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The Surgical Clinics of North America Oct 2021Breast cancer surgery is associated with low rates of surgical morbidity. Postoperative complications related to breast surgery include seroma, infection, hematoma,... (Review)
Review
Breast cancer surgery is associated with low rates of surgical morbidity. Postoperative complications related to breast surgery include seroma, infection, hematoma, mastectomy flap necrosis, wound dehiscence, persistent postsurgical pain, Mondor disease, fat necrosis, reduced tactile sensation after mastectomy, and venous thromboembolism. Postoperative complications related to axillary surgery include seroma, infection, lymphedema, nerve injury, and reduced shoulder/arm mobility. The overall rate of complication related to axilla surgery may be confounded by the type of breast surgery performed. The management of postoperative complications related to oncologic breast and axillary surgery independent of reconstruction is reviewed here.
Topics: Breast Neoplasms; Female; Humans; Mastectomy; Postoperative Complications
PubMed: 34537147
DOI: 10.1016/j.suc.2021.06.014 -
Breast (Edinburgh, Scotland) Aug 2017Skin-sparing (SSM) and nipple-sparing (NSM) mastectomies are relatively new conservative surgical approaches to breast cancer. In SSM most of the breast skin is... (Review)
Review
Skin-sparing (SSM) and nipple-sparing (NSM) mastectomies are relatively new conservative surgical approaches to breast cancer. In SSM most of the breast skin is conserved to create a pocket that facilitates immediate breast reconstruction with implant or autologous graft to achieve a quality cosmetic outcome. NSM is closely similar except that the nipple-areola complex (NAC) is also conserved. Meta-analyses indicate that outcomes for SSM and NSM do not differ from those for non-conservative mastectomies. Recurrence rates in the NAC after NSM are acceptably low (0-3.7%). Other studies indicate that NSM is associated with high patient satisfaction and good psychological adjustment. Indications are carcinoma or DCIS that require mastectomy (including after neoadjuvant chemotherapy). NSM is also suitable for women undergoing risk-reducing bilateral mastectomy. Tumor not less than 2 cm from the NAC is recommended, but may be less important than no evidence of nipple involvement on mandatory intraoperative nipple margin assessment. A positive margin is an absolute contraindication for nipple preservation. Other contraindications are microcalcifications close to the subareolar region and a positive nipple discharge. Complication rates are similar to those for other types of post-mastectomy reconstructions. The main complication of NSM is NAC necrosis, however as surgeon experience matures, frequency declines. Factors associated with complications are voluminous breast, ptosis, smoking, obesity, and radiotherapy. Since the access incision is small, breast tissue may be left behind, so only experienced breast surgeons should do these operations in close collaboration with the plastic surgeon. For breast cancer patients requiring mastectomy, NSM should be the option of choice.
Topics: Breast Neoplasms; Carcinoma, Ductal, Breast; Carcinoma, Intraductal, Noninfiltrating; Contraindications, Procedure; Female; Humans; Mastectomy; Nipples; Organ Sparing Treatments; Patient Selection; Prophylactic Mastectomy; Skin
PubMed: 28673535
DOI: 10.1016/j.breast.2017.06.034 -
International Journal of Environmental... Jun 2018European statistics confirm a rise in breast cancer among contemporary women. Those suffering from cancer and undergoing a surgery (mastectomy) are undoubtedly... (Review)
Review
European statistics confirm a rise in breast cancer among contemporary women. Those suffering from cancer and undergoing a surgery (mastectomy) are undoubtedly considered to be in difficult situations. The range of the numerous negative and/or positive emotions, thoughts, and behaviours depend on many psychological factors such as psychological resilience. The authors are currently drawing a report on their own studies where they are trying to determine factors that protect body image resilience in women suffering from breast cancer after mastectomies. The research group consisted of 120 women after a short (up to 2 years) or a long (over 2 years) duration having elapsed since their mastectomy. The results of the research groups show that psychological resilience is a significant protecting factor for the body image that prevents the excessive development of negative self-esteem in post-mastectomy women. Female patients ought to be provided aid in the short time immediately after the procedure and afterwards, when they are less capable of tolerating negative emotions. In order to significantly improve the general body image resilience to emotional and cognitive distortions in post-mastectomy women who experienced breast cancer, it is recommended that psychological interventions (from psychoeducation to psychological assistance and specialist psychotherapy) are conducted systematically throughout the course of treatment.
Topics: Adult; Body Image; Breast Neoplasms; Female; Humans; Mastectomy; Middle Aged; Protective Factors; Resilience, Psychological; Time Factors
PubMed: 29874874
DOI: 10.3390/ijerph15061181 -
Breast Cancer (Tokyo, Japan) Jul 2020The present review evaluated health-related quality of life (HR-QoL) outcomes in surgical breast cancer survivors who received breast reconstruction (BR),... (Comparative Study)
Comparative Study Meta-Analysis
Health-related quality of life following breast reconstruction compared to total mastectomy and breast-conserving surgery among breast cancer survivors: a systematic review and meta-analysis.
The present review evaluated health-related quality of life (HR-QoL) outcomes in surgical breast cancer survivors who received breast reconstruction (BR), breast-conservation surgery (BCS) or mastectomy (M), and whether HR-QoL domains across generic and disease/surgery-specific questionnaires are compatible. Six electronic databases were searched for appropriate observational studies. Standardized scores for different HR-QoL domains in the BR, BCS, and M treatment groups were extracted from each study for the purpose of a meta-analysis. Using Stata version 14.0, a random-effects meta-analysis model was adopted for each outcome variable to estimate the effect size, 95% CI-confidence intervals, and statistical significance. Sixteen of the 18 eligible studies with BR (n = 1474) and BCS (n = 2612) or M (n = 1458) groups were included in the meta-analysis. The BR group exhibited a better physical health (k = 12; 0.1, 95% CI 0.04, 0.24) and body image (k = 12; 0.50, 95% CI 0.10, 0.89) than the M group. However, the two groups exhibited comparable social health (k = 13; 0.1, 95% CI -0.07, 0.37), emotional health (k = 13; -0.08, 95% CI - 0.41, 0.25), global health (k = 7; 0.1, 95% CI - 0.01, 0.27), and sexual health (k =11; 0.2, 95% CI - 0.02,0.57). There was no clear evidence of the superiority of BR to BCS for all the six domains. These results suggest that HR-QoL outcomes in BR and BCS groups are better than the M group. Therefore, women opting for BR or BCS are likely to report fairly better HR-QoL outcomes than M. However, due to the significant heterogeneity observed in most BR versus BCS outcomes, developing a unified questionnaire incorporating both breast/surgery-specific and generic HR-QoL domains is warranted.
Topics: Body Image; Breast; Breast Neoplasms; Cancer Survivors; Female; Humans; Mammaplasty; Mastectomy, Segmental; Mastectomy, Simple; Quality of Life; Surveys and Questionnaires
PubMed: 32162181
DOI: 10.1007/s12282-020-01076-1 -
Minerva Ginecologica Oct 2016Mastectomy rates have significantly increased over the last decades, likely due to the rising trend of risk-reducing mastectomies (RRM) in the treatment and prevention... (Review)
Review
Mastectomy rates have significantly increased over the last decades, likely due to the rising trend of risk-reducing mastectomies (RRM) in the treatment and prevention of breast cancer. Growing evidence suggests that aggressive risk-reducing surgical strategies are only justified in high-risk breast cancer situations. Notably, in this selected cohort of women, prophylactic mastectomies offer evident benefit for local and contralateral disease control, and may also provide a survival benefit. Nevertheless, the extent of the increasing frequency of this operation is not explained by the broadening of the medical indications alone. Here we analyze the current evidence regarding RRM, its clinical practice, and possible explanations for the rising phenomenon of aggressive surgical locoregional control strategies.
Topics: Breast Neoplasms; Female; Humans; Mastectomy; Risk Factors; Survival
PubMed: 26785281
DOI: No ID Found -
The Surgical Clinics of North America Feb 2023As breast oncologic surgical procedures and approaches have evolved in recent years, so have breast reconstruction techniques. Newer advances focus on expanding the... (Review)
Review
As breast oncologic surgical procedures and approaches have evolved in recent years, so have breast reconstruction techniques. Newer advances focus on expanding the options of reconstructive approaches and patient selection, optimizing quality of life, and helping improve postsurgical survivorship. These advances span from techniques to expand criteria for nipple-sparing mastectomies, optimizing and enhancing oncoplastic surgery, evolving autologous reconstruction options, and preserving and restoring sensation after mastectomy.
Topics: Humans; Female; Mastectomy; Nipples; Quality of Life; Breast Neoplasms; Mammaplasty
PubMed: 36410346
DOI: 10.1016/j.suc.2022.08.008 -
Seminars in Oncology Nursing May 2015To review immediate and delayed breast reconstructive options following surgery for high-risk or cancer-related unilateral or bilateral mastectomy and examine... (Review)
Review
OBJECTIVES
To review immediate and delayed breast reconstructive options following surgery for high-risk or cancer-related unilateral or bilateral mastectomy and examine restorative interventions to promote a positive body image and long-term survivorship.
DATA SOURCES
Review of PubMed, Scopus, and Cochran Review.
CONCLUSION
For women facing mastectomy, a consultation with a plastic/reconstructive surgeon is a first step toward recovery with restoration of a missing body part. Nursing interventions are integral to physical and psychosocial healing.
IMPLICATIONS FOR NURSING PRACTICE
An understanding of the reconstructive process can be beneficial in the care of women facing and recovering from a mastectomy. Psychological and physical issues occur whether the woman is undergoing bilateral prophylactic mastectomies for a high-risk condition or mastectomy as treatment for a malignant tumor.
Topics: Adaptation, Psychological; Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Oncology Nursing; Stress, Psychological
PubMed: 25951742
DOI: 10.1016/j.soncn.2015.02.009 -
The Surgical Clinics of North America Feb 2023New innovations aid the breast surgeon with better ability to localize tumors using wireless techniques, reduce re-excision rates by intraoperative margin evaluation and... (Review)
Review
New innovations aid the breast surgeon with better ability to localize tumors using wireless techniques, reduce re-excision rates by intraoperative margin evaluation and perform aesthetically; pleasing, and safe surgeries. In addition to improving oncological outcomes, we can continue to improve the quality of life for our patients through evolving surgeries including nerve-sparing mastectomies, robotic mastectomies, and lymphovascular surgeries (LYMPHA). Our article reviews current and evolving techniques and technology that all breast surgeons should add to his or her armamentarium to provide optimal surgical care.
Topics: Female; Humans; Mammaplasty; Margins of Excision; Mastectomy; Quality of Life; Surgeons
PubMed: 36410344
DOI: 10.1016/j.suc.2022.08.013 -
Veterinary Surgery : VS Jan 2021To describe the outcome of small ruminants treated with unilateral and bilateral mastectomy by using three surgical techniques.
OBJECTIVE
To describe the outcome of small ruminants treated with unilateral and bilateral mastectomy by using three surgical techniques.
STUDY DESIGN
Retrospective study.
ANIMALS
Twenty-five small ruminants (24 goats and one sheep).
METHODS
Medical records of animals that underwent mastectomy between November 1, 2002, and May 1, 2019, were reviewed. Follow-up information was obtained by telephone questionnaire with owners. Signalment, surgical data, intraoperative and postoperative complications, bacterial culture results, histopathologic diagnoses, short- and long-term outcomes, and other procedures performed were recorded.
RESULT
Procedures consisted of six unilateral (with an elliptical incision) and 19 total (with inverted cloverleaf or elliptical skin incisions) mastectomies. All animals survived to hospital discharge. Intraoperative complications included contamination of the surgical site with mammary-gland fluid, hemorrhage, and difficulty dissecting skin from the mammary gland. Postoperative complications included seroma formation (7/25), surgical-site infection (5/25), and dehiscence of the skin incision (3/25). Mammary neoplasia was diagnosed in seven of 15 animals with histopathologic examination. No association was detected between surgical technique, diagnosis of neoplasia, and long-term outcome. Overall, client satisfaction was high.
CONCLUSION
Mastectomy was effective at removing abnormally enlarged udders secondary to chronic mastitis, inappropriate lactation, idiopathic causes, or neoplasia and was associated with a low rate of complications in small ruminants.
CLINICAL SIGNIFICANCE
Unilateral mastectomy with an elliptical skin incision or total mastectomy, preferably with inverted cloverleaf skin incision, may be indicated to remove diseased mammary tissue in small ruminants and can result in long-term survival with low morbidity and cosmetically pleasing results.
Topics: Animals; Goats; Mastectomy; Mastectomy, Radical; Mastectomy, Simple; Postoperative Complications; Retrospective Studies; Sheep, Domestic
PubMed: 32870506
DOI: 10.1111/vsu.13509 -
The Surgical Clinics of North America Feb 2023Although surgery of the breast and axilla is generally well-tolerated by patients, the breast surgeon recognizes that complications can occur even when operating with... (Review)
Review
Although surgery of the breast and axilla is generally well-tolerated by patients, the breast surgeon recognizes that complications can occur even when operating with experience on the lowest risk patients. The operative repertoire ranges from breast conserving surgery, mastectomy (including skin-sparing and nipple-sparing types), to modified radical mastectomy, with each procedure carrying a different expected surgical morbidity. Patients and families who are fully informed of potential complications before their operation describe greater trust in their surgeon and are better able to co-manage complications with the surgical team, when they occur.
Topics: Humans; Female; Axilla; Breast Neoplasms; Mastectomy; Postoperative Complications; Mastectomy, Segmental
PubMed: 36410345
DOI: 10.1016/j.suc.2022.08.007