Lymphatic mapping in patients with breast cancer and previous augmentation mammoplasty

Sentinel lymph node biopsy (SLNB) is now an established method of axillary staging in patients with breast cancer. However, the augmented breast poses an interesting challenge to this procedure. We hypothesized that SLNB is feasible in patients with augmented breasts who subsequently develop breast cancer. A retrospective study was performed from 1995 to 2006. Ten patients with augmented breasts underwent breast conservation therapy with SLNB. Sentinel lymph nodes were identified in all 10 patients. Three patients had positive sentinel nodes. Two patients proceeded to axillary lymph node dissection (ALND), and one declined. The subsequent ALND were negative for metastatic cancer. Seven patients had negative sentinel nodes. One patient with a negative sentinel node underwent ALND with all nodes negative for metastasis. Two patients were lost to follow-up. Of the remaining eight patients, the mean duration of follow-up was 71 months. None of these patients had evidence of axillary recurrence or distant metastasis at time of last follow-up. SLNB is a feasible method of axillary node staging in patients who have undergone augmentation mammoplasty who subsequently develop breast cancer. Further studies are needed to better determine the accuracy of lymphatic mapping in this patient population.     

缩小整形与保乳术相结合在乳腺癌伴巨乳症病人中的临床应用

目的：评估对乳腺癌伴巨乳症病人行双侧乳房缩小整形术与保乳手术的可行性。方法：我院对105例巨乳症病人作了缩小整形术，对其中9例同时患乳腺癌病人在保乳基础上同时行双侧乳房缩小整形术，中位随访时间为14．2个月。结果：平均年龄45岁，平均切下含肿瘤一侧乳房标本重量为561g，肿瘤大小0．5～3cm。其中1例因切缘阳性行乳房全切除。本组术后没有出现明显的并发症，病人随访显示满意率达87％。结论：对于希望行保乳术的乳腺癌伴巨乳症病人，双侧乳房缩小整形术是可行且安全的一种方法，将是对乳腺肿瘤外科的一种挑战。     

Detecting breast cancer after reduction mammoplasty

Reductive breast surgery may give rise to parenchymal scarring that makes subsequent clinical and radiologic assessment of tumours difficult. The features that help distinguish benign from malignant lesions are discussed. Biopsy is still necessary. A screening protocol that includes preoperative mammography in patients at increased risk is proposed.     

Bilateral reduction mammoplasty in combination with lumpectomy for treatment of breast cancer in patients with macromastia

BACKGROUND: Bilateral reduction mammoplasty has been described as a surgical option for treatment of breast cancer in women with large, pendulous breasts. Using this technique can provide unique surgical oncologic challenges. METHODS: Retrospective chart review. RESULTS: Thirty-seven patients were identified. The average weight of tissue removed was 653 g. Tumor size ranged from 0.6 to 5.2 cm. One patient had microscopically positive surgical margins on final pathology. The tumor bed was not marked, and completion mastectomy was required. Two patients had unexpected malignancy in the contralateral breast. One patient required completion mastectomy for positive nonoriented margins. In another patient, tissue from the contralateral side was oriented, and mastectomy was avoided. CONCLUSIONS: Bilateral reduction mammoplasty with lumpectomy is an ideal option in women with macromastia. We recommend marking the tumor bed on the flaps and pedicle as well as orienting tissue removed from the contralateral side as maneuvers that will decrease need for completion mastectomy.     

Reduction mammoplasty improves breast conservation therapy in patients with macromastia

BACKGROUND: Macromastia has been considered a contraindication to breast conservation therapy because of difficulties with radiation therapy. This study evaluates the feasibility of bilateral reduction mammoplasty as a component of breast conservation therapy for breast cancer patients with pendulous breasts. METHODS: Of 153 patients undergoing reduction mammoplasty at the University of Texas M. D. Anderson Cancer Center, 28 were identified as breast cancer patients with macromastia receiving breast conservation therapy. Median follow-up was 23.8 months. RESULTS: Median patient age was 55 years. Nearly all patients were described as obese. Median weight of the reduction mammoplasty specimen on the cancerous side was 766 g. One patient (4%) required completion mastectomy for inadequate margin control. Major postoperative complications occurred in 2 patients (7%). There were no major postradiation complications. Patient survey revealed a satisfaction rate of 86%. CONCLUSION: Bilateral reduction mammoplasty is a reasonable and safe option for breast cancer patients with macromastia who desire breast conservation therapy.     

Factors influencing prognosis in elderly patients with primary breast cancer

A retrospective analysis was performed on 260 elderly and 294 middle-aged patients with primary breast cancer. Cox regression analysis showed that the classic prognostic factors, such as negative lymph node status, small tumour size and positive oestrogen receptor (ER) status, were favourable indicators of survival and were similar in both the elderly and the middle-aged. When the elderly and middle-aged were considered together, older age (favourable) and the presence of association disease (detrimental) were additional significant prognostic factors. It is concluded that a physically fit elderly woman in the present study had a more favourable survival outlook than a younger counterpart with similar tumor size, lymph node and ER status and should be given the best available treatment based on tumour characteristics and not on age alone.     

原发性乳腺癌患者创伤后成长的纵向调查

目的了解和分析原发性乳腺癌患者不同治疗阶段创伤后成长的变化,为临床及延续护理提供参考。方法采用创伤后成长评定量表对80例原发性乳腺癌患者于手术前1d(T1)、手术后第3天(T2)、术后首次化疗(T3)及末次化疗(T4)进行调查。结果患者T1~T4的创伤后成长得分依次为83.04±20.90、62.84±19.21、59.58±13.78、67.85±13.51;不同时段总分及各维度得分比较,差异有统计学意义(P0.05,P0.01)。结论手术及化疗对患者的创伤后成长造成一定负性影响,随化疗结束及治疗效果的显现,患者创伤后成长呈上升趋势,护理人员应根据其特点实施针对性干预,以有效地提升其创伤后成长水平。     

双侧原发性乳腺癌12例临床分析

目的分析双侧原发性乳腺癌(bilateral primary breast cancer,BPBC)的临床特点。方法对收治的12例双侧原发性乳腺癌患者的临床资料及预后进行回顾性分析,研究其特点。结果 12例BPBC患者占同期乳腺癌患者(415例)的2.9%,同时性BPBC3例,占0.7%,异时性BPBC9例,占2.2%。91.7%(11/12)的第一侧乳腺癌肿瘤大小为T2,而第二侧乳腺癌中有2例(16.7%)为T0期癌。第一侧乳腺癌病理类型均为浸润性癌,第二侧乳腺癌中有3例(25.0%)为导管内癌。第一侧原发乳腺癌行乳腺癌根治术或改良根治术,第二侧原发乳腺癌有2例行全乳切除术,1例行保乳手术。12例BPBC均无病生存。结论单侧乳腺癌发生后应积极随访,以早期检出对侧病变。BPBC有较早的临床分期和较高的导管内癌比例,可行保乳手术。     

Therapeutic mammoplasty is an appropriate option in a patient with breast cancer and macromastia

Bilateral reduction mammaplasty in women with breast cancer and macromastia allows appropriate oncological surgical treatment with functional and cosmetic benefits and facilitates postoperative radiation therapy. The surgical approach carried out in three patients with breast cancer and macromastia is discussed.     

Augmentation mammoplasty: effect on diagnosis of breast cancer.

Breast augmentation for cosmetic purposes is an increasingly common procedure in the USA and UK. In the USA in 2003, a total of 254 140 breast augmentation procedures were carried out [American Society of Plastic Surgeons, http://www.plasticsurgery.org/news_room/Procedural-Statistics-Press-Kit-Index.cfm9-1-2005; 2006.(1)]. It has been previously estimated that between 1 and 1.5 million women in the USA have prosthetic breast implants [Cook RR, Delongchamp RR, Woodbury M, et al. The prevalence of women with breast implants in the United States, 1989. J Clin Epidemiol 1995;48:519-25.(2)]. The UK National Breast Implant Registry has recorded a rise in the numbers of women receiving breast implants, with over 13 000 procedures registered in 2001; an estimated 77% of these were for cosmetic purposes. No association has been found between the presence of breast implants in a breast and an increased risk of breast cancer, and this subject has been comprehensively reviewed elsewhere [Hoshaw SJ, Klein PJ, Clark BD, et al. Breast implants and cancer: causation, delayed detection, and survival. Plast Reconstr Surg 2001;107:1393-407.(3)]. However, as the population of women with breast implants ages, an increasing number of them will develop breast cancer; a reflection of the fact that the incidence of the disease increases with increasing age. Debate continues on the effect of breast implants on the efficacy of mammography in diagnosing breast cancer, and the role of other imaging techniques for this purpose, as well as the limitations that the presence of implants place on percutaneous biopsy techniques. We review the literature on the radiological and tissue diagnosis of breast cancer in women with a history of previous augmentation mammaplasty.     

Bilateral reduction mammoplasty following breast cancer: A case-control study

PURPOSE:

Many women undergo a bilateral reduction mammoplasty after lumpectomy and radiation for breast cancer due to breast hypertrophy. The outcomes of these patients, focusing on complications and the need for additional surgery, are reviewed.

METHODS:

A matched case-control study with patients serving as their own control (treated breast cancer breasts were ‘cases’, healthy breasts were ‘controls’) was performed. Patients were identified through hospital records between 1980 and 2007. Patients treated by lumpectomy and radiation with subsequent bilateral reduction surgery were included. Data regarding demographics, medical history, and peri- and postoperative complications were collected. Measured outcomes included hematoma or seroma, delayed wound healing, infection, nipple-areolar complex problems, scarring, asymmetry and the need for further surgery. Continuous variables are reported as mean ± SD, and categorical variables are reported as proportions.

RESULTS:

Of the nine patients included in the study, delayed wound healing occurred in 22% of cases. Wound infections occurred in 66.7% of cases, with 22.2% experiencing a second wound infection. One patient experienced partial nipple-areolar complex loss on the radiated breast. There was abnormal scarring in 33.3% of radiated breasts. Postoperative asymmetry occurred in 77.8% of patients. Additional surgery was performed on three patients (33.3%).

CONCLUSIONS:

Results of the present study suggest that women with a history of breast cancer treated by lumpectomy and radiation experience higher occurrence of postoperative complications on the radiated breast following bilateral breast reduction. Patients must be informed of these potential risks and require careful postoperative follow-up. An appropriately powered, prospective, multicentred study is required to draw definitive conclusions.     

Relationship between DNA ploidy and survival in patients with primary breast cancer

The DNA ploidy of breast cancer tissue from paraffin blocks was measured by flow cytometry in 117 patients whose disease had been detected and treated with surgery between 1974 and 1976. Patients with aneuploid tumours had positive axillary nodes and distant metastases more often than those with diploid tumours. Aneuploid tumours were more common in postmenopausal than premenopausal women. The S-phase fraction (SPF) was significantly higher in aneuploid than in diploid tumours and positive axillary lymph nodes were found in 26 per cent of the patients who had a tumour with a SPF below the median (4.8 per cent) and in 48 per cent of those with tumours with SPF values above the median. At the primary clinical investigation 2 per cent of the patients with diploid tumours and 6 per cent of those with aneuploid tumours had distant metastases. During the follow-up, the proportion of patients with distant metastases increased to 42 and 72 per cent, respectively. With a follow-up of 11.5 years, the DNA aneuploidy of the tumour showed a significant association with decreased survival. Thirty-three per cent of patients with diploid and 65 per cent of patients with aneuploid tumours had died from breast cancer during the follow-up (P less than 0.001). All patients with hypertetraploid or multiploid tumours died from breast cancer. High SPF values were associated more closely with distant metastases or death during the follow-up than low SPF values. Our results suggest that DNA ploidy measured by flow cytometry from paraffin embedded tissue blocks of human breast cancer can be used to predict the aggressiveness of the tumour and the survival of the patients.     

Metastases and primary neoplasms of the stomach in patients with breast cancer

Seven hundred seventy-five cases of breast cancer treated in the Surgical Department of Kyoto University, Japan, were studied in relation to metastatic growth and primary neoplasm of the stomach. Metastases involving the stomach were found in three of the twelve autopsy cases and primary stomach cancer occurred in 7 of 775 patients with cancer of the breast. Clinicopathologic findings of these cases are reported. In the present series the incidence of both neoplastic processes in patients with breast cancer was significantly higher than that demonstrated in the world literature. The present study indicates that the occurrence of these neoplastic processes may be attributed to the susceptibility or predisposition of a certain population to cancer. The frequent finding of cancer of the stomach in our patients with cancer of the breast emphasizes the vital importance of early detection of a second primary gastric lesion in Japanese women with cancer of the breast.     

Mammographic density and prognosis in primary breast cancer patients

PurposeMammographic density (MD) is one of the strongest risk factors for breast cancer (BC). However, the influence of MD on the BC prognosis is unclear. The objective of this study was therefore to investigate whether percentage MD (PMD) is associated with a difference in disease-free or overall survival in primary BC patients.MethodsA total of 2525 patients with primary, metastasis-free BC were followed up retrospectively for this analysis. For all patients, PMD was evaluated by two readers using a semi-automated method. The association between PMD and prognosis was evaluated using Cox regression models with disease-free survival (DFS) and overall survival (OS) as the outcome, and the following adjustments: age at diagnosis, year of diagnosis, body mass index, tumor stage, grading, lymph node status, hormone receptor and HER2 status.ResultsAfter median observation periods of 9.5 and 10.0 years, no influence of PMD on DFS (p = 0.46, likelihood ratio test (LRT)) or OS (p = 0.22, LRT), respectively, was found. In the initial unadjusted analysis higher PMD was associated with longer DFS and OS. The effect of PMD on DFS and OS disappeared after adjustment for age and was caused by the underlying age effect.ConclusionsAlthough MD is one of the strongest independent risk factors for BC, in our collective PMD is not associated with disease-free and overall survival in patients with BC.     

Incidental breast carcinoma in reduction mammoplasty

Aim: The objective of this study was to analyze the incidence and treatment options of occult cancer or atypical lesions found in the histopathological examination of reduction mammoplasty (RM) specimens. The role of preoperative mammography and systematic histopathological examination are discussed.

Methods: We performed a retrospective single-center database review of all patients who underwent a RM between January 2005 and December 2014. Preoperative examination, histopathological findings and follow-up were documented.

Results: A total of 1045 patients underwent RM, of which 97% were bilateral (1021). All patients received a mammography and routine clinical examination to exclude cancer preoperatively. The overall mean patient age was 40.2 years (14.2–73.4). A total of 19 patients (1.18%) had significant histopathological findings, all of whom were over 40 years of age. There were 4 incidental carcinomas (0.38%), of which 2 were DCIS (0.19%) and 2 invasive ductal carcinomas (0.19%).

Conclusions: Incidence of postoperative diagnosis of occult breast cancer in RM specimens remains low, but poses significant therapeutic challenges. While emphasis should lay on preoperative diagnostics, routine histological analysis of RM specimens is recommended.     

Management of asymptomatic silicone-injected breast with reduction mammoplasty

Even though Silicone injection for breast augmentation has been related to disastrous long-term effects and complications, some patients do not develop significant symptoms at all (asymptomatic). Unfortunately, the management of asymptomatic Silicone-injected breast is still unclear and has never been reported exclusively. We present two cases of asymptomatic patients with a history of liquid Silicone injections who refused to have a mastectomy. They were concerned with the breast ptosis and chose to undergo reduction mammoplasty to improve the appearance of the breasts. Magnetic resonance imaging may be useful as an additional screening tool to confirm the diagnosis and exclude the presence of malignancy in breasts with injected Silicone. We believe that breast reduction may be the alternative option for women with a history of liquid Silicone injection who have no symptoms but desire to preserve their breasts and improve their aesthetics.KEY WORDS: Breast, magnetic resonance imaging, mammaplasty, mastectomy, Silicone     

硅胶囊假体隆乳术并发症

应用硅胶假体的隆乳术在我国普遍开展，各种并发症也屡有报道，手术医生应掌握该方面的相关知识及并发症的防治方法，以使受术者的痛苦减少到最低程度。过去的十年里在我科共施行１１５例硅胶假体隆乳术，发生并发症９例，主要包括血肿、积液、假体破裂、位置不正。血肿和积液早期都会引起局部疼痛且有并发感染的可能，应尽早引流血肿和积液。假体破裂的诊断很重要，最常用的方法是Ｂ超，但以ＭＲＩ最为准确。位置不正可通过准确的分离腔隙和有效的包扎固定得以预防。与硅胶假体隆乳术相关的自身免疫性疾病越来越引起关注，１５例硅凝胶乳房假体的受术者的免疫功能检查，ＩｇＧ，ＩｇＭ及Ｃ３增高提示硅胶做为一种异物长期存在体内引起非特异性免疫活动增强，但这方面尚需做进一步的临床与实验研究证实。     

95例乳腺癌保乳治疗近期观察

目的探讨乳腺癌保乳治疗的方法与疗效。方法95例Ⅰ-Ⅱ期原发性乳腺癌,施行局部扩大切除并腋窝淋巴结清扫,手术后患侧乳房接受放射治疗。结果手术后6个月随访,患者本人对保留乳房的满意率100％,十分满意者为92％。经随访2～51个月,平均随访17个月,仅1例同侧乳腺局部复发,2年局部复发率1．4％。无远处转移和死亡病例。结论Ⅰ-Ⅱ期乳腺癌实施保乳治疗,近期疗效满意,远期效果有待长期随访观察。