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Anesthesiology May 2020
Topics: Anesthesia; Breast Neoplasms; Humans; Mastectomy; Neoplasm Recurrence, Local
PubMed: 32053560
DOI: 10.1097/ALN.0000000000003196 -
CMAJ : Canadian Medical Association... Oct 2023
Topics: United States; Humans; Female; Mastectomy; Breast Neoplasms; Retrospective Studies
PubMed: 37788839
DOI: 10.1503/cmaj.230801 -
Anesthesiology Apr 2020Pain and nausea are the most common challenges in postoperative recovery after mastectomy. Preventive measures include multimodal analgesia with preoperative... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Pain and nausea are the most common challenges in postoperative recovery after mastectomy. Preventive measures include multimodal analgesia with preoperative glucocorticoid. The aim of this study was to investigate whether 24 mg of preoperative dexamethasone was superior to 8 mg on early recovery after mastectomy in addition to a simple analgesic protocol.
METHODS
In a randomized, double-blind trial, patients 18 yr of age or older having mastectomy were randomized 1:1 to 24 mg or 8 mg dexamethasone, and all received a standardized anesthetic and surgical protocol with preoperative acetaminophen, total intravenous anesthesia, and local anesthetic wound infiltration. The primary endpoint was number of patients transferred to the postanesthesia care unit according to standardized discharge criteria (modified Aldrete score). Secondary endpoints included pain and nausea at extubation, transfer from the operating room and upon arrival at the ward, length of stay, seroma occurrence, and wound infections.
RESULTS
One hundred thirty patients (65 in each group) were included and analyzed for the primary outcome. Twenty-three (35%) in each group met the primary outcome, without significant differences in standardized discharge scores (odds ratio, 1.00 [95% CI, 0.49 to 2.05], P > 0.999). More patients had seroma requiring drainage in the 24 mg versus 8 mg group, 94% versus 81%, respectively (odds ratio, 3.53 [95% CI, 1.07 to 11.6], P = 0.030). Median pain scores were low at all measured time points, numeric rating scale less than or equal to 2 versus less than or equal to 1 in the 24 mg versus 8 mg group, respectively. Six patients in each group (9%) experienced nausea at any time during hospital stay (P > 0.999). Length of stay was median 11 and 9.2 h in the 24 and 8 mg group, respectively (P = 0.217).
CONCLUSIONS
The authors found no evidence of 24 mg versus 8 mg of dexamethasone affecting the primary outcome regarding immediate recovery after mastectomy. The authors observed a short length of stay and low pain scores despite a simple analgesic protocol.
Topics: Adult; Aged; Aged, 80 and over; Dexamethasone; Dose-Response Relationship, Drug; Double-Blind Method; Female; Glucocorticoids; Humans; Male; Mastectomy; Middle Aged; Pain, Postoperative; Postoperative Care; Prospective Studies; Recovery of Function; Time Factors; Young Adult
PubMed: 31977520
DOI: 10.1097/ALN.0000000000003112 -
Canadian Journal of Surgery. Journal... Oct 2011Prophylactic mastectomy is performed to decrease the risk of breast cancer in women at high risk for the disease. The benefit of sentinel lymph node biopsy (SLNB) at the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Prophylactic mastectomy is performed to decrease the risk of breast cancer in women at high risk for the disease. The benefit of sentinel lymph node biopsy (SLNB) at the time of prophylactic mastectomy is controversial, and we performed a meta-analysis of the reported data to assess that benefit.
METHODS
We searched MEDLINE, EMBASE and the Cochrane Library databases from January 1993 to December 2009 for studies on patients who underwent SLNB at the time of prophylactic mastectomy. Two reviewers independently evaluated all the identified papers, and only retrospective studies were included. We used a mixed-effect model to combine data.
RESULTS
We included 6 studies in this review, comprising a total study population of 1251 patients who underwent 1343 prophylactic mastectomies. Of these 1343 pooled prophylactic mastectomies, the rate of occult invasive cancer (21 cases) was 1.7% (95% confidence interval [CI] 1.1%-2.5%), and the rate of positive SLNs (23 cases) was 1.9% (95% CI 1.2%-2.6%). In all, 36 cases (2.8%, 95% CI 2.0%-3.8%) led to a significant change in surgical management as a result of SLNB at the time of prophylactic mastectomy. In 17 cases, patients with negative SLNs were found to have invasive cancer at the time of prophylactic mastectomy and avoided axillary lymph node dissection (ALND). In 19 cases, patients with positive SLNBs were found not to have invasive cancer at the time of prophylactic mastectomy and needed a subsequent ALND. Of the 23 cases with positive SLNs, about half the patients had locally advanced disease in the contralateral breast.
CONCLUSION
Sentinel lymph node biopsy is not suitable for all patients undergoing prophylactic mastectomy, but it may be suitable for patients with contralateral, locally advanced breast cancer.
Topics: Breast Neoplasms; Female; Global Health; Humans; Incidence; Intraoperative Period; Lymphatic Metastasis; Mastectomy; Reproducibility of Results; Sentinel Lymph Node Biopsy
PubMed: 21651834
DOI: 10.1503/cjs.006010 -
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 -
Breast Cancer Research and Treatment Jan 2024Up to 40% of the 56,000 women diagnosed with breast cancer each year in the UK undergo mastectomy. Seroma formation following surgery is common, may delay wound healing,...
PURPOSE
Up to 40% of the 56,000 women diagnosed with breast cancer each year in the UK undergo mastectomy. Seroma formation following surgery is common, may delay wound healing, and be uncomfortable or delay the start of adjuvant treatment. Multiple strategies to reduce seroma formation include surgical drains, flap fixation and external compression exist but evidence to support best practice is lacking. We aimed to survey UK breast surgeons to determine current practice to inform the feasibility of undertaking a future trial.
METHODS
An online survey was developed and circulated to UK breast surgeons via professional and trainee associations and social media to explore current attitudes to drain use and management of post-operative seroma. Simple descriptive statistics were used to summarise the results.
RESULTS
The majority of surgeons (82/97, 85%) reported using drains either routinely (38, 39%) or in certain circumstances (44, 45%). Other methods for reducing seroma such as flap fixation were less commonly used. Wide variation was reported in the assessment and management of post-operative seromas. Over half (47/91, 52%) of respondents felt there was some uncertainty about drain use after mastectomy and axillary surgery and two-thirds (59/91, 65%) felt that a trial evaluating the use of drains vs no drains after simple breast cancer surgery was needed.
CONCLUSIONS
There is a need for a large-scale UK-based RCT to determine if, when and in whom drains are necessary following mastectomy and axillary surgery. This work will inform the design and conduct of a future trial.
Topics: Female; Humans; Mastectomy; Seroma; Breast Neoplasms; Drainage; Postoperative Complications
PubMed: 37878150
DOI: 10.1007/s10549-023-07042-7 -
Acta Veterinaria Scandinavica Jun 2015Surgery is the treatment of choice for regional control of mammary neoplasms in female dogs. Various surgical techniques may be used, as long as mammary gland anatomy,...
BACKGROUND
Surgery is the treatment of choice for regional control of mammary neoplasms in female dogs. Various surgical techniques may be used, as long as mammary gland anatomy, lymphatic drainage, and known prognostic factors are respected. The purpose of this study was to compare surgical stress-including duration of surgery, nociception and hematological changes-and postoperative complications in dogs undergoing regional and unilateral radical mastectomy. Eighteen dogs were selected for each technique. Postoperative pain (nociception), hematological changes, and postoperative complications were compared between the two groups.
RESULTS
The group treated with radical mastectomy had a longer surgical duration, showed more intense physiological changes, achieved higher scores on nociception scales, and experienced more postoperative complications.
CONCLUSION
Compared to regional mastectomy, radical mastectomy was associated with longer surgical duration, greater nociceptive stimulus, greater surgical stress, and higher incidence of postoperative complications in dogs. Although evaluation of long-term results was not a goal of this study, it is suggested that postoperative recovery and patient quality of life should be considered when choosing a surgical approach for treating mammary tumors in dogs.
Topics: Animals; Blood Chemical Analysis; Dog Diseases; Dogs; Female; Hematologic Tests; Mammary Neoplasms, Animal; Mastectomy; Mastectomy, Radical; Nociception; Postoperative Complications; Stress, Physiological; Time Factors
PubMed: 26104069
DOI: 10.1186/s13028-015-0121-3 -
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 -
Archives of Gynecology and Obstetrics Nov 2023The development of a seroma after breast cancer surgery is a common postoperative complication seen after simple mastectomy and axillary surgery. We could recently...
PURPOSE
The development of a seroma after breast cancer surgery is a common postoperative complication seen after simple mastectomy and axillary surgery. We could recently demonstrate that breast cancer patients undergoing a simple mastectomy with subsequent seroma formation developed a T-helper cell increase within the aspirated fluid measured by flow cytometry. The same study revealed a Th2 and/or a Th17 immune response in peripheral blood and seroma fluid of the same patient. Based on these results and within the same study population, we now analyzed the Th2/Th17 cell associated cytokine content as well as the best known clinical important cytokine IL-6.
METHODS
Multiplex cytokine measurements (IL-4, IL-5, IL-13, IL-10, IL-17, and IL-22) were done on 34 seroma fluids (Sf) after fine needle aspiration of patients who developed a seroma after a simple mastectomy. Serum of the same patient (Sp) and that of healthy volunteers (Sc) were used as controls.
RESULTS
We found the Sf to be highly cytokine rich. Almost all analyzed cytokines were significantly higher in abundance in the Sf compared to Sp and Sc, especially IL-6, which promotes Th17 differentiation as well as suppresses Th1 differentiation in favor of Th2 development.
CONCLUSION
Our Sf cytokine measurements reflect a local immune event. In contrast, former study results on T-helper cell populations in both Sf and Sp tend to demonstrate a systemic immune process.
Topics: Humans; Female; Cytokines; Breast Neoplasms; Interleukin-6; Th17 Cells; Th1 Cells; Seroma; Mastectomy
PubMed: 37243864
DOI: 10.1007/s00404-023-07074-w -
Nursing Forum Nov 2020Recent discourses within breast cancer and gendered studies literature suggest some women are challenging postmastectomy bodies as abject bodies. Tattooing is an...
Recent discourses within breast cancer and gendered studies literature suggest some women are challenging postmastectomy bodies as abject bodies. Tattooing is an emerging body project in contemporary society that can offer women who live disembodied from their postmastectomized body an alternative. We consider embodied health movements, a type of social movement, to explore how acquiring meaningful tattoo art over a mastectomized site can been seen as challenging hegemonic, gendered discourses of the female breast and patriarchal ideals of beauty, post mastectomy. As part of emancipatory practices, tattooed bodies have historically been used to challenge dominant discourses related to identity and is currently evolving into practices of self-expression, healing, and transformation. As an emerging phenomenon among women, it is important for nurses to understand the prevalence and role of tattoos more broadly, and the possible means for women to embody healing and transformation post mastectomy.
Topics: Adult; Body Image; Female; Humans; Mastectomy; Self Concept; Tattooing
PubMed: 32682350
DOI: 10.1111/nuf.12486