-
Journal of Women's Health (2002) Jan 2022Body image distress is frequently reported by women after mastectomy and is associated with negative health outcomes, such as reduced quality of life, elevated...
Body image distress is frequently reported by women after mastectomy and is associated with negative health outcomes, such as reduced quality of life, elevated depression and anxiety symptoms, and impaired sexual functioning. To reduce body image distress after mastectomy, we must first understand the factors that contribute to its development and maintenance. We therefore developed a new measure, the Body Image after Mastectomy Scale (BIMS), to comprehensively assess maladaptive appearance-related beliefs and behaviors ( avoidance and rituals) that may trigger and maintain body image distress after mastectomy. Forty-seven female patients undergoing mastectomy with breast reconstruction completed the BIMS and other measures 3 months after breast reconstruction. Evaluation of the BIMS' initial psychometric properties showed that the overall scale has good internal consistency and strong construct validity. Domain-specific subscales ranged in reliability from good to poor. The BIMS can be used clinically to identify cognitive and behavioral psychotherapy targets to reduce body image distress resulting from mastectomy. It can also be used in research to identify factors that contribute to the development and maintenance of body image distress after mastectomy. ClinicalTrials.gov identifier: NCT03428399.
Topics: Body Image; Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Quality of Life; Reproducibility of Results; Surveys and Questionnaires
PubMed: 34449252
DOI: 10.1089/jwh.2021.0131 -
Clinical Breast Cancer Jul 2022Direct-to-implant prepectoral breast reconstruction in the last years demonstrated to be a feasible and advantageous method in selected cases because it respects chest...
BACKGROUND
Direct-to-implant prepectoral breast reconstruction in the last years demonstrated to be a feasible and advantageous method in selected cases because it respects chest wall musculature integrity and avoids animation deformity. Current approaches involve implant wrapping with Acellular Dermal Matrix (ADM) or synthetic mesh to guarantee implant coverage and stability and reduce complications. Prepectoral polyurethane implant positioning without further coverage is an alternative breast reconstruction method poor described in literature.
PATIENT AND METHODS
A single-institution retrospective analysis was performed on 453 patients, extending our previous preliminary experience, who underwent nipple-sparing mastectomy (NSM) and prepectoral polyurethane implant positioning between December 2017 and June 2021. Follow-up included postoperative complications record and self-reported patient's satisfaction.
RESULTS
A total of 784 mastectomies were performed in 453 patients. 331 were bilateral procedures (73.1%) and 122 were unilateral (26.9%). Minimum follow-up time was 6 months and maximum was 42 months. No major complications were reported. Contour defects and excessive implant visibility occurred in 82 patients (18.1%) and was successfully managed with autologous fat grafting.
CONCLUSION
Nipple-sparing mastectomy with immediate prepectoral polyurethane implant reconstruction without the need for ADM or mesh is a feasible and safe option. Accurate patient selection and respectful mastectomy technique is crucial to achieve optimal outcomes with this approach. Fat grafting is a useful refinement procedure to improve cosmetic results in this setting.
Topics: Breast Implantation; Breast Implants; Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Nipples; Polyurethanes; Retrospective Studies
PubMed: 35437225
DOI: 10.1016/j.clbc.2022.03.005 -
Breastfeeding Medicine : the Official... Mar 2023Increasingly, young women are undergoing bilateral mastectomies before the completion of childbearing. This procedure, when performed prematurely, precludes any future...
Increasingly, young women are undergoing bilateral mastectomies before the completion of childbearing. This procedure, when performed prematurely, precludes any future lactation. However, not breastfeeding increases maternal and child morbidity and mortality, and carries an overall U.S. financial cost of $18.5 billion per year. The emotional and physical consequences of bilateral mastectomy in this patient population should be more carefully considered, and any prophylactic surgery deferred until childbearing has been completed.
Topics: Child; Female; Humans; Mastectomy; Breast Neoplasms; Breast Feeding; Lactation
PubMed: 36745397
DOI: 10.1089/bfm.2022.0262 -
The Breast Journal 2022The rate of inpatient mastectomies remains high despite multiple studies reporting favourably on outpatient mastectomies. Outpatient mastectomies do not compromise...
BACKGROUND
The rate of inpatient mastectomies remains high despite multiple studies reporting favourably on outpatient mastectomies. Outpatient mastectomies do not compromise quality of patient care and are more efficient than inpatient care. The objective of this study was to evaluate the feasibility of outpatient mastectomy.
MATERIALS AND METHODS
Implementation of an outpatient mastectomy program was evaluated in a retrospective study. All patients who underwent mastectomy between January 2019 and September 2021 were included.
RESULTS
213 patients were enrolled in the study: 62.4% ( = 133) outpatient mastectomies versus 37.6% ( = 80) inpatient mastectomies. A steady rise in outpatient mastectomies was observed over time. The second quarter of 2020, coinciding with the first COVID-19 wave, showed a peak in outpatient mastectomies. The only significant barrier to outpatient mastectomy proved to be bilateral mastectomy. Unplanned return to care was observed in 27.8% of the outpatient versus 36.3% of the inpatient mastectomies (=0.198); the reason for unplanned return of care was similar in both groups.
CONCLUSIONS
Outpatient mastectomy is shown to be feasible and safe with a steady increase during the study period. A barrier to outpatient mastectomy was bilateral mastectomy. Incidence of unplanned return to care or complications did not differ significantly between the outpatient and inpatient cohorts.
Topics: Breast Neoplasms; COVID-19; Female; Humans; Mastectomy; Outpatients; Retrospective Studies
PubMed: 35711886
DOI: 10.1155/2022/1863519 -
Cirugia Espanola Mar 2023In recent years, mastectomy and reconstruction techniques have evolved towards less aggressive procedures, improving the satisfaction and quality of life of women. For...
INTRODUCTION
In recent years, mastectomy and reconstruction techniques have evolved towards less aggressive procedures, improving the satisfaction and quality of life of women. For this reason, mastectomy has become a valid option for both women with breast cancer and high-risk women. The objective of this study is to analyze the safety of mastectomy and immediate prepectoral reconstruction with polyurethane implant in women with breast cancer and risk reduction.
METHOD
Observational prospective study to evaluate the feasibility and safety of immediate reconstruction using prepectoral polyurethane implant. All women (with breast cancer or high risk for breast cancer) who underwent skin-sparing or skin-and-nipple-sparing mastectomy with immediate reconstruction with a prepectoral polyurethane implant were included. Women with breast sarcomas, disease progression during primary systemic therapy (PST), delayed, autologous or retropectoral reconstruction, and those who did not wish to participate in the study were excluded. Surgical procedures were performed by both senior and junior surgeons. All patients received the corresponding complementary treatments. All adverse events that occurred during follow-up and the risk factors for developing them were analyzed.
RESULTS
159 reconstructions were performed in 102 women, 80.4% due to breast carcinoma. Fourteen patients developed complications, the most frequent being seroma and wound dehiscence. Eight women required a reoperation (5.0%), seven of them due to implant exposure. Four reconstructions (2.5%) resulted in loss of the implant. Three patients progressed from their oncological process: a local relapse in the mastectomy flap, an axillary progression and a systemic progression.
CONCLUSIONS
Prepectoral reconstruction with a polyurethane implant is a procedure with a low incidence of postoperative complications (8.8%) and implant loss (2.5%). Its use is safe with perioperative cancer treatments (neoadjuvant chemotherapy and radiotherapy).
Topics: Humans; Female; Mastectomy; Breast Neoplasms; Prospective Studies; Polyurethanes; Quality of Life; Retrospective Studies; Neoplasm Recurrence, Local; Mammaplasty; Breast Implants; Postoperative Complications
PubMed: 36108952
DOI: 10.1016/j.cireng.2022.09.021 -
Cirugia Espanola Feb 2023In recent years, cultural changes in today's society and improved risk assessment have increased the indication for mastectomies in women with breast cancer. Various...
INTRODUCTION
In recent years, cultural changes in today's society and improved risk assessment have increased the indication for mastectomies in women with breast cancer. Various studies have confirmed the oncological safety of sparing mastectomies and immediate reconstruction. The objective of this study is to analyze the incidence of locoregional relapses of this procedure and its impact on reconstruction and overall survival.
PATIENTS AND METHODS
Prospective study of patients with breast carcinoma who underwent a sparing mastectomy and immediate reconstruction. Locoregional relapses and their treatment and their impact on survival were analyzed.
RESULTS
The study group is made up of 271 women with breast carcinoma treated with a skin-sparing mastectomy and immediate reconstruction. The mean follow-up was 7.98 years and during the same 18 locoregional relapses (6.6%) were diagnosed: 72.2% in the mastectomy flap and 27.8% lymph node. There were no significant differences in the pathological characteristics of the primary tumor between patients with and without locoregional relapse, although the percentage of women with hormone-sensitive tumors was higher in the group without relapse. Patients with lymph node relapse had larger tumors (80% T2-T3) and 60% had axillary metastases at diagnosis, compared to 7.7% of women with skin relapse (p = 0.047). All patients operated on for locoregional relapse preserved their reconstruction. The incidence of metastases and deaths was significantly higher in patients with a relapse, causing a non-significant decrease in overall survival.
CONCLUSION
Locoregional relapses are a rare event in women with a sparing mastectomy and immediate reconstruction. Most patients with locoregional relapse can preserve their initial reconstruction through local resection of the tumor and adjuvant and / or neoadjuvant therapies.
Topics: Humans; Female; Breast Neoplasms; Mastectomy; Prospective Studies; Mammaplasty; Neoplasm Recurrence, Local; Recurrence
PubMed: 36064171
DOI: 10.1016/j.cireng.2022.09.007 -
Journal of Surgical Oncology Mar 2022Skin- and nipple-sparing mastectomies (SSMs/NSMs) present as an alternative for patients requiring mastectomy, with better aesthetic results. We aimed to evaluate the...
BACKGROUND
Skin- and nipple-sparing mastectomies (SSMs/NSMs) present as an alternative for patients requiring mastectomy, with better aesthetic results. We aimed to evaluate the locoregional recurrence (LRR) rate and its predictive factors.
METHODS
Retrospective analysis of all consecutive cases of SSM and NSM for a primary diagnosis of in situ or invasive breast cancer, at a national cancer center, from January 1st, 2013 to May 31st, 2019. The primary outcome was LRR. Secondary outcomes included LRR predictive factors, overall survival (OS), and disease-free survival (DFS).
RESULTS
There were included 461 patients; 402 (87%) with invasive carcinoma. The median age was 46 (interquartile range [IQR]: 40-53) years. Ninety (20%) patients had locally advanced disease. LRR rate was 3.0%, with a median follow-up time of 39 (IQR: 21-59) months. The median time to recurrence was 22 (IQR: 10-45) months. Factors independently associated with LRR were high histological grade, negative estrogen receptor status, and high Ki67 (p < 0.05). OS was 94.8% and DFS was 92.8%. LRR was associated with decreased OS.
DISCUSSION
SSM and NSM present as a safe approach to breast cancer requiring mastectomy, including selected patients with a locally advanced tumor. The associated LRR rate is 3.0%, with risk factors being high grade, negative estrogen receptor status, and high Ki67.
Topics: Adult; Breast Neoplasms; Carcinoma; Disease-Free Survival; Female; Humans; Mastectomy, Simple; Mastectomy, Subcutaneous; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Retrospective Studies; Survival Rate; Treatment Outcome
PubMed: 34687468
DOI: 10.1002/jso.26725 -
Journal of Tissue Engineering and... Feb 2020The complexity of mammary tissue and the variety of cells involved make tissue regeneration an ambitious goal. This review, supported by both detailed macro and micro... (Review)
Review
The complexity of mammary tissue and the variety of cells involved make tissue regeneration an ambitious goal. This review, supported by both detailed macro and micro anatomy, illustrates the potential of regenerative medicine in terms of mammary gland reconstruction to restore breast physiology and morphology, damaged by mastectomy. Despite the widespread use of conventional therapies, many critical issues have been solved using the potential of stem cells resident in adipose tissue, leading to commercial products. in vitro research has reported that adipose stem cells are the principal cellular source for reconstructing adipose tissue, ductal epithelium, and nipple structures. In addition to simple cell injection, construct made by cells seeded on a suitable biodegradable scaffold is a viable alternative from a long-term perspective. Preclinical studies on mice and clinical studies, most of which have reached Phase II, are essential in the commercialization of cellular therapy products. Recent studies have revealed that the enrichment of fat grafting with stromal vascular fraction cells is a viable alternative to breast reconstruction. Although in the future, organ-on-a-chip can be envisioned, for the moment researchers are still focusing on therapies that are a long way from regenerating the whole organ, but which nevertheless prevent complications, such as relapse and loss in terms of morphology.
Topics: Adipocytes; Adipose Tissue; Animals; Breast; Breast Neoplasms; Cell Differentiation; Cell Line, Tumor; Female; Homeostasis; Humans; In Vitro Techniques; Mastectomy; Mice; Neoplasm Transplantation; Plastic Surgery Procedures; Regeneration; Regenerative Medicine; Stem Cells; Stromal Cells; Tissue Engineering; Tissue Scaffolds
PubMed: 31825164
DOI: 10.1002/term.2999 -
International Journal of Surgery... Mar 2024With comparable overall survival and local recurrence rates with mastectomy, breast-conserving surgery (BCS) has become the cornerstone of therapy for breast cancer;...
Breast-conserving surgery is associated with a lower incidence of suicide among females with breast cancer in the United States: a population-based retrospective cohort study.
BACKGROUND
With comparable overall survival and local recurrence rates with mastectomy, breast-conserving surgery (BCS) has become the cornerstone of therapy for breast cancer; however, the difference in the incidence of suicide between BCS and mastectomy among breast cancer survivors remains unclear. This study evaluated the mortality risk from suicide among breast cancer survivors and compared suicide risk between BCS and mastectomy using a population-based cohort.
MATERIALS AND METHODS
Female patients newly diagnosed with first primary breast cancer, recorded in the Surveillance, Epidemiology and End Results database, were included. Standardized mortality ratio (SMR) and cumulative mortality rate from suicide among those who underwent BCS and mastectomy were compared.
RESULTS
A total of 1 190 991 patients with newly diagnosed first primary breast cancer were included in the study, of whom 56.5% underwent BCS and 36.1% underwent mastectomy. During the follow-up period, 667 suicides were recorded. Patients who underwent mastectomy exhibited significantly higher suicide mortality than the general population [mortality rate, 8.16 per 100 000 person-years; SMR 1.18 (95% CI 1.05-1.33)], while there was no significant difference in suicide rate between patients who underwent BCS and the general population [SMR 0.92 (95% CI 0.83-1.02)]. Multivariate Cox analysis revealed that BCS, compared with mastectomy, was associated with a significantly decreased risk of suicide among females with breast cancer [hazard ratio 0.80 (95% CI 0.68-0.95); P = 0.009].
CONCLUSION
BCS was associated with a significantly lower incidence of suicide among females with breast cancer. BCS offers a compelling option for improving the quality of life and self-esteem of patients with cancer and provides a novel perspective on cancer management.
Topics: Humans; Female; United States; Breast Neoplasms; Mastectomy, Segmental; Mastectomy; Retrospective Studies; Incidence; Quality of Life; Suicide
PubMed: 38215250
DOI: 10.1097/JS9.0000000000001060 -
Plastic and Reconstructive Surgery Apr 2024Oncoplastic breast reconstruction seeks to address partial mastectomy defects in the setting of breast-conserving surgery to achieve superior aesthetic outcomes with... (Review)
Review
Oncoplastic breast reconstruction seeks to address partial mastectomy defects in the setting of breast-conserving surgery to achieve superior aesthetic outcomes with comparable oncologic safety compared with traditional breast conservation surgery. As such, oncoplastic breast-conserving surgery has grown in popularity in recent years. Several techniques have been used to displace the volume with the remaining breast tissue or replace it with local soft-tissue options, with decision-making guided by patient and tumor characteristics, additional treatment requirements, patient preference, and available tissue resources. The purpose of this review is to provide an overview of considerations in oncoplastic breast reconstruction with a focus on techniques and tips to achieve optimal outcomes.
Topics: Humans; Female; Mastectomy; Breast Neoplasms; Mammaplasty; Mastectomy, Segmental; Patient Preference
PubMed: 37220250
DOI: 10.1097/PRS.0000000000010731