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PubMedDate not supplied

Architectural pattern of the normal and cancerous breast under the influence of parity.

Epidemiological and clinical observations indicate that breast cancer incidence is greater in nulliparous women, whereas early parity confers protection. Since the initiation of breast cancer is related to the degree of development of the organ, this study was designed with the purpose of determining what basic differences exist between the parous and the nulliparous women's breast, and whether these differences correlated with the presence or absence of malignancies. For this purpose, the architecture of the mammary gland of parous and nulliparous women with breast cancer was compared with that of women free of mammary pathology. The women ranged in an age from 20 to 63 years. Normal whole breasts obtained at autopsy or cancer-bearing breasts surgically removed by modified radical mastectomy were studied in whole mount preparations in which the number and relative proportion of normal structures, i.e., lobules type 1, 2, and 3 (Lob 1, 2, and 3), were determined. In the breast of nulliparous women, the predominant structure present was the Lob 1; the presence of cancer did not modify the basic architectural pattern of the breast, which contained a higher proportion of Lob 1, as well. In parous women free of cancer, the breast contained a greater percentage of Lob 3 and a moderately increased number of Lob 2, with a concomitant reduction in Lob 1. Parous women with breast cancer, on the other hand, exhibited a different architecture in the mammary gland, which had a greater percentage of Lob 1 and a lower of Lob 3 than the noncancerous group, approaching the percentages found in nulliparous women.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Management of radiation dermatitis in a patient after mastectomy.

Women who are diagnosed with breast cancer and undergoing chemotherapy and radiation are at high risk of developing acute radiation dermatitis. The purpose of this case study is to explore an alternative topical therapy for skin toxicity in the post-radiation care of a patient with a history of breast cancer. The patient, a 54-year-old white female, was treated by modified radical mastectomy, chemotherapy, and radiation. During post-radiation therapy the patient developed wet desquamation reaction over the midincision line into the right axilla. Balsam Peru, hydrogenated castor oil, trypsin (Xenaderm Healthpoint, San Antonio, Tex) was trialed to evaluate efficacy in providing wound healing to the denuded skin. Within 14 days of treatment, the area was completely healed and topical therapy stopped. This case study provides the basis for further research into the area of topical therapy for women with moist desquamation after radiation for breast cancer.

Balsams↗
PubMed2001

Differences in risk factors for local and distant recurrence after breast-conserving therapy or mastectomy for stage I and II breast cancer: pooled results of two large European randomized trials.

PURPOSE: Risk factors for local and distant recurrence after breast-conserving therapy and mastectomy were compared to define guidelines for the decision making between both treatments. PATIENTS AND METHODS: The data of two randomized clinical trials for stage I and II breast cancer patients were pooled. The total number of patients in the study was 1,772, of whom 879 underwent breast conservation, and 893, modified radical mastectomy. Representative slides of the primary tumor were available for histopathologic review in 1,610 cases (91%). RESULTS: There were 79 patients with local recurrence after breast-conservation and 80 after mastectomy, the 10-year rates being 10% (95% confidence interval [CI], 8% to 13%) and 9% (95% CI, 7% to 12%), respectively. Age no more than 35 years (compared with age >60: hazard ratio [HR], 9.24; 95% CI, 3.74 to 22.81) and an extensive intraductal component (HR, 2.52; 95% CI, 1.26 to 5.00) were significantly associated with an increased risk of local recurrence after breast-conserving therapy. Vascular invasion was predictive of the risk of local recurrence, irrespective of the type of primary treatment (P <.01). Tumor size, nodal status, high histologic grade, and vascular invasion were all highly significant predictors of distant disease after breast-conserving therapy and mastectomy (P <.01). Age no more than 35 years and microscopic involvement of the excision margin were additional independent predictors of distant disease after breast-conserving therapy (P <.01). CONCLUSION: Age no more than 35 years and the presence of an extensive intraductal component are associated with an increased risk of local recurrence after breast-conserving therapy. Vascular invasion causes a higher risk of local recurrence after mastectomy as well as after breast-conserving therapy and should therefore not be used for deciding between the two treatments.

Adult↗
PubMedDate not supplied

[Immediate reconstruction after radical mastectomy using Becker's prosthesis: long-term results].

The authors present their experience about 36 immediate breast reconstruction after radical mastectomy by Becker's prostheses, concerning early and delayed postoperative complications, cosmetic results and patients satisfaction. The indication to reconstruction has been proposed considering stage disease, breast features (volume, skin flaps, symmetry with the other breast). The postoperative mortality was none; overall incidence of early complications was 11% and in two cases has obliged to implant removal. Mean follow-up has been 31 months: a severe contracture (Baker IV) has been observed in 2 patients which obliged to implants removal 90% of the patients (20 cases) had no contracture (Baker I) whereas 2 patients presented a Baker II contracture. The majority of the patients declared their complete satisfaction. Finally the authors suggest an immediate breast reconstruction after radical mastectomy because this procedure has a low incidence of complications and contracture and it can be surely done by a general surgeon.

Breast↗
PubMed2001

Chemotherapy-induced histologic changes in mastectomy specimens and their potential significance.

The aim was to assess chemotherapy-induced histologic changes in breast cancer and to evaluate their relationship with tumour response, to treatment and patient survival. We examined paired pre- and post-chemotherapy tumour specimens from 57 patients with stages II and III breast cancers. All patients received three to four courses of anthracycline-containing preoperative treatment and subsequently underwent modified radical mastectomy 3-5 months after diagnosis. Histologic parameters evaluated included extent of residual disease and cytologic changes in residual tumour and in non-neoplastic breast tissue and lymph nodes. Correlation of pathologic changes with disease-free and overall survival was evaluated. Clinical evaluation indicated that 24% (n=14) of patients had a complete response, 53% (n=30) had a partial response, and 22% (n=13) had stable disease. Pathologic assessment revealed a complete response in 14% (n=8) of patients. Clinical and histologic complete responses were discordant in 35% of patients. Sixty-eight percent of tumours demonstrated moderate to severe cytologic changes in the cytoplasm and nucleus of neoplastic cells. These were characterized by increased overall cell size, cytoplasmic vacuolization, nuclear enlargement, multinucleation, and vesiculation of chromatin. Chemotherapy-induced histologic changes varied within a tumour and between patients. Tumour cytologic changes were significantly associated with histologic (p=0.03) as well as clinical (p=0.02) tumour response. Pathologic tumour response, but not histologic changes, was also a powerful predictor of overall survival and relapse-free survival. In the non-neoplastic glandular tissue, periductal and perilobular fibrosis and atrophy of lobular acini similar to those seen in postmenopausal breast tissue were noted. Changes in lymph nodes were characterized by lymphoid depletion and fibrosis with and without tumour metastasis. Chemotherapy-induced cytologic changes are frequently seen in neoplastic breast epithelium and correlate with response to treatment. Histologic confirmation of clinical tumour response to preoperative chemotherapy is necessary for accurate characterization of patients', response to treatment.

Journal Article↗
PubMed2002

Women's perceptions of seroma and their drainage following mastectomy and axillary lymph node dissection.

AIM: The aim of this research was to study the effect of seroma on women's perception of daily functional and emotional status after surgical treatment for breast cancer. Furthermore, the experiences of the actual drainage procedure of seroma was studied. METHOD: The study had a prospective and comparative design. A study specific questionnaire was developed and used. Eighty-two women operated with modified radical mastectomy completed the forms. Forty-one women with seroma were compared with the 41 without seroma. The items focused on women's perceptions of daily-life situations, postoperative pain, problems with the surgical scar, preoperative information, general health, levels of anxiety, depression, psychosocial support and contact with the registered nurse in the hospital. RESULTS: Overall the perceived emotional and functional status, pain and general health did not differ between the two groups. Women with seroma contacted the registered nurse in the hospital more frequently after hospital discharge. Most women with seroma had no or little pain and anxiety during the aspiration and found the procedure fully acceptable. Practical information concerning self-care and the aspiration procedure was considered insufficient. The return visit to the nurse for wound observation was important and provided psychosocial support. CONCLUSION: Seroma and its drainage is well accepted. Patients should be better informed about the possibility of a seroma and its treatment. Staff continuity and particularly the presence of a special trained nurse for wound control and for psychosocial support are much appreciated.

Journal Article↗
PubMed1992

Immediate breast reconstruction at the time of mastectomy for breast cancer.

Immediate breast reconstruction avoids or lessens the psychosocial trauma associated with a disfiguring mastectomy. The complications seen in this small patient sample are not in excess of those seen in patients undergoing delayed reconstruction. Fifteen immediate breast reconstructions were performed at the time of mastectomy for cancer. Flap or implant reconstruction alone was determined on an individual basis. No delays in the initiation of adjuvant chemotherapy or hormone therapy were caused by the reconstructions. There were no instances of total flap loss or wound infection. One implant was lost due to exposure. Other complications were similar to those associated with modified radical mastectomy alone. These preliminary results suggest that immediate breast reconstruction at the time of mastectomy may be offered with safety to newly diagnosed breast cancer patients.

Adult↗
PubMed1980

Reconstructive breast surgery following mastectomy and adjunctive radiation therapy.

With modern radiation, surgical therapy, and surgical reconstructive techniques, it is now possible to give adequate treatment for breast cancer and to reconstruct the breast as well, using a silicone implant prosthesis. Twelve mastectomies and reconstructions were performed on 8 patients. Seven of these had pre- or postoperative irradiation to one breast region, and 1 patient received irradiation to both breast areas. The clinical staging of patients with combined irradiation and surgery was Stage I--3 cases; Stage II--4 cases; and Stage III--1 case. Primary surgical procedures consisted of modified radical mastectomy for ten breast lesions and simple mastectomy for two others. Megavoltage radiotherapy was administered with a CO-60 Unit. Pre-operative irradiation of 4000 rads to the breast, chest wall, and regional lymphatics was given to 3 patients. Postoperative radiation therapy of 5000 rads to the chest wall and 4400-5000 rads to the regional lymphatics was given to 5 other patients, one of whom received bilateral irradiation. Adjunctive chemotherapy was employed in 5 patients with interruption during the period of implant surgery. Reconstructive surgery was performed 5 months to 14 months after irradiation in 7 patients and 51/2 years later in one patient. The procedure was a single stage operation with placement of a silicone prosthesis under the pectoralis muscle. No significant morbidity was encountered from radiotherapy, chemotherapy, or from the surgical procedures. Healing of surgical wounds after implantation was uncomplicated. Cosmetic results have been good. All patients are alive and well, 8 months to 6 1/2 years postirradiation and three months to three years post-breast reconstruction. Results to date have been most gratifying.

Adult↗
PubMed1996

Quality of the capsule in reconstructions with textured or smooth silicone implants after mastectomy.

Many women desire some kind of reconstruction after mastectomy for breast cancer to improve the cosmetic result. Since the introduction of silicone breast implants, capsular contracture has been the most common complication of breast augmentation or reconstruction. The aim of the present study was to evaluate the capsule quality in patients with breast cancer who had undergone reconstructions with either textured (rough) or smooth silicone implants after simple or modified radical mastectomy. Forty-three consecutive patients had reconstructions with textured silicone implants (49 implants) and were evaluated 32 months post-operatively in a prospective clinical trial. The last 43 consecutive patients who had reconstructions with bilumen smooth silicone implants (49 implants) acted as controls. The results were graded by Baker's classification. Among the patients with textured implants only 9% (4/47) was graded as having moderate or severe capsular contracture in contrast to 24% (11/46) in patients with bilumen smooth-surface implants (p < 0.05). These results confirm previous reports that favour textured silicone implants in breast augmentation and reconstruction.

Breast Implants↗
PubMed1988

Prognostic implications of age in breast cancer patients treated with tumorectomy and irradiation or with mastectomy.

Conservation breast treatment is of particular interest to young women, but whether saving the breast carries a penalty in shorter survival or local-regional recurrent disease has not been well-established. At The University of Texas M.D. Anderson Hospital and Tumor Institute at Houston, 1161 patients treated prior to 1983 with Stage I or II breast cancer were reviewed. Of these patients, 378 were treated with tumorectomy plus irradiation, and 783 were treated with radical or modified radical mastectomy. The two patient groups were compared relative to local-regional disease recurrence and overall and disease-free survivals. Local recurrences in the breast appear to be more frequent in patients less than or equal to 35 years of age treated with tumorectomy and irradiation than in patients older than 35 years, but in patients aged less than or equal to 50 or greater than 50 or less than or equal to 35 or greater than 35 years, there was no significant statistical difference between tumorectomy and irradiation or mastectomy nor was there a difference in disease-free survival. Overall survival rates favored patients treated by tumorectomy and irradiation.

Adult↗
PubMed1992

Swiss adjuvant trials in women with node-negative breast cancer. OSAKO.

Women with node-negative breast cancer have a 30% chance of relapse 5 years after mastectomy. If it is possible to prevent or defer recurrent disease with adjuvant systemic therapy, node-negative patients, with their low tumor burden, should theoretically benefit most from such treatment. In 1974 we started a randomized adjuvant trial in eastern Switzerland, using a subjectively less toxic regimen [chlorambucil, methotrexate, and fluorouracil (LMF)]. Two hundred fifty-four patients were randomly assigned after standardized modified radical mastectomy to observation only or to treatment with oral LMF for 6 months followed by BCG skin scarifications monthly for up to 2 years. While we find no significant statistical difference between the control group and the treated group in terms of relapse-free survival, there is a strong and consistent trend toward prolongation of overall survival within the treated group.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Predictive value of some clinical and pathological parameters on upper level axillary lymph node involvement in breast cancer.

The role of radical axillary dissection in breast cancer management is presently under discussion. In this study we have evaluated the relationship between the pattern of metastatic axillary lymph node involvement by level and some of the main prognostic factors (age of the patient, size, grading, estrogen receptor and progesterone receptor status of the primary tumor) in 185 patients with operable breast cancer. The III level appeared to be involved in 31 (16.8%) out the 108 patients with axillary lymph nodes positive for metastases. A discontinuous pattern of axillary involvement (skip metastases) was observed in about 10% of cases. Logistic regression analysis of the data shows that only G3 is significantly correlated with the risk of III level invasion (p less than 0.05). We conclude that, at present, a selection of possible candidates for a less than radical axillary dissection is not as yet feasible. Since the risk for III level invasion cannot be sufficiently defined.

Breast Neoplasms↗
PubMed1985

Surgical treatment of carcinoma of the breast. V. Changes in patient population and therapeutic modalities at a metropolitan hospital (1971-1980).

This is a retrospective study of 408 patients who had mastectomy for carcinoma of the breast during 1971-1980. Over these 10 years, we have had a significant increase in Hispanic patients. Although the mean size of breast tumors among the Hispanic patients was smaller than that of our black patients, Hispanic patients are more likely to have higher numbers of positive axillary lymph nodes. Similar to the nationwide trend, over 90% of the patients had modified radical mastectomy in recent years, and adjuvant systemic chemotherapy has replaced postoperative radiotherapy for patients with axillary metastasis. Postmastectomy actuarial 5-year relapse rates of our patients with none or 1-3 positive axillary nodes were quite similar. Among patients with 1-3 positive axillary nodes, year of diagnosis and whether postoperative radiotherapy or chemotherapy was added or not did not affect disease-free probability. However, among patients who had four or more positive axillary nodes, those who were admitted after 1976 and who received systemic chemotherapy (90% had CMF) had a much lower probability of developing recurrence.

Actuarial Analysis↗
PubMed2004

Seroma prevention following axillary dissection in patients with breast cancer by using ultrasound scissors: a prospective clinical study.

AIMS: Seroma formation following axillary dissection is a common complication of breast surgery. The aims of this study were (1) to analyse the risk factors of seroma formation, and (2) to evaluate the role of ultrasound scissors in performing axillary dissection in patients with primary breast cancer undergoing mastectomy and breast-conserving surgery. METHODS: Ninety-two women (median age 55 years, range 33-73 years) requiring surgery for known unilateral primary breast cancer (pT1a=1, pT1b=20, pT1c=43, pT2=25, pT3=3) were prospectively randomised to undergo axillary dissection by either using (Group A, 45 patients) or not using (Group B, 47 patients) ultrasound scissors (US). Thirty-eight (41.3%) patients underwent modified radical mastectomy, while 54 (58.7%) underwent breast-conserving surgery. RESULTS: Twenty-eight (30.4%) patients (Group A=9 out of 45, 20%; Group B=19 out of 47, 42%; P=NS) developed a wound seroma. Multivariate analysis using a logistic regression model showed that surgical procedure (RR=8.9; 95% CI: 3.2-25.3), total amount of drainage (RR=7.8; 95% CI: 2.8-22.0), and size of the tumour (RR=6.0; 95% CI: 2.2-16.5) independently correlated with seroma formation. The logistic regression function (RR=19.4; 95% CI: 6-62) correctly allocated 75 out of 92 (81.5%) patients. CONCLUSIONS: Size of the tumour, and total amount of drainage represent the principal factors of seroma formation following axillary dissection in patients undergoing surgery for breast cancer. Although the use of ultrasound cutting devices may reduce the risk of seroma formation, further studies are need to verify the real impact on long-term morbidity of such technique.

Adult↗
PubMed1990

Multicentric adult secretory breast carcinoma: DNA flow cytometric findings, prognostic features, and review of the world literature.

A case of multicentric secretory breast carcinoma in a 39-year-old white female is described. Mammograms, DNA analysis, touch preparation cytology, and positive estrogen receptors are reported for the first time in this rare favorable mammary carcinoma. A review of the 33 reported cases with follow-up in adult females, including the present case, has revealed lymph node metastases in nine (27%), recurrence in four (12%), and distant metastases leading to death in two cases (6%). In patients treated with less than simple mastectomy there has been local recurrence in 4 (33%) of 12 cases and in three of the four cases (75%) greater than or equal to 2.0 cm. Increased size and lack of gross circumscription of the neoplasm and presentation in the adult age group appear to identify cases with an increased risk of disease progression. In patients over 20 years old, especially with neoplasms greater than 2 cm in diameter, modified radical mastectomy has to date achieved the most favorable outcome. Minimal experience (two cases) is available regarding treatment with limited surgery and radiation therapy, and there is no available data regarding possible benefit from adjuvant chemotherapy.

Adult↗
PubMed1991

The oncologic risks of skin preservation at mastectomy when combined with immediate reconstruction of the breast.

Most oncologic surgeons agree that removal of the nipple, the areola and any recent scar at the site of the biopsy is necessary during a mastectomy for treatment of carcinoma of the breast. There is less agreement about what should be done with the remaining uninvolved mammary skin. Its preservation facilitates the performance of immediate reconstruction of the breast and can lead to improved aesthetic results, but many oncologists fear that this practice could lead to an increased incidence of local tumor recurrence. To determine if that fear was justified, 87 patients who had undergone unilateral or bilateral mastectomy with immediate reconstruction for treatment of early carcinoma of the breast were studied. Preservation of uninvolved skin was used in all instances. All patients had a documented follow-up study of 12 months or more; the average follow-up time was 23.1 months. One peripheral local recurrence was observed. This 1.2 per cent rate of early local recurrence is lower than that reported from several series using modified radical mastectomy without skin preservation or immediate reconstruction, and suggests that skin preservation does not confer additional risks of local recurrence of carcinoma of the breast in properly selected patients.

Breast Neoplasms↗
PubMed1989

[Surgical procedure for secondary breast reconstruction after mastectomy].

The type of reconstruction is determined by the mastectomy deformity and requirements for symmetry. There are five basic techniques. A silicone breast implant placed submuscularly beneath the available tissues is the most straight-forward procedure. Latissimus dorsi flap is used with a silicone breast implant when additional skin and/or muscular cover is needed. Transverse rectus abdominis musculocutaneous utilizes excess lower abdominal tissue for reconstruction of the breast with autogenous tissue. The tissue expander is most frequently used following modified radical mastectomy. The external oblique rectus abdominis musculofascial turn-over flap is an attractive new technique.

Breast Neoplasms↗