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PubMed1995

Tumour excision plus continuous tamoxifen compared with modified radical mastectomy in patients over 70 years of age with operable breast cancer.

Between 1985 and 1991, we randomly assigned 77 women over the age of 70 years with stage I-3a breast cancer to undergo a modified radical mastectomy or tumour excision followed by tamoxifen. Median follow-up was 45 months. Patients treated by tumour excision and tamoxifen had a significantly better survival (P = 0.04). The disease-free survival of the tumour excision and tamoxifen group was close to significantly better (P = 0.10). Only two patients in the tamoxifen group required an axillary dissection on follow-up for progressive nodal enlargement. Two patients underwent a local mastectomy for locally recurrent disease. We conclude that tumour excision followed by continuous tamoxifen is an acceptable, safe alternative to a modified radical mastectomy in patients over 70 years of age.

Aged↗
PubMed1990

[Modified radical mastectomy in the treatment of stage III breast carcinoma].

From 1972 to 1982, 237 patients with stage III breast carcinoma were admitted into our institute. One hundred and eleven cases underwent Auchincloss and Madden modified radical mastectomy (MRM), and the remaining 126 cases received Halsted radical mastectomy (RM). The 5 and 10 years survival rates were 59.17% (61/111), and 36.92% (24/65) in MRM group. The 5 and 10 years survival rates were 53.17% (67/126) and 29.31% (17/58) in RM group. There were no statistically significant differences in the long-term survival rates between the two groups (P greater than 0.05). The authors believe that MRM causing less trauma should be considered in the treatment of stage III breast carcinoma unless in cases with major pectorial muscle involvement or large metastatic axillary nodes.

Adult↗
PubMed1993

Randomized trial of laser scalpel for modified radical mastectomy.

The efficacy of a contact neodymium yttrium-aluminium-garnet laser scalpel was assessed during breast surgery. Forty consecutive women undergoing modified radical mastectomy were randomized to operation performed with a conventional or laser scalpel. The laser scalpel was associated with a significant reduction in mean operative blood loss (149 versus 421 ml; 95 per cent confidence interval of difference 176-368 ml, P < 0.001), but the mean operating time was longer (105 versus 80 min; 95 per cent confidence interval of difference 16-34 min, P < 0.001). No significant differences were found in the volume of postoperative wound drainage, incidence of axillary seroma, postoperative pain score or time to return of shoulder mobility. Use of a laser scalpel in breast surgery cannot be recommended.

Adult↗
PubMed1976

The primary surgical treatment of carcinoma of the breast: a changing trend toward modified radical mastectomy.

To study the effectiveness of a trend at the Mayo Clinic toward modifying the standard radical mastectomy, the 5-year survival of 873 women treated surgically for breast cancer from 1965 through 1968 was evaluated. The observed survival of 534 patients treated by the standard radical mastectomy was 85% when nodes were negative and 56% when nodes were positive. For 339 patients treated by the modified radical mastectomy, the observed survival was 80% and 48% when axillary nodes were negative and positive, respectively. In order to accomplish a more significant analysis of cancer risk and results of the two operative procedures, a relatively homogeneous group of 541 patients was established from the total group. In this homogeneous group, the observed survival of 336 patients treated by the standard radical mastectomy was 86% when nodes were negative and 66% when nodes were positive. For 205 patients treated by the modified radical mastectomy, the observed survival was 84% and 66% when axillary nodes were negative and positive, respectively. When patients were further analyzed and compared according to the extent of axillary-node involvement, age at the time of treatment, grade, size, location, and histopathologic type of tumor, and the use of postoperative irradiation, survival was essentially the same, irrespective of the type of mastectomy performed.

Adult↗
PubMed2004

[Improvement of wound treatment in modified radical mastectomy of breast cancer].

OBJECTIVE: To evaluate the efficacy of Dexon continuous intracutaneous sewing (DCIS) and Redon negative pressure absorbing drainage (RNPAD) in modified radical mastectomy of breast cancer. METHODS: The clinical data of 128 patients treated with DCIS and RNPAD, and 123 cases treated with traditional sewing and negative pressure absorbing ball were analyzed retrospectively. RESULTS: There were 16 cases (12.5%) of seroma formation,1 (0.8%) of skin flay necrosis among 128 cases treated by DCIS and RNPAD, and 47 cases (38%) of seroma formation, 16 (13%) of skin flay necrosis among 123 cases treated by traditional method. The statistically significant difference was found (P <0.001). The average length of post-operation hospital stay in DCIS and RNPAD group was 8.8 days compared with 14.7 days in traditional treatment group. CONCLUSION: The use of DCIS and TNPAD could decrease the complication rate of breast cancer operation.

Adult↗
PubMed1992

Early drain removal following modified radical mastectomy: a randomized trial.

The dilemma of increasing costs of medical care and shrinking health budgets has stimulated attempts to implement stricter control on expenditure without affecting the quality of care. This study shows that in patients with operable breast cancer, a policy of early discharge after a mastectomy did not have deleterious effects on wound healing and was well accepted by patients. In a randomized trial, drains were removed after either 3 or 6 days postmastectomy, and in both groups of patients there was no difference between the mean volumes of seromas aspirated or the number of aspirations and return visits to the hospital. This suggests that a policy of early discharge is safe, acceptable, economical, and may improve bed utilization.

Adult↗
PubMed1990

Achievements of physical therapy in patients after modified radical mastectomy compared with quadrantectomy, axillary dissection, and radiation for carcinoma of the breast.

Flexion of the shoulder, abduction, and external rotation in 90 degrees abduction are impaired after operations for breast cancer. We compared postoperative range of motion in 27 patients who underwent modified radical mastectomy and 21 patients who underwent quadrantectomy with axillary dissection and radiation therapy. The patients in the quadrantectomy group demonstrated a significantly higher range of flexion on postoperative day 1 and the day of suture removal. After 3 months, all patients had regained their preoperative range of flexion, with no difference between the groups. The better compliance of the quadrantectomy group to physical therapy may indicate that they suffer less pain and require a briefer or less intensive course of physical therapy.

Adult↗
PubMed1988

[Autotransplantation of nipple-areolar complex in a modified radical mastectomy--indications and three-stage breast reconstruction].

Necessity of breast reconstruction after mastectomy has been increasing in recent years. For better reconstruction, we preserve a nipple-areolar complex (NAC) by transplanting it temporarily onto the lower abdominal wall and retransplant it to the restored breast mound in a subsequent operation. Indications for NAC preservation are as follows: (1) by palpation the tumor is found to be smaller than 3.0cm in diameter without apparent regional and distant metastasis, (2) neither abnormal nipple discharge nor nipple retraction is observed, (3) tumor is remote more than 3.0cm from the areolar margin, (4) no abnormal shadows are seen below the nipple and areola in the mammogram, (5) no microscopic extension of the cancerous cells is detected beneath the resected NAC. We have performed 18 transplantations using this procedure with good cosmetic results. There were no recurrent cases due to NAC preservation. It is concluded that this technique for preserving the NAC by autotransplantation is easy to perform and useful for breast reconstruction because of low risk of recurrence and better cosmetic results.

Adult↗
PubMed2005

Thoracic epidural anesthesia (TEA) with 0.2% ropivacaine in combination with ipsilateral brachial plexus block (BPB) for modified radical mastectomy (MRM).

BACKGROUND: Breast cancer is the 2nd most common tumors in Thai women. Until now, oncologic breast surgeries are typically performed by general anesthesia (GA). However, GA cannot provide adequate postoperative pain control and routine use of parenteral opioids aggravate postoperative sedation, nausea, emesis, impaired oxygenation and depressed ventilation. Thoracic epidural anesthesia (TEA) is one of the regional anesthetic techniques that can be done by using a low dose of local anesthetic in combination with ipsilateral brachial plexus block (BPB) for axillary node dissection. TEA can provide a better pain relief without potential paralysis of respiratory muscle and sedation. MATERIAL AND METHOD: Fifty ASA PS I-III patients undergoing MRM were randomly assigned to two study groups of 25 patients each. In the TEA group, an epidural catheter was inserted at T4 to T5, and 10-15 ml of 0.2% ropivacaine was injected, then interscalene BPB was done with 8 ml of 0.2% ropivacaine. Anesthesia was maintained with 5-10 ml of 0.2% ropivacaine per hour. GA was induced with 1 microg/kg of fentanyl followed by 1.5-2 mg/kg of propofol and was maintained with sevoflurane and 70% N2O in oxygen. The authors evaluated the adequacy of anesthesia, surgical condition, postanesthetic recovery, postanesthetic analgesia and patients' satisfaction. RESULTS: The demographic data was similar in both groups. The number of patients immediately arrived at PACU with a sedation score of 1 was significantly greater in TEA group (p = 0.003) while the number of patients with an Aldrete score of 10 was greater but not statistically significant (p = 0.25). The verbal rating scale and analgesic requirement were significantly lower in the TEA group (p < 0.001 and p = 0.002 respectively). Patients' satisfaction was greater with TEA than with GA (p = 0.014). Surgical condition was similar in both groups. CONCLUSION: The present study shows that TEA combined with BPB by using a low dose of 0.2% ropivacaine is a safe and reliable alternative technique for MRM. It can provide not only effective anesthesia but also better postoperative pain relief faster anesthetic recovery and greater patient satisfaction than those of the GA technique.

Adult↗
PubMed1991

Wound complications after modified radical mastectomy compared with tylectomy with axillary lymph node dissection.

Tylectomy with axillary lymph node dissection and radiotherapy (TAD) has become an accepted treatment for early breast cancer and has been shown to result in equal 5- and 8-year survival when compared with modified radical mastectomy (MRM). In order to determine the safety of TAD with respect to wound complications and to identify potential risk factors, we reviewed the charts of 560 patients undergoing MRM (n = 387) and TAD (n = 173) at Virginia Mason Medical Center from 1983 through 1989. The incidence of infection, seroma, hematoma, and epidermolysis were compared, and obesity, age 60 years or older, smoking, antibiotics, and wound drainage were examined as possible risk factors. There were more wound complications in the MRM group versus the TAD group (49% versus 35%; p less than 0.01), specifically more seromas (29% versus 18%; p less than 0.01) and epidermolysis (18% versus 0%). In the MRM group, age 60 years or older was associated with seroma (p less than 0.01) and smoking was associated with epidermolysis (p less than 0.01). In the TAD group, obesity was associated with infection. In both groups, volume of drainage from closed suction wound drains greater than 30 mL in the 24 hours prior to removal of the last drain was associated with seroma (p less than 0.05).

Axilla↗
PubMed1977

Total mastectomy with axillary dissection. A modified radical mastectomy.

A technic for total mastectomy with complete axillary dissection has been described. The procedure utilizes division of the pectoralis major muscle between its clavicular and sternal portions, perservation of its innervation, and reconstruction after completion of the dissection. The pectoralis minor muscle is resected. This modification facilitates a thorough axillary dissection, particularly at the apex, while preserving the cosmetic and functional benefits of the Patey operation.

Axilla↗
PubMed1988

Management of elderly patients with primary breast cancer.

From 1974 through 1983, three hundred forty-three patients aged 70 years or older at diagnosis received comprehensive post-operative radiation therapy for localized (Stage I-III) breast cancer following surgical procedures ranging from incisional biopsies to classical radical mastectomy. The 5- and 10-year overall survival rates for this series of elderly patients are 67% and 33%. The respective disease-free survival rates are 67% and 42%. Over one-half of these women were treated by less than total mastectomy. No differences were seen in survival, disease-free survival, or local regional control rates comparing similarly staged patients treated by radical mastectomy, modified radical mastectomy, or tylectomy. Complications were few and seen primarily in those patients subjected to axillary dissection prior to irradiation. Long term survival appears to be achievable in the majority of elderly patients with regionally confined disease at presentation and aggressive treatment with curative intent is warranted. These elderly patients are often poor candidates for radical surgery. In this patient population, conservative surgery with post-operative radiation therapy is well tolerated and provides equivalent results to more radical surgical procedures.

Age Factors↗
PubMed1998

Dose and dose intensity as determinants of outcome in the adjuvant treatment of breast cancer. The Cancer and Leukemia Group B.

BACKGROUND: Both total dose and dose intensity of adjuvant chemotherapy are postulated to be important variables in the outcome for patients with operable breast cancer. The Cancer and Leukemia Group B study 8541 examined the effects of adjuvant treatment using conventional-range dose and dose intensity in female patients with stage II (axillary lymph node-positive) breast cancer. METHODS: Within 6 weeks of surgery (radical mastectomy, modified radical mastectomy, or lumpectomy), 1550 patients with unilateral breast cancer were randomly assigned to one of three treatment arms: high-, moderate-, or low-dose intensity. The patients received cyclophosphamide, doxorubicin, and 5-fluorouracil on day 1 of each chemotherapy cycle, with 5-fluorouracil administration repeated on day 8. The high-dose arm had twice the dose intensity and twice the drug dose as the low-dose arm. The moderate-dose arm had two thirds the dose intensity as the high-dose arm but the same total drug dose. Disease-free survival and overall survival were primary end points of the study. RESULTS: At a median follow-up of 9 years, disease-free survival and overall survival for patients on the moderate- and high-dose arms are superior to the corresponding survival measures for patients on the low-dose arm (two-sided P<.0001 and two-sided P = .004, respectively), with no difference in disease-free or overall survival between the moderate- and the high-dose arms. At 5 years, overall survival (average +/- standard error) is 79% +/- 2% for patients on the high-dose arm, 77% +/- 2% for the patients on the moderate-dose arm, and 72% +/- 2% for patients on the low-dose arm; disease-free survival is 66% +/- 2%, 61% +/- 2%, and 56% +/- 2%, respectively. CONCLUSION: Within the conventional dose range for this chemotherapy regimen, a higher dose is associated with better disease-free survival and overall survival.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

Thoracic manifestations of breast cancer and its therapy.

Breast cancer is the second most common cause of cancer-related death in women. In most patients, imaging demonstrates thoracic changes resulting from either treatment, complications of treatment, or tumor recurrence or metastasis. The postsurgical imaging appearance of the chest wall depends on the surgical method used (radical mastectomy, modified radical mastectomy, breast-conserving surgery, breast reconstruction). The most common surgery-related complication is seroma. Radiation therapy frequently causes radiation pneumonitis, which occurs approximately 4-12 weeks after the completion of therapy and is characteristically limited to the field of irradiation. Chemotherapy-related complications include cardiotoxicity, pneumonitis, and infection. Ultrasonography and computed tomography are more sensitive than physical examination for detecting local and regional recurrence. The thorax is a common site of metastasis, which may affect the lymph nodes, bone, lung, pleura, or heart and pericardium. Bone metastasis is usually evaluated with bone scintigraphy and may cause spinal cord compression, a serious complication that requires early diagnosis. Intrapulmonary metastasis may manifest as single or multiple pulmonary nodules, airspace pattern metastasis, lymphangitic metastasis, or endobronchial metastasis. Pleural metastasis usually manifests as pleural effusion, with or without a pleural mass. Familiarity with the spectrum of radiologic findings in breast cancer patients allows accurate image interpretation and correct diagnosis.

Adult↗
PubMed1996

Cancer of the male breast: a review.

A review of 20 cases of male breast cancer in 17 patients from 1959 to 1990 was performed. The median age at presentation was 53.3 years (range: 29 to 79). At the time of diagnosis, 30% (6) patients were stage I, 65% (13) stage II, and 5% (1) stage IV. Surgery was the initial form of therapy in all cases either as a radical mastectomy, modified radical mastectomy, or total mastectomy. The median disease-free survival was 4.8 years with a 5-year disease-free survival of 41%, and with a 5-year overall survival of 47%. Seven patients are alive with no evidence of disease, two are alive with disease, five have died of disease, and two died of other causes. Estrogen receptor (ER) and progesterone receptor (PR) assays were performed on the tumors of 10 patients, with 80% being ER positive and 70% PR positive. The median disease-free survival for ER positive patients was 6 months with a 5-year disease-free survival of 12.5%. The overall median survival for this group was 2.9 years with an overall 5-year survival of 25%. In this review there was a high percentage of patients who were ER positive. The positive receptor status had value in predicting decreased survival.

Adult↗
PubMed1992

Comparison of pain, motion, and edema after modified radical mastectomy vs. local excision with axillary dissection and radiation.

Recent data suggest that prognosis is similar for women with primary breast cancer whether they receive modified radical mastectomy (MRM) or local excision and axillary dissection with radiation (XRT). The effects of either of these treatments on arm mobility, pain, or edema have not been compared. To assess the impact of MRM or XRT on mobility, pain, or edema, we evaluated patients treated in a prospective randomized trial designed to assess prognosis following MRM or XRT. All were provided a standardized physical therapy program including arm mobilization, shoulder strengthening, prevention and treatment of upper extremity edema, and education about arm function. Patients were evaluated for chest wall pain, arm motion, muscle strength, and edema as determined by circumferential measurements at the wrist, forearm, and arm. Evaluations were performed preoperatively and at yearly anniversaries of their surgery. Women receiving XRT had more chest wall tenderness at 1 and 2 years after surgery than those receiving MRM (p2 less than 0.0001 and p2 = 0.0007 respectively). Those receiving MRM were slower to reach their preoperative range of motion (ROM) (p2 = 0.043). Incidence of muscle weakness was similar in both groups. The few patients with local recurrence of tumor had more upper extremity edema than those who did not recur (p2 = 0.085) at 1 year and (p2 = 0.02) at 2 years. In patients who did not develop local recurrence, those who had received XRT had greater but nonsignificant increases in upper extremity circumferential measures compared with those receiving MRM at any anniversary evaluation. Patients receiving MRM and XRT are likely to have some differences in functional outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Breast Neoplasms↗
PubMed1975

Modified radical mastectomy with preservation of the pectoralis major muscle.

A new technique of modified radical mastectomy for early breast cancer was devised with an express purpose of preserving pectoralis major muscle but still enabling radical removal of the regional lymphnodes. The pectoralis major muscle was transected at its midportion to expose the thoracic wall for radical dissection of axillar and subclavicular lymphnodes followed by resuturing of the muscle to preserve its continuity. The parasternal nodes can also be dissected if necessary. The pectoralis minor muscle is either resected or preserved. This procedure should be applied mainly in T1N0 and T1N1a (Stage I in the TNM staging system) which seems recently to be increasing rapidly in number and for which the radical mastectomy with resection of pectoralis major muscle is thought to be too excessive. The procedure proposed in the present communication offers advantage not only in functional but also cosmetic aspect by preserving the pectoralis major muscle while the radicality of the operation is retained. Although the number of cases thus treated is limited and the long-term follow up with survival rate is not yet available, the procedure seems to be of considerable value in selected patients.

Adult↗