1999

Recurrent ductal carcinoma in situ after total mastectomy.

A case report is presented of a woman with recurrent DCIS occurring several years following a total mastectomy, the diagnosis of which was aided by a subpectoral saline implant. A discussion of factors associated with recurrence and a review of the literature is provided. A role for selective use of mammography in screening postmastectomy reconstructed breasts in patients at high risk for recurrence is suggested.

Adult↗
PubMed1998

Type of mastectomy and quality of life for long term breast carcinoma survivors.

BACKGROUND: Despite numerous studies of partial mastectomy and psychologic morbidity in the first 24 months following surgery, little is known about the long term psychosocial repercussions of partial and total mastectomy. METHODS: The effect of the type of mastectomy on psychologic adjustment was assessed among 124 breast carcinoma survivors, 47 of whom underwent partial mastectomy and 77 of whom underwent total mastectomy, 8 years after initial treatment. Interviews were also conducted 3 and 18 months after surgery. Psychologic distress was assessed using the Psychiatric Symptom Index. Other outcomes included physical symptoms, patients' perceptions of their own health, satisfaction with the type of surgery performed and with the appearance of the scar, and marital and sexual adjustments. RESULTS: No statistically significant differences between partial and total mastectomy were observed with respect to long term quality of life. Age at diagnosis modified the relation between the type of mastectomy and psychologic distress in both the short term and the long term (P = 0.04). Among women younger than 50 years, partial mastectomy appeared to be protective against distress when compared with total mastectomy. In contrast, among women age 50 years or older, partial mastectomy was associated with higher psychologic distress levels at all interviews. CONCLUSIONS: Assessed globally, partial and total mastectomy appear to be equivalent treatments in terms of patients' long term quality of life. However, both short term and long term distress levels after partial and total mastectomy may depend on patients' age at diagnosis. The findings of this study suggest that the increased use of partial mastectomy may lessen the negative effects of breast carcinoma on younger survivors' quality of life. Nevertheless, total mastectomy may be an appropriate initial treatment for some women who truly choose it.

Adaptation, Psychological↗
PubMed2000

Malignant phyllodes tumor metastatic to the forearm: a case report.

We describe the cytological features of a malignant phyllodes tumor, in a 40-yr-old female, that metastasized to the forearm, and we correlate these findings with the criteria suggested by other authors for predicting the clinical and metastatic behavior of this tumor. The diagnosis of metastasis was based on fine-needle aspiration (FNA) cytology. One year prior, the patient had undergone mastectomy of the left breast for malignant phyllodes tumor, as proven by histopathology. The patient then presented with right forearm swelling, 1 yr later. FNA cytology was performed, and the diagnosis was metastatic malignant phyllodes tumor. Histologic review of the breast tumor revealed stromal overgrowth, which is the most important histologic criterion for predicting the metastatic behavior of malignant phyllodes tumor as reported by some authors.

Adult↗
PubMed1988

Diffuse cystic angiomatosis of the breast.

Vascular tumors of the breast are extremely rare, and the majority are malignant. In this report, the presentation of a diffuse, benign, cystic, vascular tumor that histologically was angiomatosis of the breast is described. The clinical presentation, magnetic resonance imaging (MRI) appearance, and histologic features of this rare lesion are reviewed. This case is of particular interest because the tumor recurred during pregnancy and underwent massive enlargement despite negative hormone receptor values. Angiomatosis is prone to local recurrence, so complete excision with histologically negative margins is the treatment of choice.

Adult↗
PubMed1988

Management of stage III primary breast cancer with primary chemotherapy, surgery, and radiation therapy.

One hundred seventy-four evaluable patients with noninflammatory Stage III (both operable and inoperable) breast cancer were treated with a combined modality strategy between 1974 and 1985. All patients received combination chemotherapy with 5-fluorouracil, Adriamycin (doxorubicin), and cyclophosphamide (FAC) as their initial form of therapy. After three cycles of chemotherapy, local treatment in the form of a total mastectomy with axillary dissection, or radiotherapy, or both, was completed. Subsequently, adjuvant chemotherapy was continued. There were 48 patients with Stage IIIA, and 126 patients with Stage IIIB disease. A complete remission was achieved in 16.7% of the patients, and 70.7% achieved a partial remission after the initial three cycles of FAC. The complete response rate was higher for patients with Stage IIIA, than for patients with Stage IIIB disease. All but six of the 174 patients treated were rendered disease-free after induction chemotherapy and local treatment. The median follow-up of this group of patients is 59 months. The 5-year disease-free survival rates were 84% for patients with Stage IIIA, and 33% for patients with Stage IIIB disease. The 5-year survival rate for, patients with Stage IIIA was 84%, and for patients with Stage IIIB 44%. At 10 years, 56% of patients with Stage IIIA and 26% of patients with Stage IIIB disease are projected to be alive. Younger patients, and those with estrogen receptor-positive tumors, had a trend for better survival than older patients and those with estrogen receptor-negative tumors. The quality of response to induction chemotherapy correlated prominently with prognosis, as did compliance with treatment. Twenty-six patients (15.3%) had locoregional recurrence. This multidisciplinary approach to locally advanced breast cancer rendered most patients disease-free and produced an excellent local control rate. Modifications of this treatment strategy may result in further improvement of survival rates.

Adult↗
PubMed1989

Carcinoembryonic antigen immunocytochemistry in primary breast cancer.

We studied the immunoreactivity by immunohistology of two carcinoembryonic antigens (CEA) with specific and two CEA antibodies with nonspecific cross-reacting antigen (NCA) cross reactivity (CEA/NCA) in 180 primary breast carcinomas. Positive tissue staining was found in more than 90% of the specimens with CEA/NCA antibodies, compared with less than 30% for both CEA-specific antibodies. There was no correlation between the positivity of CEA immunocytochemistry for any of the four antibodies and histologic grade, lymph node stage, locoregional recurrence, disease-free interval (DFI), or patient survival. This large study with a long follow-up period for patients has shown that CEA and CEA/NCA immunocytochemistry have no relation to prognosis in breast cancer. An extensive review of the literature that confirms these findings should end the controversy over the place of CEA and CEA/NCA immunocytochemistry in breast cancer.

Animals↗
PubMed1992

Tumor hormone receptor status and recurrences in premenopausal patients with node-negative breast carcinoma.

To ascertain the prognostic significance of tumor hormone receptor status in premenopausal patients with node-negative breast cancer, a retrospective review of 199 patients who met these criteria was conducted. Of these 199 patients, estrogen receptor (ER) data were available for 147. One hundred four patients (71%) had ER-negative disease and 22 (21%) exhibited local or distant recurrence with a median follow-up time of 85.4 months. Thirteen patients in this group had died of breast cancer. Of the 43 patients who had ER-positive disease, 5 (12%) had recurrences and 2 died of breast cancer. After observing patients for a longer period of time (median follow-up time, 85.4 months), no statistically significant differences in disease-free survival (DFS) or overall survival (OS) were demonstrated. However, as seen in our first analysis of this group at 45 months, tumor size after a median follow-up time of 85.4 months continues to have significant prognostic implications, regardless of ER status.

Adult↗
PubMed1992

Fear of recurrence, breast-conserving surgery, and the trade-off hypothesis.

Fear of recurrence has been at the heart of the controversy between surgeons favoring mastectomy versus those advocating a less radical operation. Breast-conserving surgery is thought to result in a better body image, but patients are expected to worry more about a cancer recurrence because only a small part of the breast is excised. To assess survival rates after breast-conserving intervention, patients were randomized into the National Surgical Adjuvant Breast Project (NSABP) prospective clinical trial (Protocol B06) with three treatment groups: total mastectomy, lumpectomy, and lumpectomy followed by radiation therapy. A fourth group was created to include patients who had a recurrence after their first operation and thus underwent a subsequent total mastectomy. Differences appeared, not according to the type of treatment, but with respect to the number of surgical interventions. Patients with multiple operations reported a greater fear of cancer recurrence and a worse body image, similar to those that underwent total mastectomy. Contrary to the trade-off hypothesis, patients who underwent radical surgery did not manifest less fear of recurrence. These results show unequivocally that the expected trade-off between breast conservation and fear of cancer recurrence does not occur. Those who undergo lumpectomy do not more express more fear of cancer than do patients who undergo mastectomy.

Breast Neoplasms↗
PubMed1992

Risk factors for failure of immediate breast reconstruction with prosthesis after total mastectomy for breast cancer.

BACKGROUND: Immediate breast reconstruction (IBR) after mastectomy represents a clear improvement in the quality of life of patients with breast cancer, but prosthesis removal is relatively frequent. Therefore, it is important to identify risk factors related to this removal. METHODS: A series of 142 patients treated with mastectomy and IBR at the Institut Gustave-Roussy between January 1976 and December 1988 were studied. Forty-seven had an in situ carcinoma, 93 an infiltrating carcinoma, and 2 a fibrosarcoma. IBR failures were defined as removal of the prosthesis, and early failures as removal during the first 7 weeks after IBR. RESULTS: The early failure rate was significantly higher in patients with invasive carcinomas or fibrosarcomas than patients with in situ carcinomas (12% versus 0%, P = 0.04). The risk of late IBR failure was significantly higher in patients who had received postoperative radiation therapy than patients who did not (P = 0.0002). However, this increased risk applied only to women in whom the chest wall was exposed to radiation because of a high risk of recurrence. CONCLUSION: It might be preferable to postpone breast reconstruction for patients with infiltrating breast carcinoma because early complications are not infrequent and could delay adjuvant chemotherapy. Late complications associated with chest wall irradiation could be avoided with the use of alternative techniques such as the transverse rectus abdominis myocutaneous (TRAM) flap procedure.

Breast↗