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European Journal of Surgical Oncology :... Jul 2016Skin-sparing mastectomy (SSM) facilitates immediate breast reconstruction. We investigated locoregional recurrence rates after SSM compared with simple mastectomy and...
UNLABELLED
Skin-sparing mastectomy (SSM) facilitates immediate breast reconstruction. We investigated locoregional recurrence rates after SSM compared with simple mastectomy and the factors predicting oncological failure.
METHODS
Patients with early breast cancer that underwent mastectomy between 2000 and 2005 at a single institution were studied to ascertain local and systemic recurrence rates between groups. Kaplan-Meier curves and log-rank test were used to evaluate disease-free survival.
RESULTS
Patients (n = 577) underwent simple mastectomy (80%) or SSM (20%). Median follow up was 80 months. Patients undergoing SSM were of younger average age, less often had involved lymph nodes (22% vs 44%, p < 0.001), more often had DCIS present (79% vs 53%, p < 0.001) and involved margins (29% vs 15%, p = 0.001). Involved surgical margins were associated with large size (p = 0.001). The 8-year local recurrence (LR) rates were 7.9% for SSM and 5% for simple mastectomy respectively (p = 0.35). Predictors of locoregional recurrence were lymph node involvement (HR 8.0, for >4 nodes, p < 0.001) and involved surgical margins (HR 3.3, p = 0.002). In node negative patients, SSM was a predictor of locoregional recurrence (HR 4.8 [1.1, 19.9], p = 0.033).
CONCLUSION(S)
Delayed reconstruction is more appropriate for node positive early breast cancer after post-mastectomy radiotherapy. Re-excision of involved margins is essential to prevent local recurrence after mastectomy.
Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Chemotherapy, Adjuvant; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Margins of Excision; Mastectomy, Simple; Middle Aged; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Neoplasm Staging; Organ Sparing Treatments; Predictive Value of Tests; Radiotherapy, Adjuvant; Retrospective Studies; Risk Factors; Skin
PubMed: 27256869
DOI: 10.1016/j.ejso.2016.04.055 -
The New England Journal of Medicine Jan 1999Options for women at high risk for breast cancer include surveillance, chemoprevention, and prophylactic mastectomy. The data on the outcomes for surveillance and...
BACKGROUND
Options for women at high risk for breast cancer include surveillance, chemoprevention, and prophylactic mastectomy. The data on the outcomes for surveillance and prophylactic mastectomy are incomplete.
METHODS
We conducted a retrospective study of all women with a family history of breast cancer who underwent bilateral prophylactic mastectomy at the Mayo Clinic between 1960 and 1993. The women were divided into two groups - high risk and moderate risk - on the basis of family history. A control study of the sisters of the high-risk probands and the Gail model were used to predict the number of breast cancers expected in these two groups in the absence of prophylactic mastectomy.
RESULTS
We identified 639 women with a family history of breast cancer who had undergone bilateral prophylactic mastectomy: 214 at high risk and 425 at moderate risk. The median length of follow-up was 14 years. The median age at prophylactic mastectomy was 42 years. According to the Gall model, 37.4 breast cancers were expected in the moderate-risk group; 4 breast cancers occurred (reduction in risk, 89.5 percent; P<0.001). We compared the numbers of breast cancers among the 214 high-risk probands with the numbers among their 403 sisters who had not undergone prophylactic mastectomy. Of these sisters, 38.7 percent (156) had been given a diagnosis of breast cancer (115 cases were diagnosed before the respective proband's prophylactic mastectomy, 38 were diagnosed afterward, and the time of the diagnosis was unknown in 3 cases). By contrast, breast cancer was diagnosed in 1.4 percent (3 of 214) of the probands. Thus, prophylactic mastectomy was associated with a reduction in the incidence of breast cancer of at least 90 percent.
CONCLUSIONS
In women with a high risk of breast cancer on the basis of family history, prophylactic mastectomy can significantly reduce the incidence of breast cancer.
Topics: Adolescent; Adult; Aged; Breast; Breast Neoplasms; Female; Follow-Up Studies; Humans; Incidence; Mastectomy; Mastectomy, Simple; Mastectomy, Subcutaneous; Middle Aged; Nuclear Family; Probability; Retrospective Studies; Risk Factors
PubMed: 9887158
DOI: 10.1056/NEJM199901143400201 -
Journal of the American College of... Jan 2001
Topics: Breast; Breast Neoplasms; Female; Humans; Mastectomy, Modified Radical; Mastectomy, Simple; Plastic Surgery Procedures
PubMed: 11192925
DOI: 10.1016/s1072-7515(00)00769-9 -
Annals of Surgery Feb 1963
Topics: Breast Neoplasms; Humans; Mastectomy, Simple; Postoperative Period; Therapeutics
PubMed: 14030019
DOI: No ID Found -
The Nigerian Postgraduate Medical... 2021Various regional anaesthetic techniques are used for post-mastectomy pain relief; however, thoracic paravertebral block (TPVB) has shown some advantages over other... (Randomized Controlled Trial)
Randomized Controlled Trial
Analgesic and opioid sparing effects of preoperative thoracic paravertebral block: A double blind evaluation of 0.5% bupivacaine with adrenaline in patients scheduled for simple mastectomy.
BACKGROUND
Various regional anaesthetic techniques are used for post-mastectomy pain relief; however, thoracic paravertebral block (TPVB) has shown some advantages over other methods. This study sought to demonstrate the post-operative benefit of pre-operative TPVB in patients scheduled for simple mastectomy.
METHODS
The study was carried out on 60 adult female patients with the American Society of Anesthesiologists physical status Class I to III scheduled for unilateral mastectomy. Pre-operatively, a nerve stimulator was used to locate the paravertebral space thereafter bupivacaine with adrenaline or saline was injected into the space. Post-operatively, intravenous morphine patient controlled analgesia was commenced in the two groups for 24 h after the surgery. In addition, intravenous paracetamol 15 mg/kg was administered 6 hourly for 24 h in both groups.
RESULTS
The 24 h morphine consumption was significantly reduced in the bupivacaine group compared to the control group (P = 0.000). The Numerical pain rating score was significantly lower in the bupivacaine group than in the control group in the 1 6 h; P = 0.001. The time to first request for analgesia was significantly longer in the bupivacaine group than the control group (P = 0.000). Nausea was the major side effect detected and this was significantly higher in the control group (P = 0.024). The morphine sparing effect was 65.7% in the bupivacaine group.
CONCLUSION
The study showed that bupivacaine-based TPVB provided an effective post-operative analgesic and opioid-sparing effect for simple mastectomy when compared with a saline-based control group that received only intravenous morphine patient controlled analgesia and paracetamol.
Topics: Adult; Analgesia, Patient-Controlled; Analgesics; Analgesics, Opioid; Anesthetics, Local; Breast Neoplasms; Bupivacaine; Epinephrine; Female; Humans; Mastectomy; Mastectomy, Simple; Nigeria; Pain, Postoperative
PubMed: 34494595
DOI: 10.4103/npmj.npmj_460_21 -
Health Services Research Oct 2001To determine (1) the use of outpatient services for all surgical breast procedures for breast cancer and (2) the influence of payer and state on the use of outpatient...
OBJECTIVE
To determine (1) the use of outpatient services for all surgical breast procedures for breast cancer and (2) the influence of payer and state on the use of outpatient services for complete mastectomy in light of state and federal length-of-stay managed care legislation.
DATA SOURCES
Healthcare Cost and Utilization Project representing all discharges from hospitals and ambulatory surgery centers for five states (Colorado, Connecticut, Maryland, New Jersey, and New York) and seven years (1990-96).
STUDY DESIGN
Longitudinal, cross-sectional analyses of all women undergoing inpatient and outpatient complete mastectomy (CMAS), subtotal mastectomy (STMAS), and lumpectomy (LUMP) for cancer were employed. Total age-adjusted rates and percentage of outpatient CMAS, STMAS, and LUMP were compared. Independent influence of state and HMO payer on likelihood of receiving an outpatient CMAS was determined from multivariate models, adjusting for clinical characteristics (age < 50 years, comorbidity, metastases, simple mastectomy, breast reconstruction) and hospital characteristics (teaching, ownership, urban).
PRINCIPAL FINDINGS
In 1993, 1 to 2 percent of CMASs were outpatient in all states. By 1996, 8 percent of CMASs were outpatient in Connecticut, 13 percent were outpatient in Maryland, and 22 percent were outpatient in Colorado. In comparison, LUMPs were 78 to 88 percent outpatient, and by 1996, 43 to 72 percent of STMASs were outpatient. In 1996, women were 30 percent more likely to receive an outpatient CMAS in New York, 2.5 times more likely in Connecticut, 4.7 times more likely in Maryland, and 8.6 times more likely in Colorado compared to New Jersey. In addition, women with Medicare, Medicaid, or private commercial insurance were less likely to receive an outpatient CMAS compared to women with an HMO payer.
CONCLUSIONS
LUMP is an outpatient procedure, and STMAS is becoming primarily outpatient. CMAS, while still primarily inpatient, is increasingly outpatient in some states. Although clinical characteristics remain important, the state in which a woman receives care and whether she has an HMO payer are strong determinants of whether she receives an outpatient CMAS.
Topics: Adult; Ambulatory Surgical Procedures; Breast Neoplasms; Comorbidity; Cross-Sectional Studies; Female; Geography; Health Maintenance Organizations; Health Services Research; Humans; Insurance Coverage; Logistic Models; Longitudinal Studies; Mastectomy; Mastectomy, Segmental; Mastectomy, Simple; Medicare; Middle Aged; Practice Patterns, Physicians'; United States; Utilization Review
PubMed: 11666108
DOI: No ID Found -
International Journal of Radiation... Mar 2008To determine the incidence and factors associated with the development of arm edema in women who participated in the National Surgical Adjuvant Breast and Bowel Project... (Randomized Controlled Trial)
Randomized Controlled Trial
The incidence of arm edema in women with breast cancer randomized on the National Surgical Adjuvant Breast and Bowel Project study B-04 to radical mastectomy versus total mastectomy and radiotherapy versus total mastectomy alone.
PURPOSE
To determine the incidence and factors associated with the development of arm edema in women who participated in the National Surgical Adjuvant Breast and Bowel Project (NSABP) study B-04.
METHODS AND MATERIALS
Between 1971 and 1974, the NSABP protocol B-04 randomized 1,665 eligible patients with resectable breast cancer to either (1) the Halstead-type radical mastectomy; (2) total mastectomy and radiotherapy to the chest wall, axilla, supraclavicular region, and internal mammary nodes if by clinical examination axillary nodes were involved by tumor; and (3) for patients with a clinically uninvolved axilla, a third arm, total mastectomy alone. Measurements of the ipsilateral and contralateral arm circumferences were to be performed every 3 months.
RESULTS
There was at least one recorded measurement of arm circumferences for 1,457 patients (87.5% of eligible patients). There were 674 women (46.3%) who experienced arm edema at some point during the period of follow-up until February 1976. For radical mastectomy patients, total mastectomy and radiotherapy patients, and total mastectomy patients alone, arm edema was recorded at least once in 58.1%, 38.2%, and 39.1% of patients, respectively (p<.001) and at last recorded measurement in 30.7%, 14.8%, and 15.5%, respectively (p=or<.001). Increasing body mass index (BMI) also showed a statistically significant correlation with arm edema at any time (p=.001) and at last assessment (p=.005).
CONCLUSIONS
Patients who undergo mastectomy, including those whose treatment plans do not include axillary dissection or postoperative radiotherapy, suffer an appreciable incidence of arm edema.
Topics: Analysis of Variance; Arm; Breast Neoplasms; Combined Modality Therapy; Dose Fractionation, Radiation; Female; Humans; Incidence; Lymphedema; Mastectomy, Radical; Mastectomy, Simple; Regression Analysis
PubMed: 18029105
DOI: 10.1016/j.ijrobp.2007.07.2376 -
The Breast Journal 2009After total mastectomy, many women choose to wear external breast prosthesis rather than undergo breast reconstruction. The purpose of this study was to evaluate...
After total mastectomy, many women choose to wear external breast prosthesis rather than undergo breast reconstruction. The purpose of this study was to evaluate long-term satisfaction among external breast prosthesis wearers and the impact of satisfaction on prosthesis use. A questionnaire was designed to assess demographic information, prosthesis information provision, prosthesis use, and satisfaction with prosthesis. Fifty-nine women who had undergone total mastectomy without breast reconstruction completed the questionnaire. The majority of women (68%) were at least 5 years out from mastectomy. Approximately half (49%) of the women had received information about breast prostheses prior to mastectomy; 29% received information from the surgeon performing the operation. Frequent and prolonged prosthesis use was prevalent with 64% of participants reporting prosthesis use all the time, 6-7 days/week. Participants showed high rates (83%) of overall satisfaction. However, women who wore their prosthesis out in public only were less satisfied than more frequent wearers (50% versus 89%, chi(2) = 8.83, d.f. = 1, alpha = 0.05). Satisfaction increased over time, as women who were greater than 5 years out from mastectomy were more satisfied than women less that 5 years post-mastectomy (90% versus 67%, chi(2) = 4.43, d.f. = 1, alpha = 0.05). The vast majority of women are satisfied with their external breast prosthesis several years after mastectomy. Most women used their prosthesis all the time and overall satisfaction contributed to higher levels of prosthesis use. Given the long-term importance of external breast prostheses for women who have undergone mastectomy, a greater effort to inform patients about external breast prostheses prior to surgery is needed.
Topics: Breast Implantation; Educational Status; Equipment Design; Ethnicity; Female; Follow-Up Studies; Humans; Mastectomy, Simple; Personal Satisfaction; Surveys and Questionnaires; Time Factors
PubMed: 19601944
DOI: 10.1111/j.1524-4741.2009.00742.x -
Microsurgery Feb 2022Superficial circumflex iliac artery (SCIA) perforator (SCIP) flap has been applied in various reconstructions. Unlike traditional groin flap, SCIP flap has a longer...
Superficial circumflex iliac artery (SCIA) perforator (SCIP) flap has been applied in various reconstructions. Unlike traditional groin flap, SCIP flap has a longer pedicle and can be used as a chimeric flap for complex reconstruction. By utilizing both the superficial and the deep branches of the SCIA, a SCIP flap can be raised as an extended large bulky flap. Although there are many articles reporting usefulness of SCIP flap, there is no case reporting a large SCIP flap transfer for breast reconstruction after total mastectomy. We applied a free extended SCIP flap for a case of post-total-mastectomy breast reconstruction. A 51-year-old female who had undergone total mastectomy and sentinel lymph node biopsy was referred for autologous tissue breast reconstruction. Physical exam revealed that the iliac and lower abdominal regions were suitable for a donor site. As the patient desired to preserve a similar donor site for possible future contralateral breast reconstruction, the iliac region was selected as a donor site. A 23 × 15 cm SCIP flap was elevated based on the superficial and the deep branches of the SCIA, and was transferred to the recipient site. The SCIA and concomitant vein were anastomosed to the lateral thoracic artery and vein in an end-to-end fashion. Postoperative course was uneventful. The reconstructed breast shape and texture were similar to the contralateral breast with no donor site complication, and the patient was very satisfied with functionally and esthetically pleasing results. Extended SCIP flap may be an option for relatively-small breast reconstruction.
Topics: Breast Neoplasms; Female; Humans; Iliac Artery; Mammaplasty; Mastectomy; Mastectomy, Simple; Middle Aged; Perforator Flap; Plastic Surgery Procedures
PubMed: 34076295
DOI: 10.1002/micr.30776 -
The New England Journal of Medicine Dec 2002
Topics: Breast Neoplasms; Female; Humans; Mastectomy, Radical; Mastectomy, Simple; Muscle Neoplasms; Neoplasm Invasiveness; Pectoralis Muscles
PubMed: 12501860
DOI: No ID Found