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PubMed1992

Breast reconstruction in women treated with radiation therapy for breast cancer: cosmesis, complications, and tumor control.

The records of 55 patients who had breast cancer treated by mastectomy, irradiation, and breast reconstruction were reviewed for cosmetic outcome, complications, and tumor control. Median follow-up was 35 months. Local control rates were 95 percent in patients treated for high risk factors or breast conservation and 85 percent in patients treated for recurrent breast cancer. Acceptable cosmetic results were obtained in only 42 percent of patients. The incidence of complications was 55 percent. Transverse rectus abdominis muscle (TRAM) reconstructions gave superior cosmetic results compared with all other types of reconstructions. The timing of reconstruction in relation to mastectomy or radiation therapy did not significantly influence cosmetic outcome, although other factors suggest that delayed reconstruction may give better results. A majority of patients were satisfied with cosmetic outcome.

Abdominal Muscles↗
PubMed1992

Subcutaneous avulsion of the breast caused by a seat belt injury. Report on a case requiring emergency mastectomy.

A 60-year-old female car driver wearing a combined three-point lap-shoulder seat belt was involved in a head-on-collision. The entire right breast was separated from the chest wall, whereas the overlying skin remained intact. The injury resulted in a rapid development of a monstrous haematoma in the retromammary space, and required emergency mastectomy. Seat belt lesions of the female breast are seldom referred in the literature.

Accidents, Traffic↗
PubMed1992

Total mastectomy is not always mandatory for the treatment of recurrent breast cancer after lumpectomy alone.

To determine the treatment that offered the best local control for isolated local recurrences of breast cancer after lumpectomy without radiotherapy, the authors reviewed 355 patients initially treated by lumpectomy (with or without axillary dissection) without radiotherapy. Local breast cancer recurred in 79 patients. They underwent either repeat partial mastectomy (PM) or completion total mastectomy (TM). Twenty-four patients (5 TM, 19 PM) received radiotherapy. Local control was defined as the absence of further recurrence of breast or chest-wall cancer. The 19 patients treated with repeat PM and radiotherapy had an actuarial local control rate of 82% at 5 years. Those treated with TM (28 patients) [corrected] or TM plus radiation (5 patients) had rates of local control of 60% and 52% respectively. Although there were no significant differences between the TM and PM plus radiotherapy groups, the 27 patients who had a repeat PM without radiotherapy had a significantly lower rate of local control (32%, p < 0.005). Treatment of recurrent breast cancer with PM and radiotherapy is a viable alternative to TM for enhancing local control. Repeat PM alone gave much poorer results. The authors conclude that local cancer recurrences after lumpectomy alone do not necessarily require TM and can often be treated with repeat excision and radiotherapy.

Adult↗
PubMedDate not supplied

Patterns of treatment for ductal carcinoma in situ of the breast in Louisiana, 1988-1999.

Data from numerous studies show that lumpectomy (breast-conserving therapy) plus radiation therapy provides survival equivalent to that following mastectomy (either modified radical or radical mastectomy) for patients with ductal carcinoma in situ (DCIS). According to the data from the National Cancer Data Base and the Surveillance Epidemiology End Results (SEER) Program, use of lumpectomy among female DCIS patients has increased dramatically over the last decade. This study examined population-based trends in treatment for DCIS among Louisiana women and compared the trends with the SEER data. Our data revealed that the percentage of the DCIS patients who received a lumpectomy increased from 34.3% in 1988-1991 to 53.7% in 1996-1999 in Louisiana (p<0.05) while DCIS patients who received a modified radical mastectomy decreased from 51.7% to 26.1% (p<0.05). Increasing use of lumpectomy was seen across all races, age groups, rural/urban areas, and poverty-level areas. Utilization of lumpectomy was about the same for white and African-American women but varied by age group, rural/urban area, and poverty level. Female DCIS patients residing in rural areas or high poverty level areas were less likely to receive a lumpectomy than those residing in urban or affluent areas. Among the patients who had a lumpectomy, 34.4% received post-lumpectomy radiotherapy in the first study period (1988-1991) and 49.7% in the last study period (1996-1999). In Louisiana, utilization of post-lumpectomy radiotherapy decreased with advancing age. Despite the increase in use of lumpectomy, its utilization remained approximately 10% lower than in the SEER areas throughout the study period. A similar deficit was observed for post-lumpectomy radiation therapy.

Adult↗
PubMed2003

Does reoperation predispose to postoperative wound infection in women undergoing operation for breast cancer?

Reoperations for breast cancer predispose to a higher risk of postoperative wound infections than primary procedures. We accomplished a retrospective chart review of 320 women who underwent multiple breast cancer procedures between 10/97 and 8/02. The mean number of procedures was 2.4 (range, 2-5). The overall incidence of wound infection was 6.1 per cent. Wound infections developed, on average, 12 days after surgery (range, 2-30). There was a statistically significant difference in the incidence of wound infection comparing the initial procedure versus the subsequent operation (1.6% vs. 9.4%, P < 0.001). This was also seen with reoperation after an operative biopsy compared to operation after a core biopsy (11.1% vs. 9.7%, P < 0.01). The incidence was increased to 22.0 per cent when the initial operation involved lymph node dissection (sentinel lymph node biopsy or complete axillary lymph node dissection). Wire localization did not increase the incidence of postoperative wound infections, and prophylactic antibiotics were associated with a decreased incidence of wound infection in the reoperative setting. The incidence of wound infection is increased with reoperation after operative biopsy compared to operation after core biopsy and is further increased when the initial biopsy involved lymph node dissection.

Antibiotic Prophylaxis↗
PubMedDate not supplied

Radiation therapy and breast preservation: past achievements, current results, and future prospects.

In this overview the historical development of breast-conserving therapy is sketched briefly from its origins in the second and third decades of this century, and current radiotherapeutic techniques are described. All randomized trials thus far conducted using modern radiotherapy indicate that total mastectomy provides no survival advantage compared with breast-conserving techniques. In patients suitable for such treatment, macroscopically complete local tumor excision followed by appropriate radiotherapy will lead to 90-96% local control in the breast at 5 years, and 81-93% at 10 years. It is likely that the strategy of reserving total mastectomy for treatment of intramammary failures will result in ultimate local control of disease on the chest wall which is superior to that provided by primary total mastectomy. Future prospects include the use of primary chemotherapeutic approaches for larger tumors, extending the possibilities of breast conservation to a majority of patients with tumors classically considered unsuitable for lumpectomy. In this context an increase in the use of radiotherapy in the primary treatment of breast cancer is anticipated.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Complete axillary conversion after neoadjuvant chemotherapy in locally advanced breast cancer: a step towards conserving axilla?

OBJECTIVES: This study was designed to assess the clinical, sonographic and histopathological response of axillary lymph node metastasis to neoadjuvant chemotherapy in patients with locally advanced breast cancer. MATERIAL AND METHODS: Forty patients with locally advanced breast cancer (LABC) with clinically palpable or sonographically detectable axillary nodes were studied. FNAC of the primary tumor and axillary nodes was done and patients were started on neoadjuvant chemotherapy. Axillary nodes were assessed clinically and sonographically for response after 3 cycles of chemotherapy. All patients underwent total mastectomy with axillary clearance and the lymph nodes in the specimen were examined for metastasis. RESULTS: 47% patients had complete clinical nodal response, while 19% showed complete sonographic response. Complete pathological nodal response was documented in 22% of patients. Ultrasonography was found to be more sensitive than clinical examination in assessing complete nodal response. 10% of the patients had complete pathological response of both primary tumor and axillary nodes. There was significant correlation between pathological response of primary tumor and lymph nodes (P=0.004). Patients with complete sonographic or clinical response were found to have no or minimal residual disease in axilla and hence axillary dissection may be avoided in them.

Analysis of Variance↗
PubMed1992

[Development of thoracic wall recurrence after mastectomy. Surgical consequences].

It has been demonstrated, that in a regular mastectomy a certain amount of glandular tissue is left back in the overlying skin flaps. If direct skin closure is achieved postoperatively, the glandular tissue remnants are laid with the skin flaps on top of the denuded pectoral muscle. Since these glandular tissue remnants may contain or develop breast cancer, a latter recurrence on the thoracic wall may take place. In order to avoid these iatrogenic thoracic wall recurrences an interpositioning of vital tissues between the thoracic wall and the skin is recommended. This is achieved by reconstructing the breast immediately after mastectomy.

Breast↗
PubMed2004

Nipple leiomyoma in man: a case report.

We describe a rare case of a man, 38 year old, with a nipple leiomyoma, and report the presentation as a small nodule of the areola spreading the nipple, the symptoms, the clinical signs, the treatment that includes a complete excision; free margins should be histologically established to prevent recurrence.

Adult↗
PubMed2004

[Puberal gynaecomastia. Review of nine cases].

Gynaecomastia is more frequent during the adolescence. In this paper, a retrospective study of nine cases diagnosed and treated on a period of six years is presented. The reports of nine patients are reviewed. The mean age at diagnosis was 10.4 years (range 9-12). In all cases a bilateral mammary hypertrophy was detected, symmetrical in 6 cases (67%) and asymmetric in 3 (33%). After a mean follow-up period of 24 months, surgical treatment was indicated: a subtotal subcutaneous mastectomy was performed in all nine cases. Only two patients developed early complications: one wound infection and one haematoma. The long-term plastic results were satisfactory after a mean follow-up postoperative period of 11 months. The general management of this kind of pathologic process is presented. In the authors experience the elective surgical procedure is the subtotal subcutaneous mastectomy as simple procedure with a very short morbidity and excellent plastic results.

Child↗
PubMed1992

Salvage mastectomy for local and regional recurrence after breast-conserving operation and radiation therapy.

Forty-six patients initially treated for carcinoma of the breast by tumor excision and radiation therapy who had local and regional recurrence with no evidence of distant disease and who underwent salvage mastectomy at Memorial Sloan-Kettering Cancer Center between 1970 and 1990 were reviewed retrospectively. These patients represent a recent series of patients treated with breast-conserving surgery, radiation therapy and subsequent salvage mastectomy with a median follow-up period of five years (range of one to 20 years). The mean age at initial diagnosis was 52 years (range of 31 to 75 years). All patients had excision of the primary tumor; 27 underwent local excision with axillary dissection. The median radiation therapy dose to the breast was 48 Gy. The distribution of stage of disease at the time of breast conserving treatment was stage 0 in seven patients, stage I in 13 patients, stage II in 14 and stage III in one patient. Twenty-seven patients received conservation treatment at other institutions and were referred to our institution for salvage operation. Local and regional relapse occurred at a median of 28 months (range of five months to seven years) after initial treatment. Relapses occurred only in the breast in 35 patients, in the axilla in one patient and in both sites in ten patients. Salvage operation consisted of total mastectomy in 50 per cent, modified radical mastectomy in 33 per cent and radical mastectomy in 17 per cent. Follow-up evaluation after salvage mastectomy (median 28 months, range of one month to 18 years) yielded an actuarial proportion free of disease at five years of 55 per cent (+/- 11 per cent) and an over-all five year survival rate of 76 per cent (+/- 10 per cent). The median time to relapse was 97 months (+/- eight months) and the median survival time was 103 months (+/- seven months). The local recurrence rate after salvage mastectomy was 15 per cent. These data suggest that salvage mastectomy provides local control of recurrent carcinoma of the breast and relapse-free survival time may be improved by postsalvage systemic therapy.

Adult↗
PubMed2004

Lymphatic mapping improves staging and reduces morbidity in women undergoing total mastectomy for breast carcinoma.

Lymphatic mapping (LM) and sentinel lymph node biopsy (SLNB) have become widely accepted in the setting of breast conservation surgery. We hypothesized that LM can be extended to women undergoing total mastectomy, being technically feasible, yielding highly accurate and sensitive results, improving axillary staging, and reducing postoperative morbidity. Between 1995 and 2003, 99 women (mean age 59 years, range 34-87) underwent 100 mastectomies with LM using blue dye alone. Fifty-nine operations (60%) were followed by a completion axillary lymph node dissection (ALND). Ninety per cent of patients had invasive carcinoma; 10 per cent had in situ carcinoma. Mean tumor size was 2.5 cm (range 0.3-8 cm). One hundred fifty-nine sentinel nodes (SNs) (mean 1.65, range 1-5) were successfully identified in 96 (96%) axillae. Twenty-five (25%) sentinel nodes revealed nodal metastases. Five of 25 (20%) SNs had micrometasteses. Three patients had a false-negative SN, yielding a sensitivity of 91 per cent. The accuracy of LM was 97 per cent. No patient who underwent SLNB alone developed lymphedema, axillary seroma formation, infection, or restricted arm movement. This was contrasted with patients undergoing ALND, where 10 (16%) developed lymphedema and 2 (3%) developed an infection. Ten (25%) patients developed axillary paresthesias after SNB compared with 47 (78%) patients after ALND (P < 0.0001). LM in the setting of mastectomy is accurate and sensitive. This technique improves axillary staging and decreases morbidity. Patients who are not candidates for breast conservation should be offered LM and SLNB at the time of mastectomy.

Adult↗