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Alderman AK Hawley ST Morrow M Salem B Hamilton A Graff JJ Katz S 《Annals of surgical oncology》2011,18(6):1748-1756
Background
Postmastectomy breast reconstruction is an important component of breast cancer care, but few receive it at the time of the mastectomy. Virtually nothing is known about receipt of reconstruction after initial cancer therapy and why treatment might be delayed.Materials and Methods
A 5-year follow-up survey was mailed to a population-based cohort of mastectomy-treated breast cancer patients who were initially surveyed at time of diagnosis in 2002 and reported to the Los Angeles and Detroit SEER registries (N = 645, response rate 60%). Outcomes were receipt of reconstruction (immediate [IR], delayed [DR], or none) and patient appraisal of their treatment decisions.Results
About one-third (35.9%) had IR, 11.5% had DR, and 52.6% had no reconstruction. One-third delayed reconstruction because they focused more on other cancer interventions, and nearly half were concerned about surgical complications and interference with cancer surveillance. Two-thirds of those with no reconstruction said that the procedure was not important to them. A large proportion of all patients were satisfied with their reconstruction decision-making (89.4% IR, 78.4% DR, 80.4% no reconstruction, P = NS). However, only 59.3% of those with no reconstruction felt that they were adequately informed about their reconstructive options (vs 82.7% IR and 78.4% DR, P < .01).Conclusions
There was modest uptake of breast reconstruction after initial cancer treatment. Factors associated with delayed reconstruction were primarily related to uncertainty about the procedure, concern about cancer surveillance, and low priority. Those without reconstruction demonstrated significant informational needs, which should be addressed with future research efforts. 相似文献3.
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Juvenile or giant fibroadenoma (JF) is an uncommon fibroadenoma variant usually presenting in adolescence. Although these
masses are benign, when multiple and bilateral, they present a complex challenge to the attending surgeon, both in diagnosis,
and in selection of the most appropriate therapy. Treatment is usually surgical and ranges from simple excision to subcutaneous
mastectomy with reconstruction. We report an unusual case of refractory JF, initially treated with combined hormonal and surgical
treatment but ultimately requiring bilateral subcutaneous mastectomies to prevent tumor regrowth. This case highlights the
occasional difficulty in the management of macromastia in the adolescent female. 相似文献
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Adkisson CD Bagaria SP Parker AS Bray JM Gibson T Thomas CS Heckman MG McLaughlin SA 《Annals of surgical oncology》2012,19(4):1129-1136
Purpose
Breast conserving therapy (BCT) and mastectomy offer equivalent survival for women with newly diagnosed breast cancer (BrCa). Despite this, many women eligible for BCT elect mastectomy. Herein, we identify factors associated with choosing ipsilateral mastectomy instead of BCT when mastectomy is not required. 相似文献6.
Women’s Regrets After Bilateral Prophylactic Mastectomy 总被引:3,自引:0,他引:3
Background: Primary prevention strategies such as chemopreventive agents (e.g., tamoxifen) and bilateral prophylactic mastectomy (PM) have received increasingly more attention as management options for women at high risk of developing breast cancer.Methods: A total of 370 women, who had registered in the Memorial Sloan-Kettering Cancer Center National Prophylactic Mastectomy Registry, reported having undergone a bilateral PM. Twenty-one of these women expressed regrets about their decision to have a PM. A psychiatrist and psychologist interviewed 19 of the women about their experiences with the PM.Results: A physician-initiated rather than patient-initiated discussion about the PM represented the most common factor in these women. Psychological distress and the unavailability of psychological and rehabilitative support throughout the process were the most commonly reported regrets. Additional regrets about the PM related to cosmesis, perceived difficulty of detecting breast cancer in the remaining breast tissue, surgical complications, residual pain, lack of education about the procedure, concerns about consequent body image, and sexual dysfunction.Conclusions: Although a PM statistically reduces the chances of a woman developing breast cancer, the possibility of significant physical and psychological sequelae remains. Careful evaluation, education, and support both before and after the procedure will potentially reduce the level of distress and dissatisfaction in these women. We discuss recommendations for the appropriate surgical and psychiatric evaluation of women who are considering a PM as risk-reducing surgery. 相似文献
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de la Peña-Salcedo JA Soto-Miranda MA Lopez-Salguero JF 《Aesthetic plastic surgery》2012,36(1):140-148
Background
Breast cancer is the second mortality-related cancer and the leading cause of general mortality in women aged 40–55. Prophylactic mastectomy has proved to be effective in several clinical scenarios but is still a somewhat controversial procedure. 相似文献8.
Visnu Lohsiriwat MD Nicole Rotmensz MSc Edoardo Botteri MSc Mattia Intra MD Paolo Veronesi MD Stefano Martella MD Cristina Garusi MD Francesca De Lorenzi MD PhD Andrea Manconi MD Giuseppe Lomeo MD Mario Rietjens MD Mario Schorr MD Maximiliano Cassilha Kneubil MD Jean Yves Petit MD 《Annals of surgical oncology》2013,20(3):990-996
Background
The selections of nipple-sparing mastectomy (NSM) are principally depending on oncologic indication and oncologic safety. The main complication of NSM is nipple areolar complex (NAC) necrosis, and it is usually related to surgical technique. However, the patients’ clinicopathological factors should be also considered.Method
We retrospectively reviewed 934 consecutive NSM patients during 2002–2007 at the European Institute of Oncology, Milan, Italy. We identified a group of patient who had NAC excision because of NAC necrosis and compared this group with those who had successful NAC conservation. We analyzed the association between the risk of NAC necrosis and the clinicopathological features of the patients.Results
Among 934 NSM, 772 were invasive cancers and 162 were in situ cancers. Of the 934, 40 NAC (4.2 %) were removed during the postoperative period because of necrosis. When we considered age, BMI, menopausal status, smoking status, tumor size, axillary lymph node status, in situ or invasive cancer histology, presence of extensive situ component, grading, estrogen receptor, progesterone receptor, HER2/neu overexpression, Ki-67 proliferative index, and peritumoral vascular invasion, no association was observed between patients’ clinicopathological features and NAC necrosis incidence.Conclusions
In our study, clinicopathological features have no significant impact on necrosis complication in therapeutic NSMs. Positive retroareolar margin is the risk of necrosis. Further studies are required to avoid bias due to the different cancer treatments such as different reconstruction techniques and intraoperative radiation protocols. The correlation between breast morphology and NAC necrosis should also be investigated in the future. 相似文献9.
Kopkash Katherine Novak Kevin Kuchta Kristine Yashina Irene Poli Elizabeth Rabbitt Sarah Pesce Catherine Winchester David Yao Katharine 《Annals of surgical oncology》2019,26(10):3216-3223
Annals of Surgical Oncology - Nipple-sparing mastectomies (NSMs) with reconstruction are believed to be more difficult to perform than skin-sparing mastectomies (SSMs), but there is little... 相似文献
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Wagner JL Fearmonti R Hunt KK Hwang RF Meric-Bernstam F Kuerer HM Bedrosian I Crosby MA Baumann DP Ross MI Feig BW Krishnamurthy S Hernandez M Babiera GV 《Annals of surgical oncology》2012,19(4):1137-1144
Background
Psychological effects of mastectomy for women with breast cancer have driven treatments that optimize cosmesis while strictly adhering to oncologic principles. Although skin-sparing mastectomy is oncologically safe, questions remain regarding the use of nipple–areola complex (NAC)-sparing mastectomy (NSM). We prospectively evaluated NSM for patients undergoing mastectomy for early-stage breast cancer or risk reduction.Methods
We enrolled 33 early-stage breast cancer and high-risk patient; 54 NSMs were performed. NAC viability and surgical complications were evaluated. Intraoperative and postoperative pathologic assessments of the NAC base tissue were performed. NAC sensory, cosmetic and quality of life (QOL) outcomes were also assessed.Results
Twenty-one bilateral and 12 unilateral NSMs were performed in 33 patients, 37 (68.5%) for prophylaxis and 17 (31.5%) for malignancy. Mean age was 45.4 years. Complications occurred in 16 NACs (29.6%) and 6 skin flaps (11.1%). Operative intervention for necrosis resulted in 4 NAC removals (7.4%). Two (11.8%) of the 17 breasts with cancer had ductal carcinoma-in-situ at the NAC margin, necessitating removal at mastectomy. All evaluable patients had nipple erection at 6 and 12 months postoperatively. Cosmetic outcome, evaluated by two plastic surgeons, was acceptable in 73.0% of breasts and 55.8% of NACs, but lateral displacement occurred in most cases. QOL assessment indicated patient satisfaction.Conclusions
NSM is technically feasible in select patients, with a low risk for NAC removal resulting from necrosis or intraoperative detection of cancer, and preserves sensation and QOL. Thorough pathologic assessment of the NAC base is critical to ensure disease eradication. 相似文献12.
Kandace P. McGuire MD Alfredo A. Santillan MD MPH Paramjeet Kaur MD Tammi Meade BS Jateen Parbhoo BS Morgan Mathias Corinne Shamehdi BS Michelle Davis BS Daniel Ramos BS Charles E. Cox MD FACS 《Annals of surgical oncology》2009,16(10):2682-2690
Background
The equivalency of survival between mastectomy and breast conservation therapy (BCT) has long been established, resulting in two decades of predominant BCT. Recently, surgeons have recognized a trend toward increasing mastectomy. Institutional trends of mastectomy and BCT were reviewed, confirming this perception in the surgical treatment of breast cancer. This report evaluates the factors that influence patient decisions to choose surgical therapies. 相似文献13.
The value of follow-up after mastectomy for breast cancer is controversial. One reason is to detect metachronous tumour in the contralateral breast, but the optimum method for achieving this is undecided. The long-term follow-up policy of our unit is annual clinical review combined with biennial mammography. We have assessed the benefit of this policy in the detection of tumours of the contralateral breast. The case notes of 216 patients undergoing mastectomy between 1978 and 1985, under the care of one consultant surgeon (DJTW) were reviewed. Follow-up was complete to December 1997, thus allowing a minimum follow-up of 12 years. The development of a metachronous tumour was recorded as was its method of detection : either clinically, by the patient or the clinician, or by routine mammography. Two-hundred and five patients were available for follow-up of the contralateral breast. Seventeen (8.3%) developed metachronous tumours. Eight were detected by the patient, 4 by the clinician and 5 by routine follow-up mammography. Biennial mammography does not appear to be beneficial in breast cancer follow-up. More work is required to determine the benefits of more frequent mammography, with or without breast self-examination and clinical review within the hospital environment or within primary care. 相似文献
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Background This article provides an algorithm for achieving an aesthetically pleasing nipple–areola complex in cases of skin-sparing
mastectomy and immediate reconstruction
Methods If the contralateral nipple was big enough and the nipple-sharing technique could be used in the future for reconstruction,
we left a round skin paddle at the time of the skin-sparing mastectomy and immediate flap reconstruction. The diameter of
the round skin paddle was approximately the same as the contralateral areola. For nipple reconstruction we placed the graft
from the contralateral nipple in the middle of the aforementioned skin paddle. If the contralateral nipple was not sufficiently
large for use as a donor, then the C-V flap was used for nipple reconstruction. In these cases we deliberately left an oval
skin paddle when the skin-sparing mastectomy and immediate flap reconstruction were performed. The short diameter of the oval
skin paddle was approximately the same as the diameter of the contralateral areola. The position and the height of the C-V
flap were marked in order to transform the oval skin paddle to a round one when the donor site of the C-V flap was closed.
Results Following this algorithm an optical illusion of a nipple–areola complex that is similar to the contralateral normal one is
created.
Conclusion From our experience this algorithm can help create an aesthetically pleasing nipple–areola complex and also provides a ready
pattern to our tattoing experts for the dermatography of the nipple–areola complex. 相似文献
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Objectives
Nipple-sparing mastectomy (NSM) improves cosmetic outcome of mastectomy, but many patients are not candidates for this procedure because of concerns about nipple-areolar viability. Surgical delay is a technique that has been used for more than 400?years to improve survival of skin flaps. We used a surgical delay procedure to improve nipple viability in patients who were identified to be at high risk for nipple necrosis following NSM.Methods
Patients at high risk for nipple necrosis following NSM underwent a surgical delay procedure 7?C21?days prior to mastectomy. Subareolar biopsy and sentinel node biopsy, if indicated, were performed at the time of the delay procedure. Nipple viability was assessed before and after NSM. If the subareolar biopsy revealed malignancy, the NAC was removed at the time of mastectomy.Results
31 NAC in 20 patients underwent surgical delay. All of the NAC subjected to a surgical delay survived following the delay procedure. In 2 patients, the subareolar biopsy was positive and 3 NAC were removed at the time of mastectomy (1 for purposes of symmetry). Of the 28 delayed NAC left at the time of NSM, all survived the post-mastectomy course.Conclusion
A procedure to surgically delay the NAC 7?C21?days prior to NSM is demonstrated to ensure viability of NAC in patients previously thought to be at high risk for nipple loss. 相似文献16.
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Local Recurrence After Skin-Sparing Mastectomy: Tumor Biology or Surgical Conservatism? 总被引:10,自引:2,他引:8
Carlson GW Styblo TM Lyles RH Bostwick J Murray DR Staley CA Wood WC 《Annals of surgical oncology》2003,10(2):108-112
Background:Long-term follow-up of the use of skin-sparing mastectomy (SSM) in the treatment of breast cancer is presented to determine the impact of local recurrence (LR) on survival.Methods:A total of 539 patients were treated for 565 cases of breast cancer by SSM and immediate breast reconstruction from January 1, 1989 to December 31, 1998. The American Joint Committee on Cancer pathological staging was stage 0 175 (31%), stage I 135 (23.9%), stage II 173 (30.6%), stage III 54 (9.6%), stage IV 8 (1.4%), and recurrent 20 (3.5%). The mean follow-up was 65.4 months (range, 23.7–86.3 months). Five patients were lost to follow-up.Results:Thirty-one patients developed a LR during the follow-up including five who received adjuvant radiation. The distribution of LR stratified by cancer stage was stage 0 1, stage I 5, stage II 17, stage III 6, and recurrent 2. The overall LR was 5.5%. Twenty-four patients (77.4%) developed a systemic relapse and 7 (22.6%) patients remained free of recurrent disease at a mean follow-up of 78.1 months. The cancer stage of those remaining disease free was stage 0 1 (100%), stage I 4 (80%), and stage II 2 (11.8%).Conclusions:LR of breast cancer after SSM is not always associated with systemic relapse. 相似文献
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Beyond Palliative Mastectomy in Inflammatory Breast Cancer—A Reassessment of Margin Status 总被引:3,自引:0,他引:3
Lisa D. Curcio MD Elizabeth Rupp MD Wydell L. Williams MD David Z. J. Chu MD K. Clarke MS Tamara Odom-Maryon PhD Joshua D. I. Ellenhorn MD George Somlo MD Lawrence D. Wagman MD 《Annals of surgical oncology》1999,6(3):249-254
Background: Inflammatory breast cancer is a locally advanced tumor with an aggressive local and systemic course. Treatment of this disease has been evolving over the last several decades. The aim of this study was to assess whether current therapies, both surgical and chemotherapeutic, are providing better local control (LC) and overall survival (OS). We also attempted to identify clinical and pathologic factors that may be associated with improved OS, disease-free survival (DFS), and LC.Methods: A 25-year retrospective review performed at the City of Hope National Medical Center identified 90 patients with the diagnosis of inflammatory breast cancer.Results: Of the 90 patients identified with inflammatory breast cancer, 33 received neoadjuvant therapy (NEO) consisting of chemotherapy followed by surgery with radiation (n = 26) and without radiation (n = 7). Fifty-seven patients received other therapies (nonNEO). Treatments received by the nonNEO group consisted of chemotherapy, radiation, mastectomy, adrenalectomy, and oophorectomy, alone or in combination. The median follow-up was 28.9 months for the NEO group and 17.6 months for the nonNEO group. Borderline significant differences in the OS distributions between the two groups were found (P =.10), with 3- and 5-year OS for the NEO group of 40.0% and 29.9% and for the nonNEO group of 24.7% and 16.5%, respectively. DFS and LC were comparable in the two groups. Lower stage was associated with an improved OS (P < .05). The 5-year OS for stage IIIB was 30.9%, compared to 7.8% for stage IV. In those patients with stage III disease who were treated with mastectomy and rendered free of disease, margin status was identified by univariate analysis to be a prognostic indicator for OS (P < .05). The 3-year OS, DFS, and LC for patients with negative margins were 47.4%, 37.5%, and 60.3%, respectively, compared to 0%, 16.7%, and 31.3% in patients with positive margins.Conclusions: This study suggests that in patients with inflammatory breast cancer and nonmetastatic disease, an aggressive surgical approach may be justified with the goal of a negative surgical margin. Achievement of this local control is associated with a better overall outcome for this subset of patients. The ability to obtain negative margins may further identify a group of patients with a less aggressive tumor biology that may be more responsive to other modalities of therapy.Presented at the 50th Annual Cancer Symposium of The Society of Surgical Oncology, Chicago, Illinois, March 17–21, 1997. 相似文献