SEARCH · PubMed Health

Results for “Mastectomy, Modified Radical”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 127 records · Page 7Linked to original sources

PubMedDate not supplied

Breast conserving treatment versus modified radical mastectomy in Japanese patients with operable breast cancer.

From January, 1988 to October, 1995, 96 patients with operable breast cancer were treated by breast conserving treatment (BCT) including wide excision and axillary dissection followed by breast radiation. During the same period, 188 patients were treated by modified radical mastectomy (MRM) with or without breast reconstruction. In order to compare the survival of BCT and MRM groups, univariate and multivariate analyses were performed in this retrospective study. Univariate analysis revealed that the 5-year survival rates in the BCT and MRM groups were 97% +/- 2% and 87% +/- 3%, respectively (p < 0.05 with the Cox-Mantel test). However, the baseline variables were different between the groups. The adjusted Cox regression analysis revealed that the results of BCT were almost equivalent with those of MRM. Moreover, no breast recurrence was found in the BCT group. Therefore, it is suggested that our technique of BCT is as effective as modified radical mastectomy in treating operable breast cancer in Japanese patients.

Adult↗

PubMed1982

Modified radical mastectomy with immediate breast reconstruction.

Surgery for breast cancer continues to evolve. Less radical procedures and increasing concern about appearance and rehabilitation are now the trend. Such considerations prompted a detailed anatomic study and review of the location and course of the medial and lateral pectoral nerves, the development of a technique for immediate reconstruction of the breast during modified radical mastectomy that protects the innervation of the pectoral muscles and incorporates them in the construction of a submuscular pocket to receive a silicone breast prosthesis, and the administration of low doses of heparin sodium to prevent necrosis of ischemic breast flaps. Fifty immediate reconstructions of the breast after modified radical mastectomy were performed in 48 women with carcinoma of the breast. We believe this procedure greatly enhances rehabilitation and quality of life without diminishing the ability to diagnose or treat recurrent disease.

Adult↗

PubMed2000

Postoperative intramuscular dextromethorphan injection provides pain relief and decreases opioid requirement after modified radical mastectomy.

BACKGROUND: Narcotics are still the therapeutic mainstay for postoperative pain relief. However, many unwanted side effects are accompanied. NMDA antagonists have been demonstrated to produce analgesic and antihyperalgesic effects, moreover, to possess potentiated effect of narcotics on postoperative pain management. AIMS: To examine whether postoperative dextromethorphan (DM), an antitussive and also an NMDA antagonist, intramuscular injection (I.M.) reduced pain and analgesic requirement after modified radical mastectomy (MRM). METHODS: Sixty-one patients scheduled for MRM were included and randomly allocated into two groups. For the control group (n=31), patients received chlorpheniramine maleate (CPM, 20 mg) I.M., while in the DM group (n = 30), 40 mg DM containing 20 mg CPM (I.M.) was given at the end of surgery. Meperidine (1 mg/kg, I.M.) was prescribed for postoperative pain relief, if ask. The time to first meperidine injection, total meperidine consumption, worst pain score, bed-rest time, and meperidine-related side effects were recorded for 48 hours postoperation. RESULTS: A longer time to first meperidine injection (20.3 +/- 1.4 vs 1.5 +/- 0.2 hr, p < 0.001) and lower meperidine consumption (10.7 +/- 4.0 vs 70.7 +/- 8.9 mg, p < 0.001) were observed in the DM group than the control group. The average bed rest time was significantly shorter in the DM group than in the control group (18.9 +/- 1.5 vs 23.4 +/- 1.6 hr, p < 0.001). The number of patients who required meperidine injection (6 vs 27, p < 0.005) and meperidine-related side effects were significantly lower in the DM group than in the control group (1 vs 7, p < 0.025). No difference was noted in worst VAS pain score between the DM and the study groups. CONCLUSION: Postoperative DM I.M. injection provided an analgesic effect and reduced meperidine requirement after MRM.

Analgesics, Opioid↗

PubMed1992

[Attempt for modified radical mastectomy in the treatment of early breast cancer].

Until five years ago the Aichi Cancer Center had adopted the standard radical mastectomy where breast, major and minor pectoral muscles, and axillary adipose tissues were resected en bloc. In case tumor was found at the inner half or the center of the breast, parasternal lymph node dissection was concomitantly carried out. Recently, however, we begin to perform Auchincloss by which major and minor pectoral muscles can be conserved, as an attempt for modified radical mastectomy. In some cases, furthermore, breast conserving operation is made. The reasons why we changed the operation methods are: 1) Due to the advancement of diagnostic imaging and widespread self examination, percentage of early breast cancer has considerably increased. 2) Postoperative adjuvant therapy, especially adjuvant endocrine therapy, has remarkably progressed.

Breast Neoplasms↗

PubMed1981

A comparison of the psychological effects of breast-saving procedures with the modified radical mastectomy.

Twenty women who underwent conservative surgical treatment of their breast cancer were compared with 20 women who underwent modified radical mastectomies on several indices of body image and psychological adjustment. The women were matched by pairs in terms of age and time postsurgery, and were group matched with respect to marital status. Women who underwent conservative surgical procedures showed significantly greater intactness of their external body boundaries, and significantly less change and weighted change in overall body satisfaction than women in the modified radical group. There were no significant differences between the groups with respect to body anxiety, general psychological adjustment, or marital satisfaction. The results with respect to body boundary and body satisfaction were interpreted to be the result of the less intrusive surgical procedures used to treat the breast cancer. Since body anxiety did not appear to be affected differentially by the two procedures, it may be that women in both groups were highly concerned about their bodies as a result of having had cancer. It was suggested that there was no difference in the psychological adjustment of the two groups because the women in the modified radical group were representative of that population which adjusts well to surgery. Finally, it was concluded that marital satisfaction is stable regardless of the surgical procedure undergone to treat the breast cancer.

Analysis of Variance↗

PubMed1981

Modified radical mastectomy with immediate reconstruction for carcinoma of the breast.

Fifty patients undergoing immediate reconstruction of the breast following modified radical mastectomy for carcinoma were characterized by their clinical findings and the pathologic features of their tumors. Evidence of nipple--areolar involvement by tumor was noted in five patients. This high incidence mitigates against nipple--areolar transplantation. In ten patients the breast contained multifocal tumor or intraductal carcinoma away from the primary tumor, thus emphasizing the importance of careful evaluation of the total tissue specimens. Four patients have had recurrence of tumor. The detection of the recurrence was not hindered by the presence of the prosthesis. In these four patients immediate reconstruction of the breast did not appear to adversely affect the natural history of the breast cancer. We suggest that when appropriate and thorough surgical extirpation followed by reconstruction is undertaken as a team effort among the general and plastic surgeons, pathologist and clinical psychologist, the optimal clinical and cosmetic results may be achieved. However, conclusive statements regarding the long-term implications of immediate reconstruction awaits additional follow-up.

Adult↗

PubMedDate not supplied

Effect of fibrin glue on lymphatic drainage and on drain removal time after modified radical mastectomy: a prospective randomized study.

Seroma formation is a frequently occurring complication in patients operated on because of breast cancer. This complication can be the cause of flap necrosis, can lead to infection, and can prolong the hospital stay. It can also cause a delay in chemotherapy and radiotherapy. In order to prevent seroma formation, various methods such as external compression dressings, immobilization of the arm, sclerotherapy, and suction drainage have been used, without much success. In animal models and some clinical studies, it has been stated that fibrin glue reduces seroma formation, and these statements generated high expectations. For this reason, a prospective study was planned to test this in patients who underwent modified radical mastectomy (MRM) because of breast cancer. Of the 54 patients studied, 27 patients had fibrin glue (4 ml) applied to wound surfaces and under the flap (study group); the remaining 27 patients were the control group. Daily drainage volumes, total amount of drainage, drain removal time, and seroma formation were recorded and compared between the two groups. The first-day drainage was significantly lower in the study group (p<0.05, Student's t-test). There were no significant differences in daily drainage volumes, drain removal time, seroma formation frequency, and the number of seromas between the two groups (p>0.05). In conclusion; fibrin glue application had no significant benefit on axillary lymphatic drainage, drain removal time, or seroma formation.

Aged↗

PubMedDate not supplied

[Modified radical mastectomy. Experience of the Institut J. Bordet (author's transl)].

The authors report the results of a homogeneous series of 319 modified radical mastectomies where both pectoralis muscles are respected, in the treatment of breast cancer. Operative mortality is nill and morbidity is low. Persistant lymphedema of the arm is not marked. The frequency of axillary nodes is 64%. Local recurrences occur in 12% of cases. Total 5 year survival was 50.1%. It was 89% for stage I, 57.3% for stage II and 43.7% for stage 222. It was 61.5% if there were no involved nodes, 63.9% when 1 to 3 nodes were involved and 32% when 4 or more nodes were involved. The authors recommend this type of operation of tumors of state II and III as the 5 year survival is identical to that of other techniques, as morbidity and mortality are low and distant sequellae are unimportant.

Adult↗

PubMed2003

Treatment of operable breast cancer in the elderly: a randomised clinical trial EORTC 10851 comparing tamoxifen alone with modified radical mastectomy.

For treatment of early breast cancer in older women, little evidence is available from randomised trials. We conducted a randomised trial comparing modified radical mastectomy (MRM) with tamoxifen (TAM) as the sole initial therapy in 164 patients aged >/=70 years with operable breast cancer. 82 were treated by MRM and 82 with TAM. Survival curves were estimated using the Kaplan-Meier method: multivariate analyses were performed using the Cox's proportional hazards model. Endpoints included survival, time to first relapse or progression, loco-regional progression, time to distant progression and progression-free survival. After a median follow-up of approximately 10 years, there was a significantly decreased time to progression in the TAM only group (logrank P<0.0001) and significantly shorter time to local progression within the TAM group (logrank P<0.0001). Overall survival of the two groups was similar. The results indicate that tamoxifen alone leads to an unacceptably high rate of local progression or relapse.

Aged↗

PubMed2000

Cost analysis of breast conservation surgery compared with modified radical mastectomy with and without reconstruction.

BACKGROUND: Breast conservation surgery (BCS), consisting of lumpectomy, axillary lymph node dissection, and radiation therapy, is as effective as modified radical mastectomy (MRM) for the treatment of early stage breast cancer. The costs of these treatment options have not been adequately addressed in the current era of increasing utilization of BCS and breast reconstruction. The purpose of this study is to determine differences in treatment costs among BCS, MRM alone, and MRM with reconstruction. METHODS: Patients with stage I and II breast cancer receiving inpatient treatment at a private university-affiliated hospital between January 1996 and July 1997 were analyzed (n = 230). Charges were determined as follows: inpatient and radiotherapy charges from the hospital billing department, surgeon fees from group practice billing codes, and radiotherapy physician fees from the radiation oncology group practice. Inpatient length of stay was obtained from hospital medical records. RESULTS: Average hospital inpatient charge for BCS was $4,748 (n = 74), $6,280 for MRM alone (P <0.001, n = 132), and $11,946 for MRM with reconstruction (P <0.001, n = 24). Surgeons' fees for BCS were $2,840, $3,500 for MRM alone, and $10,774 for MRM with reconstruction. The average radiotherapy charge was $18,742. Average length of stay was 1.03 days for BCS, 2.44 days for MRM alone (P <0.001), and 3.71 days for MRM with reconstruction (P <0. 001). Average total cost of BCS ($26,330) was significantly greater than the average total cost of either MRM alone ($9,780, P <0.001) or MRM with reconstruction ($22,720, P <0.001). CONCLUSIONS: BCS is more expensive than MRM with or without reconstruction. It is the addition of radiotherapy that results in the higher total cost of CS.

Adult↗

PubMedDate not supplied

[Analysis of loco-regional control rate, metastatic remission and survival in 178 breast cancer patients treated by radical modified mastectomy and post-operative irradiation (author's transl)].

178 cases of post-operative irradiation for breast cancer (145 T1, T2, T3 and 33 T4) are analyzed. According to the surgical procedure there are 146 cases of radical modified mastectomy (Patey) and 32 cases of radical mastectomy (Halsted). The axillary status reveals 50% of involved nodes, but radiotherapy has been systematic on chest wall and supra-clavicular, parasternal, axillary lymph nodes areas. Loco-regional failures are only situated on chest wall (3,9%) and in the supraclavicular area (1,7%). The five year actuarial rate of locoregional control is 93% and 98% if we exclude 7 locoregional failures contemporaneous or consecutive to a metastatic evolution. The five year actuarial rate of metastatic remission for patients with negative axillary nodes (N-) is 83% against 55% for N+ (p < 0,001). The five year actuarial survival rate is 92% (N-) and 64% (N+) (p < 0,001). We discuss about indications of selective irradiation of chest wall and parasternal area for patients with negative axillary nodes and also about post-operative immuno-suppression, and chronology of chemotherapy.

Adult↗

PubMed1983

[The range of removing fatty tissue and lymph nodes by a modified radical mastectomy with preservation of the major and minor pectoral muscles].

Thirty five patients with mammary carcinoma were selected and completeness of lymph node dissection in modified radical mastectomy (MRM) was evaluated by two step procedures, i.e., MRM was performed at the first step and then standard radical mastectomy was added immediately following the first step. Complete axillary dissection was possible in all the cases with MRM, however, in some cases, excision of the other areas was insufficient, especially in an obese patient. There were number of cases in which the number of subclavicular lymph nodes and Halsted lymph nodes felt by palpation during the MRM operation did not correspond to the actual number of excised lymph nodes. MRM may be indicated in those cases where no metastasis is observed in the histological examination of the frozen section of axillary lymph nodes during operation and/or where there is no recognizable swelling of axillary lymph nodes under palpation when the size of breast lump is less than 2 cm in diameter.

Adipose Tissue↗

PubMedDate not supplied

[Reduction of lymphatic drainage posterior to modified radical mastectomy with the application of fibrin glue].

OBJECTIVE: Our objective was to investigate the effectiveness of fibrin glue to reduce hemato-lymphatic fluid production after modified radical mastectomy (MRM) in women with breast cancer. MATERIAL AND METHODS: A total of 43 women treated surgically were randomly assigned to receive 10 ml of fibrin glue at the end of the breast resection plus closed suction drains (n = 22), or drain system only as a control group (n = 23). Outcome variables were fluid collected in the drainage system measured each 24 h. Drains were removed when a 50 ml output per day was obtained. Seroma formation and flap complications were also investigated. RESULTS: The average age was 48.36 +/- 8.9 years for the study group and 52.87 +/- 9.74 years for the control group (p = 0.11). Body mass index (BMI) ranged between 22 and 35 kg/m2: 28.1 +/- 2.7 vs. 29.92 +/- 4.0 kg/m2 (p = 0.27). A reduction of the fluid drained was observed from the first postoperative day in the study group in contrast with the control (174.55 +/- 64.69 vs. 281.22 +/- 116.91, p = 0.001). A correlation between the BMI and the exposed surgical area was also statistically significant (p < 0.002), as well as the day the drains were extracted (p < 0.05). The incidence of seroma formation was 9% in the study group and 34.78% in the control, a statistically significant finding (p < 0.05). CONCLUSIONS: Fibrin glue locally applied to the surgical wound under the flap and axilla significantly reduced the amount and duration of lymphatic fluid produced after MRM with axillary dissection. Also, a significant reduction in the incidence of seromas was observed.

Breast Neoplasms↗

PubMed1984

Immediate breast reconstruction following modified radical mastectomy.

Reducing postoperative psychological morbidity is an important goal in breast cancer patient care; a multidisciplinary approach is crucial in order to select candidates for immediate breast reconstruction. There is no oncologic reason for a delay after a modified radical mastectomy. Our procedure allows immediate breast reconstruction without significantly prolonging operative time and hospitalization. Complete muscular coverage of the implant and shifting of the redundant skin to the mastectomy site minimize the risk of postoperative complications and provide a natural looking reconstructed breast. Delayed reconstruction of the nipple-areolar complex performed at the time of contralateral mammaplasty ensures satisfactory breast symmetry. Satisfactory reconstruction of the nipple-areolar complex is achieved without additional scars by means of grafts taken from the opposite breast or utilizing the cryopreserved nipple and areola.

Breast↗

PubMed2001

Continuous thoracic epidural anesthesia with 0.2% ropivacaine versus general anesthesia for perioperative management of modified radical mastectomy.

We evaluated in this prospective study the effectiveness of continuous thoracic epidural anesthesia (TEA) and postoperative analgesia with ropivacaine and compared it with general anesthesia (GA) and opioids for pain relief, side effects, postanesthesia recovery, and hospital discharge after modified radical mastectomy. Sixty ASA physical status II and III patients undergoing mastectomy were randomly assigned to two study groups of 30 patients each. In the TEA group, an epidural catheter was inserted at T6-7, and 5--10 mL of 0.2% ropivacaine was injected to maintain anesthesia and to continuously administer adequate analgesia for 48 h. GA was induced with IV 1--2 mg of midazolam or 50--100 microg/mL of fentanyl followed by 50--150 mg of propofol and was maintained with sevoflurane and 50% N(2)O in oxygen. The Aldrete score system was used to evaluate postanesthesia recovery, a verbal rating scale was used for assessment of pain intensity, and a postanesthesia discharge scoring system was used for discharge home. The demographic data and side effects (except for nausea and vomiting) (GA 43%, TEA 10%, P = 0.0074) and discharge home were similar in both groups. However, the number of patients ready for discharge from the recovery room during the first postanesthesia hour (Aldrete score of 10) was significantly larger after TEA (80%) than after GA (33%) (P = 0.0006). GA patients experienced significantly more (P < 0.001) substantial pain than TEA patients on Day 0 (70%), Day 1 (53%), and Day 2 (27%) after the surgery. Patient satisfaction was greater with TEA (70%) than with GA (30%) (P < 0.001). We conclude that TEA with ropivacaine provides better postoperative pain relief and less nausea and vomiting, facilitates postanesthesia recovery, and gives greater patient satisfaction than GA.

Adult↗

PubMed2003

Treatment of operable breast cancer in the elderly: a randomised clinical trial EORTC 10850 comparing modified radical mastectomy with tumorectomy plus tamoxifen.

We have examined the outcome of older patients with operable breast cancer treated in a randomised trial by either standard surgery or less extensive surgery and tamoxifen. There were 236 participants aged >/=70 years, randomised to either modified radical mastectomy MRM (n=120) or wide local excision (WLE) and tamoxifen (T) 20 mg daily (n=116). Survival curves were estimated using the Kaplan-Meier method and multivariate analyses were performed using Cox's proportional hazards model. Endpoints were survival and time to first relapse or progression, loco-regional progression, time to distant progression and progression-free survival. No significant difference was seen in terms of progression-free survival, but there were significantly more loco-regional relapses in the WLE+T group. In contrast, there were more distant metastases in the MRM group, but with a similar overall survival in both groups. The results of this trial give cautious support for the use of WLE+T for selected older women.

Age Factors↗

PubMed1995

Comparison of Modified Radical Mastectomy with Quadrantectomy, Axillary Dissection, and Radiation Therapy in Early Breast Cancer in Japaness Women.

From January 1987 to December 1993, Stage I (T1N0M0) breast cancers were treated by quadrantectomy with axillary lymph node dissection plus radiation therapy (QUART) in 57 cases and by modified radical mastectomy (MRM) in 57 cases. The results for these two treatment groups were compared retrospectively. Booster irradiation of 10 Gy to the tumor bed was given to 1 of 5 cases with a positive resection margin. The remaining 56 cases received 50 Gy lineac X-ray to the ipsilateral breast. Systemic adjuvant therapy, tamoxifen and /or 5-FU derivatives p.o., were given to the majority of cases in both groups. There were no significant differences between the two groups with regard to the patient background; ie, age, tumor size, pathological node status, histology and estrogen receptor status. During the follow-up period of 12 to 89 months (median 55 months) in the QUART group, no local recurrence was observed and only 1 case of bone metastasis occurred. In the MRM group, recurrence occurred in 4 cases during the follow-up period of 12 to 95 months (median 52 months). These consisted of 2 cases of regional lymph node recurrence and 2 cases of lung metastases. The differences in the disease-free survival rate and the overall survival rate between the two groups were not significant. In the QUART group, mild radiation pneumonitis and mild telangiectasia in the breast skin were observed in 2 cases(3.5%) and 1 case, respectively. Mild arm edema was observed in 4 cases (7%) in each group. These results demonstrated that QUART was as effective as MRM in treating T1M0M0 breast carcinoma in Japanese women.

Journal Article↗

PubMed1987

Adjuvant chemotherapy after conservative surgery plus irradiation versus modified radical mastectomy. Analysis of drug dosing and toxicity.

In a cohort of 764 evaluable patients with primary breast cancer, we have compared the ability to deliver full doses of adjuvant chemotherapy in two patient groups: one undergoing conservative breast surgery plus irradiation and the other having modified radical mastectomy as primary treatment for the cancer. We have also analyzed the toxicities of the concurrent radiation and chemotherapy. The group having irradiation had significantly more moderate leucopenia, which caused a short delay (median, three weeks) in the overall time necessary to complete the planned chemotherapy. However, among those patients who completed the planned chemotherapy cycles, the fraction who received more than 85 percent average drug doses was 96 percent or higher in all but one small subgroup. Interaction between the irradiation and chemotherapy caused mild breast skin reactions in 42 percent of patients so analyzed and worse reactions in 12 percent. When follow-up tracings were performed, mild electrocardiogram abnormalities occurred in 19 percent of patients, apparently because of the irradiation. We conclude that intravenous adjuvant chemotherapy, as administered in this study, can be delivered as intensely with conservative primary treatment as after mastectomy and that toxicity is mild, rarely requiring intervention or treatment discontinuation.

Antineoplastic Combined Chemotherapy Protocols↗