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Plastic and Reconstructive Surgery Feb 2017Although quadrantectomy and lumpectomy help diminish the psychological and physical devastation inflicted, mastectomy is still elected in 20 to 30 percent of breast...
BACKGROUND
Although quadrantectomy and lumpectomy help diminish the psychological and physical devastation inflicted, mastectomy is still elected in 20 to 30 percent of breast cancers. Although initially inciting controversy over heightened risk of local recurrences, recent studies maintain that nipple-sparing mastectomy can be used in any patient qualifying for total mastectomy and also improves aesthetic and psychologic outcomes. The manner in which mastectomy influences reconstructive implant outcomes has been documented by several groups. This report details the authors' experience performing nipple-sparing mastectomy with immediate implant-based breast reconstruction, focusing attention on patient characteristics and aspects of surgical mastectomy that influence reconstruction outcomes. The aim of the study was to examine various issues, such as surgical access, mode of tissue dissection, and flap thickness, clearly linked to development of complications and poor results.
METHODS
A retrospective study was conducted, analyzing patients with breast cancer. An external three-surgeon panel served to generate average scores for predefined parameters. Based on total scores, outcomes were designated excellent, good, moderate, or poor.
RESULTS
The authors' cohort included 1647 patients. Overall, 2023 nipple-sparing mastectomies were performed, including bilateral procedures in 376 patients. After a minimum follow-up period of 12 months, the authors' cohort was stratified by scored outcomes. Significant impact of body mass index, skin incision, flap thickness, and grade of ptosis has been demonstrated.
CONCLUSIONS
The authors' data suggest that proper patient selection and well-executed operations are mandatory to limit complications. They also indicate that aesthetic outcome is clearly dependent on surgical proficiency and some patient characteristics.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, III.
Topics: Adult; Aged; Breast Neoplasms; Female; Humans; Mastectomy; Middle Aged; Nipples; Organ Sparing Treatments; Outcome Assessment, Health Care; Retrospective Studies; Young Adult
PubMed: 28121852
DOI: 10.1097/PRS.0000000000003027 -
Same-day mastectomy and axillary lymph node dissection is safe for most patients with breast cancer.Journal of Surgical Oncology Apr 2022The aim of this study was to evaluate the safety of same-day mastectomy, with or without a sentinel node biopsy (SNB) and/or axillary lymph node dissection (ALND).
BACKGROUND AND OBJECTIVE
The aim of this study was to evaluate the safety of same-day mastectomy, with or without a sentinel node biopsy (SNB) and/or axillary lymph node dissection (ALND).
METHODS
In this retrospective study, we reviewed 913 consecutive women who underwent a simple mastectomy for breast cancer between the years 2014 and 2019 and were treated either with same-day surgery (SDS) or an overnight stay (OS) regime. We reviewed all surgical complications, any unplanned return to care (RTC) and the rehospitalization rate for 30 postoperative days.
RESULTS
A total of 259 patients (28%) were treated with SDS and 654 patients (72%) with an OS regime. There was no difference in RTC (odds ratio: 0.79 [95% confidence interval: 0.53-1.18], p = 0.26) or any major complications between the groups. None of the investigated subgroups, such as patients with previous neoadjuvant therapy, diabetes, obesity (up to a body mass index of 40 kg/m ), the American Society of Anaesthesiologist Class of 3, or elderly patients aged 75-84 years, showed an increased complication rate when treated with the SDS regime.
CONCLUSION
A same-day simple mastectomy is safe with SNB and/or ALND. It can be performed safely for most patients with stable co-morbidities.
Topics: Aged; Aged, 80 and over; Axilla; Breast Neoplasms; Female; Humans; Lymph Node Excision; Mastectomy; Neoplasm Staging; Retrospective Studies; United States
PubMed: 35050499
DOI: 10.1002/jso.26799 -
The Surgeon : Journal of the Royal... Oct 2017Practice regarding the use of post operative drains after simple mastectomy varies widely. This project aimed to establish if not using a drain lead to an increase in...
UNLABELLED
Practice regarding the use of post operative drains after simple mastectomy varies widely. This project aimed to establish if not using a drain lead to an increase in post-operative seroma formation or other complications.
METHODS
Women undergoing simple mastectomy ± sentinel node biopsy were included. Patients were allocated to drain/no drain group via operating surgeon. Data was collected retrospectively from computer based records. Drain output, length of stay, seroma formation and volume and post-operative complications were recorded.
RESULTS
There were 39 patients in the drain group and 24 patients in the no drain group. Patients did not differ significantly in terms of age, BMI or specimen weight. Seroma was more prevalent in the no drain group (62 v 83%) and required more clinic attendances for aspiration with larger volumes drained (360 vs 725 ml, p = 0.0096). There was no difference in overall complication rate. There did not appear to be a correlation between seroma formation and age, BMI or mastectomy weight.
CONCLUSIONS
The use of a drain after simple mastectomy may confer lower rates of seroma formation as well as lower overall volumes. Therefore drainless mastectomy appears to be safe but may require more post-operative intervention.
Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Drainage; Female; Humans; Length of Stay; Mastectomy; Middle Aged; Retrospective Studies; Sentinel Lymph Node Biopsy; Seroma
PubMed: 26907221
DOI: 10.1016/j.surge.2015.12.007 -
Patient Education and Counseling Dec 2017A systematic review of quantitative and qualitative studies, to describe patient satisfaction and regret associated with risk-reducing mastectomies (RRM), and the... (Review)
Review
OBJECTIVE
A systematic review of quantitative and qualitative studies, to describe patient satisfaction and regret associated with risk-reducing mastectomies (RRM), and the patient-reported factors associated with these among women at high risk of developing breast cancer.
METHODS
Studies were identified using Medline, CINAHL, Embase and PsycInfo databases (1995-2016). Data were extracted and crosschecked for accuracy. Article quality was assessed using standardised criteria.
RESULTS
Of the 1657 unique articles identified, 30 studies met the inclusion criteria (n=23 quantitative studies, n=3 qualitative studies, n=4 mixed-method studies). Studies included were cross-sectional (n=23) or retrospective (n=7). General satisfaction with RRM, decision satisfaction and aesthetic satisfaction were generally high, although some women expressed regret around their decision and dissatisfaction with their appearance. Factors associated with both patient satisfaction and regret included: post-operative complications, body image changes, psychological distress and perceived inadequacy of information.
CONCLUSION
While satisfaction with RRM was generally high, some women had regrets and expressed dissatisfaction. Future research is needed to further explore RRM, and to investigate current satisfaction trends given the ongoing improvements to surgical and clinical practice.
PRACTICE IMPLICATIONS
Offering pre-operative preparation, decisional support and continuous psychological input may help to facilitate satisfaction with this complex procedure.
Topics: Body Image; Breast Neoplasms; Decision Making; Emotions; Female; Humans; Mastectomy; Patient Reported Outcome Measures; Patient Satisfaction; Personal Satisfaction
PubMed: 28732648
DOI: 10.1016/j.pec.2017.06.032 -
Plastic and Reconstructive Surgery Jan 2019Postoperative skin necrosis in surgical patients is costly to hospitals and health care providers. Tumescent dissection technique is commonly used in mastectomy and... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Postoperative skin necrosis in surgical patients is costly to hospitals and health care providers. Tumescent dissection technique is commonly used in mastectomy and immediate breast reconstruction, as it helps reduce blood loss; however, it may increase the risk of mastectomy skin flap necrosis. In this context, the authors have conducted a systematic review of the literature to perform a meta-analysis of the relationship between tumescent technique in mastectomy with or without breast reconstruction and complication rates.
METHODS
The authors screened the PubMed (1966 to 2016), Scopus (2004 to 2016), Embase (1966 to 2016), and Web of Science (1964 to 2016) databases for relevant articles through March 30, 2017. The authors included studies on the use of tumescent technique in the context of mastectomy with or without immediate breast reconstruction. The primary outcome the authors evaluated was the rate of skin flap necrosis; the secondary outcomes were the rates of breast hematomas and infections. Because of the heterogeneity of the studies, the authors performed a meta-analysis using the random effects model.
RESULTS
After screening, the authors evaluated five studies including 3982 mastectomies. Mastectomies performed under the preoperative application of tumescent solution had statistically higher rates of skin flap necrosis overall (p = 0.03) and major (p < 0.01) and minor skin necrosis (p = 0.03). However, the rates of hematoma and infection were not correlated with the use of tumescent technique.
CONCLUSIONS
The authors' systematic review of the literature provides a better understanding of the consequences of the application of tumescent technique in mastectomy. The authors' findings suggest that tumescent technique may increase the risk of skin necrosis in mastectomy with or without breast reconstruction.
Topics: Breast Neoplasms; Dissection; Female; Humans; Mammaplasty; Mastectomy; Necrosis; Postoperative Complications; Prognosis; Risk Assessment; Skin; Treatment Outcome
PubMed: 30589774
DOI: 10.1097/PRS.0000000000005100 -
Clinical Breast Cancer Jun 2019The objective of the study was to evaluate the morbidity, mortality, and postoperative outcomes associated with simple or subcutaneous mastectomy in the management of... (Comparative Study)
Comparative Study
INTRODUCTION
The objective of the study was to evaluate the morbidity, mortality, and postoperative outcomes associated with simple or subcutaneous mastectomy in the management of prophylactic versus therapeutic resection. In this study we aimed to assess if simple or subcutaneous mastectomy for prophylaxis affects perioperative outcomes compared with resection performed for biopsy proven malignancy.
MATERIALS AND METHODS
The American College of Surgeons National Surgical Quality Improvement Program database was queried for subjects who underwent simple or subcutaneous mastectomy between 2007 and 2012. Patient demographic characteristics, comorbid conditions, and postoperative complications were analyzed.
RESULTS
Of the 30,803 patients, 30,644 (99.5%) underwent therapeutic mastectomy and 159 (0.5%) underwent prophylactic mastectomy. Subjects who underwent prophylactic surgery were more likely to be younger (45 vs. 58 years; P < .01) and white (134 [84%] vs. 20,647 [67%]; P < .01). Surgery time was significantly greater in the prophylactic group (265 vs. 166 minutes; P < .01). There was no significant difference in mortality between groups. There was a trend toward greater 30-day morbidity (15 [9%] vs. 1835 [6%]; P = .09) and occurrence of deep venous thrombosis (DVT; 2 [1%] vs. 74 [0.2%]; P = .06) in those who underwent prophylactic mastectomy. After age adjustment, the prophylactic group showed a nearly sixfold increase in DVT (odds ratio [OR], 5.77; 95% confidence interval [CI], 1.37-24.22), which persisted when controlling for surgery time (OR, 4.95; 95% CI, 1.18-20.86).
CONCLUSION
Prophylactic simple or subcutaneous mastectomy incurs significant additional 30-day postoperative morbidity related to perioperative DVT. Risk-mitigating strategies should be considered in the perioperative care of this patient population.
Topics: Breast Neoplasms; Databases, Factual; Female; Follow-Up Studies; Humans; Mastectomy; Middle Aged; Postoperative Complications; Prognosis; Quality Improvement; Retrospective Studies; Risk Factors; Venous Thrombosis
PubMed: 30876714
DOI: 10.1016/j.clbc.2019.01.008 -
Journal of Perianesthesia Nursing :... Apr 2023To summarize and analyze available evidence on perioperative accelerated rehabilitation programs for patients diagnosed with breast cancer that have had a radical... (Review)
Review
PURPOSE
To summarize and analyze available evidence on perioperative accelerated rehabilitation programs for patients diagnosed with breast cancer that have had a radical mastectomy.
DESIGN
This article is a systematic review of literature based on evidence-based methodology.
METHODS
The '6S' evidence resource pyramid model was used to systematically search a range of databases.
FINDINGS
A total of 19 articles were extracted from the literature and used in this study, including 9 clinical decisions, 4 systematic evaluations, 4 expert consensuses, and 2 guidelines. We summarized a total of 47 lines of evidence with regard to various aspects, including preoperative, intraoperative, and postoperative nursing measures.
CONCLUSIONS
In this systematic review, an evidence-based methodology was used to summarize and analyze the best suggestions for perioperative accelerated rehabilitation nursing programs for breast cancer inpatients undergoing radical mastectomy. We aimed to provide a good reference value and evidence-based guidelines for the continuous improvement and development of nursing practice for the breast cancer patient population.
Topics: Humans; Female; Breast Neoplasms; Mastectomy; Mastectomy, Radical
PubMed: 36464572
DOI: 10.1016/j.jopan.2022.06.008 -
Breast Cancer (Tokyo, Japan) Sep 2016Breast angiosarcomas are rare neoplasm. Due to its rarity, our therapeutic strategy is extremely limited. Therefore, we investigated the clinicopathologic features and...
BACKGROUND
Breast angiosarcomas are rare neoplasm. Due to its rarity, our therapeutic strategy is extremely limited. Therefore, we investigated the clinicopathologic features and examined the treatment for angiosarcoma compared with some literatures.
METHODS
We conducted a retrospective chart and slide review of all patients in our division seen from 1997 to 2012 with a diagnosis of primary or secondary breast angiosarcoma at the National Cancer Center Hospital (Tokyo, Japan).
RESULTS
Nine patients were diagnosed with breast angiosarcoma (six primary and three secondary cases). The median age of patients with primary angiosarcoma was 39 years (range 27-65 years). The median tumor size was 6.78 cm (range 3.0-8.8 cm). In the primary tumor, 4 patients had total mastectomy and 2 had a breast conserving surgery. 3- and 5-year disease-free survival (DFS) of the patients with primary angiosarcoma was 20 and 0 %. 5-year surviving rate of primary angiosarcoma was 50 %. In all patients with secondary angiosarcoma, recurrence was observed in all cases. But one case obtained long-term survival in local control therapy.
CONCLUSIONS
Our study demonstrates breast angiosarcoma exhibits high recurrence rates. Tumor size and surgical margin may be important factor to obtain long-term survival. In this point of view, total mastectomy with adequate tumor margin with early detection is desired. In case of recurrence, if it is local, surgery may be potentially curative.
Topics: Adult; Aged; Biopsy, Large-Core Needle; Breast Neoplasms; Disease-Free Survival; Female; Hemangiosarcoma; Humans; Lymphangiosarcoma; Mastectomy, Segmental; Mastectomy, Simple; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies; Survival Rate
PubMed: 26243043
DOI: 10.1007/s12282-015-0630-y -
Plastic and Reconstructive Surgery Oct 2023Coronavirus disease of 2019 and rising health care costs have incentivized shorter hospital stays after mastectomies with immediate prosthetic reconstruction. The...
BACKGROUND
Coronavirus disease of 2019 and rising health care costs have incentivized shorter hospital stays after mastectomies with immediate prosthetic reconstruction. The purpose of this study was to compare postoperative outcomes following same-day and non-same-day mastectomy with immediate prosthetic reconstruction.
METHODS
A retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database from 2007 to 2019 was performed. Patients who underwent mastectomies and immediate reconstruction with tissue expanders or implants were selected and grouped based on length of stay. Univariate analysis and multivariate regression were performed to compare 30-day postoperative outcomes between length-of-stay groups.
RESULTS
A total of 45,451 patients were included: 1508 had same-day surgery (SDS) and 43,942 were admitted for 1 or more night (non-SDS). There was no significant difference in overall 30-day postoperative complications between SDS and non-SDS following immediate prosthetic reconstruction. SDS was not a predictor of complications (OR, 1.1; P = 0.346), whereas tissue expander reconstruction decreased odds of morbidity compared with direct-to-implant reconstruction (OR, 0.77; P < 0.001). Among patients who had SDS, smoking was significantly associated with early complications on multivariate analysis (OR, 1.85; P = 0.010).
CONCLUSIONS
This study provides an up-to-date assessment of the safety of mastectomies with immediate prosthetic breast reconstruction that captures recent advancements. Postoperative complication rates are similar between same-day discharge and at least 1-night stay, suggesting that same-day procedures may be safe for appropriately selected patients.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, III.
Topics: Humans; Female; Mastectomy; Retrospective Studies; Breast Neoplasms; Mammaplasty; Postoperative Complications
PubMed: 36862949
DOI: 10.1097/PRS.0000000000010348 -
Veterinary Immunology and... Apr 2022Surgical procedures can affect host immunity proportionally to the extent of surgical trauma. In cancer cases, surgery-induced immunosuppression can potentially promote...
Surgical procedures can affect host immunity proportionally to the extent of surgical trauma. In cancer cases, surgery-induced immunosuppression can potentially promote tumour metastasis. The aim of this study was to investigate, in bitches with malignant mammary tumours, whether major surgery (total unilateral mastectomy or bilateral regional mastectomy) has a more negative effect than minor surgery (unilateral regional mastectomy) on components of host immunity. Twenty bitches with mammary cancer of clinical stage II or III were allocated to group A (minor surgery) or group B (major surgery) of 10 animals each receiving the same anaesthetic protocol for mastectomy. Immune cell measurements in blood [number of leukocytes, neutrophils, lymphocytes and platelets, and relative percentages of T-lymphocytes (CD3) and their CD4, CD8 and CD5 subpopulations] were performed before anaesthesia (day 0) and on days 3 and 10 post-mastectomy. On day 3, leukocytes, neutrophils and platelets numbers were higher (p = 0.016, 0.032 and 0.017, respectively) in group B than in group A. For all 20 bitches, T-lymphocytes and the CD4, CD5 T-cells were significantly decreased on day 3, but no significant differences were noted between groups. Minor mastectomy seemed to preserve innate immunity better than major mastectomy, but cellular immunity was rather equally affected.
Topics: Animals; Dog Diseases; Dogs; Immunity, Cellular; Leukocytes; Lymphocytes; Mammary Neoplasms, Animal; Mastectomy
PubMed: 35276483
DOI: 10.1016/j.vetimm.2022.110403