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Archives of Internal Medicine Mar 2005Findings from several studies suggest that bilateral prophylactic mastectomy reduces breast cancer incidence by 90% or more, but the studies used highly selected... (Comparative Study)
Comparative Study
BACKGROUND
Findings from several studies suggest that bilateral prophylactic mastectomy reduces breast cancer incidence by 90% or more, but the studies used highly selected patients from referral centers, and the comparison groups were not population based. We studied the efficacy of bilateral prophylactic mastectomy in women with elevated breast cancer risk cared for in community practices.
METHODS
We conducted a retrospective case-cohort study of women aged 18 to 80 years with 1 or more breast cancer risk factors (family history of breast cancer, history of atypical hyperplasia, or > or =1 breast biopsies with benign findings). Using computerized data and medical records, we identified 276 women with bilateral prophylactic mastectomy and a stratified random sample of 196 women representing an underlying cohort of 666 800 women with elevated breast cancer risk without prophylactic mastectomy, and then we determined who developed breast cancer.
RESULTS
Breast cancer developed in 1 woman (0.4%) after bilateral prophylactic mastectomy vs 26 800 women (4.0%) without prophylactic mastectomy. Stratifying by birth year, the hazard ratio for breast cancer occurrence after bilateral prophylactic mastectomy was 0.005 (95% confidence interval, 0.001-0.044). No woman with bilateral prophylactic mastectomy died of breast cancer vs a calculated 0.2% of women without prophylactic mastectomy.
CONCLUSIONS
Bilateral prophylactic mastectomy reduced breast cancer incidence in women at elevated risk for breast cancer cared for in community-based practices. However, the absolute risk of breast cancer incidence and death in women who did not undergo the procedure in these settings was relatively low.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Breast Neoplasms; Female; Humans; Incidence; Mastectomy, Simple; Middle Aged; Primary Prevention; Retrospective Studies; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 15767526
DOI: 10.1001/archinte.165.5.516 -
Plastic and Reconstructive Surgery Jun 1991Skin-sparing mastectomy by definition describes the procedure of mastectomy, either simple or modified radical, with a minimum amount of skin excision. The surgical skin...
Skin-sparing mastectomy by definition describes the procedure of mastectomy, either simple or modified radical, with a minimum amount of skin excision. The surgical skin excision must: (1) include the nipple-areola complex, (2) include the biopsy site, and (3) allow for access to the axilla for possible dissection. In 27 mastectomies, the senior author has had direct input in the preoperative skin planning. All patients underwent immediate breast reconstruction. In large-breasted women, the mastectomy was performed to a Wise-type pattern. In small-breasted women, the mastectomy involved minimal skin excision followed by reconstruction. Non-continuous incisions were frequently used in small-breasted women, thereby minimizing breast scarring. When appropriately applied, skin-sparing mastectomy can greatly improve the final aesthetic result of the breast.
Topics: Adult; Breast Neoplasms; Carcinoma; Female; Humans; Mastectomy, Modified Radical; Mastectomy, Simple; Middle Aged; Paget's Disease, Mammary; Patient Care Planning; Surgical Flaps
PubMed: 1852020
DOI: No ID Found -
Journal of the American College of... May 2013Several previous studies have reported conflicting data on recent trends in use of initial total mastectomy (TM); the factors that contribute to TM variation are not...
BACKGROUND
Several previous studies have reported conflicting data on recent trends in use of initial total mastectomy (TM); the factors that contribute to TM variation are not entirely clear. Using a multi-institution database, we analyzed how practice, patient, and tumor characteristics contributed to variation in TM for invasive breast cancer.
STUDY DESIGN
We collected detailed clinical and pathologic data about breast cancer diagnosis, initial, and subsequent breast cancer operations performed on all female patients from 4 participating institutions from 2003 to 2008. We limited this analysis to 2,384 incident cases of invasive breast cancer, stages I to III, and excluded patients with clinical indications for mastectomy. Predictors of initial TM were identified with univariate analyses and random effects multivariable logistic regression models.
RESULTS
Initial TM was performed on 397 (16.7%) eligible patients. Use of preoperative MRI more than doubled the rate of TM (odds ratio [OR] = 2.44; 95% CI, 1.58-3.77; p < 0.0001). Increasing tumor size, high nuclear grade, and age were also associated with increased rates of initial TM. Differences by age and ethnicity were observed, and significant variation in the frequency of TM was seen at the individual surgeon level (p < 0.001). Our results were similar when restricted to tumors <20 mm.
CONCLUSIONS
We identified factors associated with initial TM, including preoperative MRI and individual surgeon, that contribute to the current debate about variation in use of TM for the management of breast cancer. Additional evaluation of patient understanding of surgical options and outcomes in breast cancer and the impact of the surgeon provider is warranted.
Topics: Adult; Age Distribution; Age Factors; Aged; Breast Neoplasms; Carcinoma, Ductal, Breast; Female; Humans; Mastectomy, Simple; Middle Aged; Multivariate Analysis; Neoplasm Grading; Odds Ratio; Risk Factors; United States
PubMed: 23490543
DOI: 10.1016/j.jamcollsurg.2013.01.011 -
The British Journal of Radiology Dec 1948
Topics: Breast; Breast Neoplasms; Humans; Mastectomy, Simple; Neoplasms
PubMed: 18099752
DOI: 10.1259/0007-1285-21-252-599 -
Seminars in Surgical Oncology 1996Reconstructive surgery has become an integral part of primary breast cancer therapy in patients requiring total mastectomy. State-of-the-art reconstructions with... (Review)
Review
Reconstructive surgery has become an integral part of primary breast cancer therapy in patients requiring total mastectomy. State-of-the-art reconstructions with autogenous tissue are transverse rectus abdominis (TRAM) flap procedures. Superior aesthetic results in terms of both appearance and consistency, seem to outweigh the disadvantages of impaired abdominal wall competence and donor site scars. The "free," microvascular TRAM flap may be the way to minimize abdominal wall weakness, since only a little portion of the rectus abdominis muscle must be sacrificed. Despite all discussions, breast reconstruction using silicone (gel) implants is a safe and reliable method and will be in the future. However, not every patient may be the right candidate for silicone reconstruction. Advantages of using silicone implants include (relatively) simple technique, short operation time, and no donor site morbidity. In patients suffering from breast-conserving therapy failures, plastic surgery has to address skin and parenchymal loss in an irradiated environment. Oncoplastic surgery, such as volume shrinking or volume replacement techniques, are useful for immediate reconstruction in breast-conserving therapy.
Topics: Breast Implants; Breast Neoplasms; Esthetics; Female; Forecasting; Humans; Mastectomy, Simple; Rectus Abdominis; Silicones; Surgery, Plastic; Surgical Flaps; Tissue Expansion
PubMed: 8821412
DOI: 10.1002/(SICI)1098-2388(199601/02)12:1<67::AID-SSU10>3.0.CO;2-6 -
American Journal of Surgery Apr 2000To identify patient characteristics associated with outpatient mastectomies and their outcomes. (Comparative Study)
Comparative Study
BACKGROUND
To identify patient characteristics associated with outpatient mastectomies and their outcomes.
METHODS
Patients diagnosed with breast cancer and treated with mastectomies in Florida in 1994 were identified from state discharge abstracts and the state tumor registry. The relationship between clinical/demographic characteristics and the odds of having an outpatient mastectomy was identified using multiple logistic regression. Outcomes were assessed by calculating the risk of being rehospitalized within 30 days of discharge.
RESULTS
Twenty percent of mastectomies were performed on an outpatient basis. Outpatient mastectomies were more likely to be performed on women who were older, who lived in higher income communities, or who were uninsured. Health insurance type was not associated with having an outpatient mastectomy. Women undergoing outpatient mastectomy were more likely to be readmitted within 30 days of discharge; however, the excess risk was very small (0.7%).
CONCLUSIONS
The risks from outpatient mastectomy are small. Ongoing monitoring of outcomes and assessment of patient satisfaction are needed.
Topics: Ambulatory Surgical Procedures; Chi-Square Distribution; Confidence Intervals; Female; Florida; Humans; Length of Stay; Mastectomy, Modified Radical; Mastectomy, Simple; Patient Readmission; Socioeconomic Factors
PubMed: 10875979
DOI: 10.1016/s0002-9610(00)00336-6 -
The New England Journal of Medicine Sep 1989
Comparative Study
Topics: Breast Neoplasms; Humans; Male; Mastectomy, Segmental; Mastectomy, Simple
PubMed: 2770797
DOI: 10.1056/NEJM198909073211016 -
Canadian Journal of Surgery. Journal... Oct 1992To determine the treatment that offered the best local control for isolated local recurrences of breast cancer after lumpectomy without radiotherapy, the authors...
To determine the treatment that offered the best local control for isolated local recurrences of breast cancer after lumpectomy without radiotherapy, the authors reviewed 355 patients initially treated by lumpectomy (with or without axillary dissection) without radiotherapy. Local breast cancer recurred in 79 patients. They underwent either repeat partial mastectomy (PM) or completion total mastectomy (TM). Twenty-four patients (5 TM, 19 PM) received radiotherapy. Local control was defined as the absence of further recurrence of breast or chest-wall cancer. The 19 patients treated with repeat PM and radiotherapy had an actuarial local control rate of 82% at 5 years. Those treated with TM (28 patients) [corrected] or TM plus radiation (5 patients) had rates of local control of 60% and 52% respectively. Although there were no significant differences between the TM and PM plus radiotherapy groups, the 27 patients who had a repeat PM without radiotherapy had a significantly lower rate of local control (32%, p < 0.005). Treatment of recurrent breast cancer with PM and radiotherapy is a viable alternative to TM for enhancing local control. Repeat PM alone gave much poorer results. The authors conclude that local cancer recurrences after lumpectomy alone do not necessarily require TM and can often be treated with repeat excision and radiotherapy.
Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Combined Modality Therapy; Female; Humans; Mastectomy, Segmental; Mastectomy, Simple; Middle Aged; Neoplasm Recurrence, Local; Reoperation
PubMed: 1393861
DOI: No ID Found -
Surgery, Gynecology & Obstetrics Sep 1993The treatment of potentially curable carcinoma of the breast has changed from one operation, radical mastectomy, to a flexible approach. At the Cleveland Clinic, we use...
The treatment of potentially curable carcinoma of the breast has changed from one operation, radical mastectomy, to a flexible approach. At the Cleveland Clinic, we use four types of treatment for primary potentially curable carcinoma of the breast (Stages 0, I and II)--modified radical mastectomy, simple mastectomy, partial mastectomy with postoperative adjuvant radiation therapy and partial mastectomy without radiation therapy. The latter treatment (partial mastectomy without adjuvant radiation) is controversial. We recommend this procedure for patients with T(is) and T1 carcinomas that appear to be localized, without lymph node metastases, Stages 0 and I disease. The overall and disease-free survival rates are similar to those of patients having modified radical or partial mastectomy with radiation. Local recurrence is slightly higher at five years (11.0 percent) as compared with the other procedures, but at ten years, is only 16.1 percent, a figure comparable with patients having partial mastectomy with radiation (14.4 percent). For patients with Stages 0 and I carcinoma of the breast, the addition of postoperative radiation therapy after partial mastectomy seems to be unnecessary.
Topics: Breast Neoplasms; Carcinoma; Carcinoma, Intraductal, Noninfiltrating; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Incidence; Mastectomy, Segmental; Mastectomy, Simple; Neoplasm Recurrence, Local; Neoplasm Staging; Survival Rate
PubMed: 8395083
DOI: No ID Found -
The American Surgeon Aug 1994This study reviewed 26 women who had resection of a malignant cystosarcoma phyllodes. Clinical presentations were palpable mass, 25; pain, 11; and ulceration, 2....
UNLABELLED
This study reviewed 26 women who had resection of a malignant cystosarcoma phyllodes. Clinical presentations were palpable mass, 25; pain, 11; and ulceration, 2. Definitive surgical therapy was radical mastectomy (RM), 2; modified radical mastectomy (MRM), 14; total mastectomy (TM), 4; and partial mastectomy (PM), 6. Tumors ranged in size from 1-20 cm (median, 7 cm). Eight patients developed recurrent disease after 10-45 months. Local recurrence was more likely after TM and PM than after MRM and RM (P < 0.05). Patients who developed local recurrence only were treated by wide re-excision, and all such patients are alive with no evidence of disease at 5-25 years. Only one of 16 patients undergoing axillary dissection had involved lymph nodes. Four patients whose tumors ranged from 5-8 cm and who underwent one RM and three MRM developed systemic recurrence; all died of their disease after 15-48 months.
CONCLUSION
1) Although there is a higher local recurrence after PM and TM as compared with MRM and RM for malignant cystosarcoma phyllodes, the local recurrence can be treated with wide excision without affecting long-term survival; 2) systemic recurrence was not related to size or extent of resection; 3) axillary dissection does not predict for or prevent recurrence.
Topics: Adult; Aged; Aged, 80 and over; Bone Neoplasms; Breast Neoplasms; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Lung Neoplasms; Lymph Node Excision; Lymphatic Metastasis; Mastectomy, Modified Radical; Mastectomy, Radical; Mastectomy, Segmental; Mastectomy, Simple; Middle Aged; Neoplasm Recurrence, Local; Phyllodes Tumor; Prognosis; Retrospective Studies; Survival Rate
PubMed: 8030812
DOI: No ID Found