-
CMAJ : Canadian Medical Association... Oct 2023
Topics: United States; Humans; Female; Mastectomy; Breast Neoplasms; Retrospective Studies
PubMed: 37788839
DOI: 10.1503/cmaj.230801 -
Plastic and Reconstructive Surgery Sep 2017Although transgender surgery constitutes a growing field within plastic surgery, prospective studies on masculinizing mastectomies are lacking. The objectives of the...
BACKGROUND
Although transgender surgery constitutes a growing field within plastic surgery, prospective studies on masculinizing mastectomies are lacking. The objectives of the present study were to prospectively follow a cohort of transmen undergoing mastectomy to assess technical and self-reported outcomes and to evaluate surgical decision-making.
METHODS
Fifty-four transmen were recruited during a 10-month period at the Department of Plastic Surgery of the Centre of Expertise on Gender Dysphoria. Preoperative assessment included standardized chest examination. Six months postoperatively, participants rated their satisfaction with surgery, and 12-month postoperative surgical outcomes were reviewed independently. Surgical decision-making was evaluated by comparing indications and outcomes per technique, and assessing the clinical validity of the most-used decision aid (using the Cohen's kappa statistic).
RESULTS
One periareolar mastectomy, 26 concentric circular mastectomies, and 22 inframammary skin resections with free nipple graft were performed in the authors' cohort. Five participants were still to be operated on. Concentric circular mastectomy was performed in smaller or medium-size breasts with low ptosis grade and good elasticity, whereas the inframammary skin resection group showed a wider range of physical characteristics. Despite being performed in better quality breasts, concentric circular mastectomy was associated with more secondary corrections (38.5 percent), dehiscence, seroma, and lower postoperative satisfaction compared with inframammary skin resections. Clinical decision-making was generally in line with the published decision aid.
CONCLUSIONS
Compared with inframammary skin resections, concentric circular mastectomy-despite being performed in favorable breast types-appears to produce poorer technical and self-reported outcomes. Surgical indications and preoperative counseling regarding secondary corrections may therefore be subject to improvement.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, IV.
Topics: Adolescent; Adult; Female; Humans; Male; Mastectomy; Middle Aged; Patient Satisfaction; Prospective Studies; Sex Reassignment Surgery; Transsexualism; Young Adult
PubMed: 28841608
DOI: 10.1097/PRS.0000000000003607 -
International Journal of Surgery... Feb 2016Mastectomy is commonly performed for breast cancer. However, a dog ear may arise at the lateral aspect of the mastectomy scar. This dog ear is not only unsightly but can... (Review)
Review
INTRODUCTION
Mastectomy is commonly performed for breast cancer. However, a dog ear may arise at the lateral aspect of the mastectomy scar. This dog ear is not only unsightly but can also be a source of discomfort. While various surgical techniques have been reported to tackle this lateral dog ear, there is no standardized technique. We hence conduct the first systematic review of these surgical techniques with the aim of comparing the merits and limitations of each technique.
METHODS
A systematic literature search using the search terms "mastectomy scar", "mastectomy dog ear", "mastectomy lateral fold" and "mastectomy cosmesis" was performed. All relevant articles written in English and involving human subjects were included.
RESULTS
There were 2503 potentially relevant articles but only 12 articles met the inclusion criteria. The 'fish-shaped' incision or Y closure and its variations were the most commonly described techniques. Other techniques include the 'tear-drop' incision, 'L' scar technique etc. 'Fish-shaped' incision or Y closure is safe and provides good exposure to the axilla but its limitations are that of an additional scar and risk of skin necrosis at the apex of the Y incision. The other techniques attempt to eliminate the lateral dog ear while avoiding the complications associated with the 'fish-shaped' incision or Y closure.
CONCLUSION
Various surgical techniques to tackle lateral dog ear of the mastectomy scar have been described, each with its own merits and limitations. 'Fish-shaped' incision or Y closure is the most commonly described technique that has been prospectively assessed and was concluded to be safe.
Topics: Breast Neoplasms; Esthetics; Female; Humans; Mastectomy
PubMed: 26776364
DOI: 10.1016/j.ijsu.2015.12.068 -
Annals of Surgical Oncology Apr 2022Currently, the operation rate of nipple-sparing mastectomy (NSM) is increasing. However, the long-term prognosis of NSM is not well documented. We utilized the...
BACKGROUND
Currently, the operation rate of nipple-sparing mastectomy (NSM) is increasing. However, the long-term prognosis of NSM is not well documented. We utilized the Surveillance, Epidemiology, and End Results (SEER) database to analyze the long-term prognosis of NSM compared with total mastectomy (TM).
METHODS
Population-level data of female breast cancer patients treated with NSM and TM were extracted from 1998 to 2016 from the SEER database. Propensity score matching (PSM) was performed to reduce the influence of selection bias and confounding variables in comparisons. Kaplan-Meier analysis, log-rank test, and Cox proportional hazard regression were performed.
RESULTS
A total of 5765 patients underwent NSM, which increased from 266 in 2004-2009 to 5370 in 2010-2016. A total of 134,528 patients underwent TM, and the number of patients undergoing TM continued to decline. The overall survival (OS) and breast cancer-specific survival (BCSS) were similar between the NSM group and the TM group (P = 0.058 and 0.87, respectively). For OS, subgroup analysis showed that patients with age ≥ 46, White race, median household income ≥ $70,000, hormone receptor-positive, and HER2 negative had a better prognosis for treatment with NSM. There was no significant difference in BCSS between the NSM group and the TM group.
CONCLUSIONS
In recent years, the clinical application of NSM has been increasing. NSM is a proper procedure for breast cancer patients to achieve long-term survival.
Topics: Breast Neoplasms; Case-Control Studies; Female; Humans; Mammaplasty; Mastectomy; Mastectomy, Simple; Nipples; Organ Sparing Treatments; Prognosis; Propensity Score; Retrospective Studies
PubMed: 34802105
DOI: 10.1245/s10434-021-11044-4 -
BMC Cancer Jul 2023Seroma is the most common complication following breast cancer surgery, with reported incidence up to 90%. Seroma causes patient discomfort, is associated with surgical... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Seroma is the most common complication following breast cancer surgery, with reported incidence up to 90%. Seroma causes patient discomfort, is associated with surgical site infections (SSI), often requires treatment and increases healthcare consumption. The quilting suture technique, in which the skin flaps are sutured to the pectoralis muscle, leads to a significant reduction of seroma with a decrease in the number of aspirations and surgical site infections. However, implementation is lagging due to unknown side effects, increase in operation time and cost effectiveness. Main objective of this study is to assess the impact of large scale implementation of the quilting suture technique in patients undergoing mastectomy and/or axillary lymph node dissection (ALND).
METHODS
The QUILT study is a stepped wedge design study performed among nine teaching hospitals in the Netherlands. The study consists of nine steps, with each step one hospital will implement the quilting suture technique. Allocation of the order of implementation will be randomization-based. Primary outcome is 'textbook outcome', i.e.no wound complications, no re-admission, re-operation or unscheduled visit to the outpatient clinic and no increased use of postoperative analgesics. A total of 113 patients is required based on a sample size calculation. Secondary outcomes are shoulder function, cosmetic outcome, satisfaction with thoracic wall and health care consumption. Follow-up lasts for 6 months.
DISCUSSION
This will be one of the first multicentre prospective studies in which quilting without postoperative wound drain is compared with conventional wound closure. We hypothesize that quilting is a simple technique to increase textbook outcome, enhance patient comfort and reduce health care consumption.
Topics: Humans; Female; Mastectomy; Breast Neoplasms; Surgical Wound Infection; Seroma; Prospective Studies; Drainage; Sutures; Postoperative Complications
PubMed: 37460983
DOI: 10.1186/s12885-023-11154-0 -
Medicine Mar 2019To investigate and compare the effects of breast-conserving therapy (BCT) and mastectomy on the disease recurrence and long-term survival in early-stage luminal breast... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
To investigate and compare the effects of breast-conserving therapy (BCT) and mastectomy on the disease recurrence and long-term survival in early-stage luminal breast cancer and the difference in prognosis across diverse luminal subtypes receiving single surgical modality.
METHODS
The databases of PubMed and Embase were retrieved to select eligible trials that were published from inception to 13 November 2018. The clinical trials that offered the details about recurrent disease and/or survival in luminal tumors underwent BCT or mastectomy met the inclusion criteria (n=24). With the random- or fixed-effect model basing on heterogeneity Chi test with its significant level of P < .1, pooled odds ratio (OR) with its 95% CI, and P value were identified for endpoints.
RESULTS
The analyzed data were constituted of 25 qualified trials with 13,032 unique women suffered from luminal cancers. The fixed-effect models were utilized. On the LRR regarding BCT versus mastectomy, the pooled data indicated no significant difference in luminal carcinomas (OR, 0.84; 95%CI, 0.43-1.64; P = .61; n = 867). In BCT cohort, the pooled data showed that there were some significant benefits favoring luminal A over luminal B in LR (OR, 0.61; 95%CI, 0.46-0.81; P = .0007; n = 5406), DM (OR, 0.53; 95%CI, 0.41-0.69; P < .00001; n = 4662), DFS (OR, 0.59; 95%CI, 0.36-0.96; P = .03; n = 776) and OS (OR, 0.65; 95%CI, 0.42-0.99; P = .05; n = 1149), but not in LRR (OR, 0.74; 95%CI, 0.48-1.13; P = .16; n = 3732), coupled with luminal A/B over luminal-HER2 in LRR (OR, 0.43; 95%CI, 0.25-0.76; P = .004; n = 890), DM (OR, 0.56; 95%CI, 0.35-0.90; P = .02; n = 1396), DFS (OR, 0.47; 95%CI, 0.27-0.83; P = .009; n = 532); in mastectomy cohort, there were apparent advantages of LRR (OR, 0.58; 95%CI, 0.36-0.92; P = .02; n = 1768), LR (OR,0.56; 95%CI, 0.38-0.83; P = .004; n = 1209), DM (OR, 0.58; 95%CI, 0.40-0.84; P = .004; n = 652) and OS (OR, 0.62; 95%CI, 0.43-0.89; P = .009; n = 652) in luminal A vs luminal B.
CONCLUSION
For early luminal breast cancer, the equality of LRR was achieved in BCT and mastectomy. In comparison, luminal A cancers benefit the most improved tumor re-appearence and survival in luminal diseases regardless of the option of surgical modality, whereas luminal-HER2 is affected by the worst clinical outcomes in them who follows BCT.
Topics: Adult; Breast Neoplasms; Female; Humans; Mastectomy; Prognosis; Treatment Outcome
PubMed: 30882711
DOI: 10.1097/MD.0000000000014912 -
BJS Open Feb 2019Despite similar survival rates, breast-conserving therapy (BCT) remains a distant second choice after simple mastectomy for patients with early-stage breast cancer in...
BACKGROUND
Despite similar survival rates, breast-conserving therapy (BCT) remains a distant second choice after simple mastectomy for patients with early-stage breast cancer in Singapore. Uptake of reconstruction after mastectomy is also low (18 per cent). The aim of this study was to explore the factors influencing a patient's choice for mastectomy when eligible for BCT, and why patients decline reconstruction after mastectomy.
METHODS
Patients from the National Cancer Centre Singapore, who were eligible for BCT but chose mastectomy without reconstruction, between December 2014 and December 2015 were included. An interviewer-administered questionnaire focusing on patients' reasons for choosing mastectomy over BCT and not opting for immediate breast reconstruction after mastectomy was used. Tumour characteristics were retrieved from medical records. Spearman's rank correlation coefficient, Mann-Whitney and Kruskal-Wallis tests were used to analyse the correlation between the patient's self-rated influential factors and variables. Statistical significance was taken as < 0·050.
RESULTS
Ninety-one patients were included (90·1 per cent response rate). The main reasons for choosing mastectomy over BCT were: fear of cancer recurrence (considered very important in 74 per cent), the perception that health outweighs breast retention (49 per cent) and the possibility of second surgery for margins (40 per cent). Key factors for rejecting immediate reconstruction after mastectomy were: patient-perceived 'old age' (very important in 53 per cent), concern about two sites of surgery (42 per cent) and financial cost (29 per cent). Given a second chance, 19·8 per cent of patients would undergo BCT instead of mastectomy.
CONCLUSION
This study has identified the considerations that women in Singapore have when deciding on breast cancer surgery. Some perceptions need to be addressed for women to make a fully informed decision, especially as one-fifth regret their initial choice.
Topics: Adult; Aged; Aged, 80 and over; Attitude to Health; Breast Neoplasms; Choice Behavior; Decision Making; Female; Humans; Mammaplasty; Mastectomy; Mastectomy, Segmental; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Patient Participation; Patient Satisfaction; Singapore; Surveys and Questionnaires
PubMed: 30734013
DOI: 10.1002/bjs5.50105 -
Veterinary Medicine and Science Mar 2022The purpose of the present study was to evaluate the postoperative analgesic efficacy of fentanyl patches versus subcutaneous tramadol after canine ovariectomy, with and...
OBJECTIVES
The purpose of the present study was to evaluate the postoperative analgesic efficacy of fentanyl patches versus subcutaneous tramadol after canine ovariectomy, with and without unilateral mastectomy.
MATERIALS AND METHODS
A total of 40 female dogs were included in the present study, all of which were domesticated, healthy and 4-12 years of age. The animals were divided into four groups (n = 10 per group) based on the surgery and the analgesic protocol used: the TO group only underwent ovariectomy, and received postoperative tramadol; the TM group underwent both ovariectomy and mastectomy, and received postoperative tramadol; the FO group only underwent ovariectomy, and received fentanyl patches; and the FM group underwent both ovariectomy and mastectomy, and received fentanyl patches. Postoperative pain was evaluated every 4 h for 24 h using a numeric analogue scale (NAS) and a modified Glasgow Composite Measure Pain Scale Short Form (CMPS-SF).
RESULTS
The results of the present study showed that patients in all four groups tolerated postoperative surgical stress well. Analysis of variance for repeated measures did not show significant differences in the NAS scores and in Glasgow CMPS-SF between groups in terms of pain scores or rescue analgesia.
CLINICAL SIGNIFICANCE
These results indicated that the analgesic effect of the fentanyl patch was similar to that of subcutaneous (SC) tramadol in female dogs after ovariectomy, with and without unilateral mastectomy, suggesting that the fentanyl patch may represent a valid supplementary tool for the control of postoperative pain in animals after surgery.
Topics: Analgesics; Analgesics, Opioid; Animals; Dog Diseases; Dogs; Female; Fentanyl; Male; Mastectomy; Ovariectomy; Pain, Postoperative; Tramadol
PubMed: 34953046
DOI: 10.1002/vms3.691 -
Medicine Feb 2023Gynecomastia is a common type of breast tissue hypertrophy in men. Surgical excision is the most effective treatment for this condition. Minimally invasive surgical...
Gynecomastia is a common type of breast tissue hypertrophy in men. Surgical excision is the most effective treatment for this condition. Minimally invasive surgical techniques can be used to avoid visible chest scarring. In this study, we evaluated the efficacy and safety of single-axillary-incision endoscopic mastectomy and liposuction for the treatment of gynecomastia. Nipple-sparing mastectomy via a single-port axillary incision was successfully performed in all patients. Twenty-four bilateral procedures were performed in total. Twenty patients underwent liposuction concomitantly. The median weight of the mastectomy pieces was 88.5 g (range: 42.5-440 g), and the median amount of liposuction was 262.5 cc (range: 25-350 cc). The median duration of surgery was 120 minutes (range, 73-195 minutes). Two patients developed a seroma, and 1 patient developed a hematoma in the early postoperative period. The mean satisfaction levels related to physical appearance, mental status, and social environment were 8.75 (standard deviation [SD]: 1.19), 9.17 (SD: 1.44), and 9.33 (SD: 0.76) points, respectively, on a 10-point visual analog scale. Endoscopic single-port nipple-sparing mastectomy combined with liposuction is a technically feasible method to avoid anterior chest wall scarring with good cosmetic results. Between June 2021 and June 2022, 30 patients underwent endoscopic single-port nipple-sparing mastectomy through a small axillary incision, while 20 underwent concomitant liposuction. The demographic information of the patients, duration of surgery, amount of tissue removed, and complications were recorded. Patients' levels of satisfaction with their physical appearance, mental status, and social environment were measured.
Topics: Male; Humans; Mastectomy; Lipectomy; Gynecomastia; Cicatrix; Breast Neoplasms; Mammaplasty; Retrospective Studies; Nipples
PubMed: 36800581
DOI: 10.1097/MD.0000000000033020 -
International Journal of Environmental... Dec 2020The aim of the study was to analyse the body composition among women after radical mastectomy. The body compositions of 30 women after radical mastectomy (study group)...
The aim of the study was to analyse the body composition among women after radical mastectomy. The body compositions of 30 women after radical mastectomy (study group) were compared with those of 30 healthy females (control group). The method of electrical bioimpedance was used to analyse body composition. The significant differences between the groups, unfavourable for women, following mastectomy concerned body mass ( = 0.021), BMI ( = 0.049), fat mass (%) ( = 0.007), fat mass (kg) ( = 0.005), total body water (%) ( = 0.002), left upper limb fat mass ( = 0.013) as well as right upper limb fat mass ( = 0.022). The body composition of women after radical mastectomy was significantly worse compared to the control group. The majority of subjects were overweight and had high levels of body fat. Abnormal body composition is a modifiable risk factor of breast cancer; therefore, improving lifestyle is important in the prevention and treatment of this disease. There is a need for education, dietary supervision and physical activity in women following radical mastectomy. The innovation of our study was the use of the modern bioelectrical impedance analysis (BIA) method, which does not cause ionisation and is a gold standard in the field of body composition analysis. In future research, we plan to broaden the assessment of lifestyle and the significance of diet and physical activity in the prevention and treatment of breast cancer.
Topics: Body Composition; Body Mass Index; Breast Neoplasms; Electric Impedance; Female; Humans; Mastectomy; Mastectomy, Radical
PubMed: 33276660
DOI: 10.3390/ijerph17238991