Postquadrantectomy deformities include localized de- fects in skin and glandular tissue, distortion and/or dislo- cation of the areola, and retraction of the breast tissue. Perhaps the most prominent and frequent failure in achieving a good aesthetic outcome is due to a lack of breast symmetry . Surgical techniques used to ad- dress the conflicts between oncological and cosmetic results, including both total and partialmastectomy, can be classed under the general term of oncoplastic surgery, which is a new surgical approach that allows wide exci- sion but prevents breast deformities by reconstructing large resection defects immediately . Several on- coplastic surgical procedures have been discussed in pre- vious reports. Hoffmann classified all breast surgeries into 12 subgroups according to a two-type, six-tier clas- sification system comprising 12 main categories . In breast conserving surgery, ranging from simple excision up to quadrantectomy, defect repair without tissue mobi- lization is regarded as grade 1 complexity, and complex oncoplastic or reconstructive breast cancer procedures involving pedicled or free distant flap reconstruction and, where indicated, microvascular anastomosis for defect coverage are regarded as grade 6. Our procedure, a spin- dle shaped partialmastectomy in which excess gland and skin tissue are removed, is regarded to be of grade 1 complexity according to their classification. In fact, it is easier than other oncoplastic breast surgical techniques that we described previously, such as volume replace- ment or reduction type breast surgery.
Bp is minimally invasive and now considered standard treatment for early breast cancer [1–3]. However, with a partialmastectomy for tumor resection, some degree of breast deformity is difficult to avoid, and patients may be concerned about surgical scars of the breast skin. We use an incision of the anterior axillary line or areola to preserve skin directly above the tumor. In addition, for any deformity due to breast resection, breast recon- struction using residual breast and adipose tissue, or simultaneous breast reconstruction using an autolo- gous LTF or latissimus dorsi muscle flap (LDMF) can
In all patients, partialmastectomy was performed with at least a 2-cm macroscopic tumor-free margin, and the nega- tive resection margin status was defined as ‘tumor not touch- ing ink’ on the frozen section. The size of the DCIS lesion was determined from pathology reports and medical records. When both data were unavailable, the mammographic ab- normality was measured on the preoperative mammogram.
Very few experiences were reported for RLDF immedi- ate breast reconstruction with no more than 17 proce- dures [9–12]. The main differences in robotic surgical technique that should be underlined included a single incision realized around NAC for SSM and the use of a single site trocar. In Selber et al.’s study , seven pa- tients were reported with RLDF reconstruction per- formed through an axillar incision for NSM without the use of a single site trocar. Chung et al.  reported 12 RLDF procedures through a 5–6-cm axillar incision without CO2 gas insufflation for three delayed breast re- constructions, four IBRs with NSM, and five cases of chest wall deformity. Clemens et al.  reported 17 RLDFRs in delayed-immediate breast reconstruction after SSM and placement of a tissue expander through anterior mastectomy incision without a single site trocar. Endoscopic non-robotic LDFR was reported in several studies [4–8], and in 2007, Missana et al. reported a study including 52 patients  and more recently by others with smaller series [6–8]. Nakajima et al.  re- ported a study with 168 LDF video-assisted reconstruc- tions but only for reconstruction after partialmastectomy. Finally, Dejode and Barranger  reported one case of endoscopic 3D latissimus dorsi-flap harvest- ing for SSM with immediate breast reconstruction.
Resection size is thought to affect blood loss during mastectomy (Clegg-Lamptey and Dakubo 2014). There- fore, mastectomies were classified in accordance with the resection size: partialmastectomy and quadrantect- omy. ESM involves two steps: an operator detaches the lacteal gland from the pectoralis major muscle under endoscopic vision through a small axillary incision. In the second step, under direct vision, the surgeon removes the lacteal gland containing the breast cancer tissue (Sakamoto et al. 2009).
level of the inframammary fold (IMF) and this is also de- epithelialized. The extended pedicle is transfer to the up- per or outer quadrant for partialmastectomy defects (Fig- ures 1 and 2), or to the upper pole for fullness in the wei- ght loss patient (Figures 3 and 4) or to match an implant reconstruction (Figure 5). The medial and lateral pillars are then created and the extended pedicle is lifted off the chest wall. If the pedicle is too large it is trimmed to the appropriate size for the indicated defect. It is released of
The proportionality assumption required for multivari- ate Cox proportional hazards analysis was violated for most factors in the mastectomy and ER-negative partialmastectomy cohorts, requiring further stratification. Uni- variate analyses, however, resulted in insufficient patient numbers in the neoadjuvant RT groups, making the com- parison with adjuvant RT infeasible. Multivariate Cox proportional hazards analysis assumptions were satisfied for all variables in the largest cohort of patients with ER- positive tumors who underwent breast-conserving sur- gery. Interestingly, there was no mortality hazard of neo- adjuvant RT compared with standard-of-care adjuvant RT (HR 1.00, P = 0.9513), with survival curves being in- distinguishable at 20-year follow-up (Fig. 3b). All other factors, including age, race, and tumor stage, however, Table 1 Baseline characteristics of the stratified neoadjuvant
margin width and maintain the breast’s shape and appearance. 5 The undertaking of both goals together in the same operation can be challenging, depending on the tumour location and relative size in the breast . If a lesion is large or located in a region that is too difficult to excise without the risk of cosmetic deformity, special approaches to resection should be considered. The value of full-thickness excision with breast-flap mastopexy closure is intuitively apparent.The term oncoplastic surgery is used differently depending on the specialty in which it is being referred. 6-10 In plastic surgery, the term typically refers to large partialmastectomy combined with a volume replacement technique of partial breast- myo cutaneous flap reconstruction using the latissimus dorsi or transrectus abdominus muscle In the present study 41 cases of breast cancer underwent oncoplastic surgery using volume ORIGINAL ARTICLE
Associated with breast removal is also hair loss as an important consequence of the effect of chemotherapy treatment. The fact of exposing the disease externally evidenced by baldness further harms the woman in her self- esteem and self-acceptance process. At the same time, the fight against cancer has brought new perspectives of health quality and life valorization. It is possible to observe that coping with this phase is different for each woman, and is closely linked to her psychological preparation and a good family structure (Almeida et al, 2015). Among sources of support for women with cancer, family and religion are important for coping with the disease and treatment. Family support and faith can bring motivating feelings that help to understand and accept the situation the woman is facing, bringing the conviction of healing, optimism and willpower to better cope with the current condition (Majewski et al, 2012; Furlan et al, 2013; Almeida et al, 2015). The discovery of cancer brings traumatic changes in a woman's life, such as the loss of her autonomy and her role as a helper within the family structure, which can result in low self-esteem, and bring feelings of devaluation, as well as feelings of mutilation, fear, crying, sadness, disinterest in life and in one's own body. Anxiety and angry behavior may also be present during the phases of this woman's illness process, which may compromise physical and emotional well- being (Frohlich, Benetti, Stumm, 2014). The feeling of tranquility shown by women facing their diagnosis and coping with cancer is seen by some authors and also through the statements of this study as a behavior that escapes their reality, a way found not to show despair, the way found not to expose their real feelings, or even the person's way of bringing benefits to their health and speeding up their treatment (Frohlich, Benetti, Stumm, 2014). In addition to breast-related feelings of loss due to the mastectomy itself, women suffer from chemotherapy and radiotherapy treatment and all their associated side effects, which often generate fear because it affects their self-image. Mastectomy impacts women by
including marine mussel protein and the Gram-positive anaerobe Corynebacterium parvum. In humans, seromadesis has been reported with talc and hypertonic saline. Although successful, both of these reports were based on the experience of one patient. The most commonly reported sclerosant in the literature is tetracycline, and, similar to fibrin glue, some reports found it useful whereas others did not. Two prospective, randomized trials from the Mayo clinic evaluated the use of tetracycline (65). They first used tetracycline postoperatively, administering it into wound cavities via drains in patients who had undergone mastectomy. This trial was aborted early due to severe pain experienced following the tetracycline administration with no associated benefit. A second trial (66) administered tetracycline intra-operatively and found no difference in postoperative pain between the groups but also found no difference in seroma formation. The non-availability of tetracycline has led to the use of erythromycin as a sclerosant, which is commonly used in pleurodesis. Ali-Khan et al. (67) showed that erythromycin was useful in one case of breast surgery and three cases of inguinal bloc dissection complicated by refractory seroma formation.
History of breast cancer dates back to at least 1600 B.C. and treatment me- thods have undergone significant progress over the last hundred years. We are moving away from frighteningly radical, and towards increasingly more con- servational breast cancer surgery. And while mastectomy is no longer a first-line choice for all breast cancers, it is still an important and, really, an es- sential procedure to discuss and research about. Different types and tech- niques exist and evidence regarding each is vast-with novel techniques ap- pearing even nowadays. For example, robotic surgery is increasingly more common in many surgical specialties and procedures, and mastectomy is no exception. With several high-profile celebrities recently discussing their expe- riences of breast cancer and mastectomies, this article covers a multitude of essential aspects relevant to this topic, in turn, hopefully, helping patients and doctors deal with the diagnosis and plan the treatment accordingly. Current breast cancer care and mastectomy trends are also discussed here, giving the readers an up-to-date overview of how breast cancer can and should be ma- naged.
The optimal timing of breast reconstruction is controversial; Patients also suffer a distortion particularly when postoperative radiotherapy is likely to be required. Immediate breast reconstruction, which has been demonstrated to be oncologically safe, spares the patient from the psychological trauma of waking from the mastectomy operation without a breast mound and allows fewer hospital admissions and anesthetics. Furthermore, the cosmetic outcome of immediate reconstruction may be superior to delayed reconstruction. Within the last 30 years the technical emphasis has focused on the use of tissue expanders with implants, latissimus dorsi myocutaneous transfer, and the transverse rectus abdominis myocutaneous (TRAM) flap and free flaps to achieve adequate breast restoration. Although all of these methods are individually sufficient for reconstruction, surgical feasibility and patient preference dictate their use.
Skin-sparing mastectomy (SSM), including nipple-sparing mastectomy (NSM), has emerged as an alternative to standard mastectomy and is known to be oncologically safe, with improved cosmetic results and quality of life for patients with breast cancer [1 – 3]. Because of this, SSM has become increasingly more common in recent years and the inclusion criteria have also been expanded . However, SSM is technically more difficult and time consuming, since it has to be performed through a smaller incision than that used in standard mastectomy.
After mastectomy, we start by the same incision and mono-trocar RLDF dissection with patient installation in lateral side. After mobilization of LDF, fixation of muscle was performed with several sutures and aspir- ate drainage disposed in dorsal area (2 drains through the inferior incision for robotic trocar) and in mastec- tomy area (1 drain). We do not perform dorsal padding. When implant was associated with RLDF, implant was disposed under the muscle without changing the patient ’ s position (patient installation in lateral side). When only implant was used, a robotic dissection of major pectoralis muscle provide pocket to manually introduce the prosthesis.
British Columbia have recently reported the results of an RCT into the effects of applying nitroglycerin ointment (a potent topical vasodilator of both arteries and veins) to mastectomy skin flaps following immediate reconstruction. A single appli- cation of 45 mg of nitroglycerin ointment (2%) was applied to the mastectomy skin flaps at the end of the operation at the time of dressing application, and the dressings were left in place for 48 hours. They terminated the study after 165 patients had been recruited (85 to treatment, 80 to placebo), as the interim analysis showed a significant reduction in MSFN in the group receiving the nitroglycerin ointment (15.3% flap necrosis rate) versus placebo (33.8% flap necrosis rate, p= 0.006). They concluded that the application of this vaso- dilator “is a simple, safe and effective way to help prevent mastectomy skin flap necrosis”. However, the evidence base in support of its widespread use is still somewhat limited as this was only a single study of 165 patients.
To the best of our knowledge, this is the first reported case of mammary Paget's disease occurring after mastectomy. The absence of the nipple/areola complex obviously raised some questions concerning whether it was mam- mary or extra-mammary Paget's disease, and how it could occur in the absence of the nipple/areola complex. The first question was answered by the immunohisto- chemical examination because hormonal receptors can only be detected in mammary Paget's disease. The second one could be explained by the high prevalence of multifo- cal disease in patients with Paget's mammary disease. However in this case the pathologist revealed unifocal Paget's disease of the nipple underlying an invasive muci-
The observed increase in the utilization of preopera- tive breast MRI and a concurrent rise in the number of unilateral and bilateral mastectomies performed over the past several years have led researchers to wonder if the two events are related. Several recent studies have reported increasing rates of contralateral prophylactic mastectomy, especially among younger, highly educated patients, and those with a positive family history [4,16-18]. Although this phenomenon does coincide with the adoption of preoperative breast MRI, it is not yet clear whether the relationship is one of cause and effect. In the present study, BCT rates did decrease slightly over the study period in favor of mastectomy, going from 60% in 2004 to 54% in 2009, but the use of
The last decade has seen a marked increase in the num- bers of women requesting contralateral risk-reducing mastectomy (CRRM) following a diagnosis of unilateral breast cancer . This is despite a decreasing incidence globally of contralateral breast cancer (CBC) as a result of successful adjuvant therapies . A contributing fac- tor has been the introduction of genetic testing to rou- tine clinical practice, but this only accounts for a small proportion of patients requesting the surgery. In breast cancer patients with a known BRCA1/BRCA2 mutation, CRRM is associated with a 48–63 % [3, 4] survival ad- vantage. Given that rates of contralateral breast cancer in this group are up to 4× greater than non-mutation carriers, a discussion of CRRM is easy to justify. For the majority of women with no known mutation, there ap- pears to be little if any survival advantage to CRRM .