Bilateral Radical Mastectomy Research Articles

Painful burning lesions on the chest wall of a patient with advanced breast cancer

A 90-year-old woman presented at our emergency department complaining of dyspnea (sO2 88% on room air, respiratory rate 24/min) and severe (NRS 8/10) burning chest pain. Ten years earlier, she had undergone a bilateral radical mastectomy and radio-chemotherapy for breast cancer. In September 2023, she developed some nodules on her chest skin treated with electrochemotherapy, multiple liver lesions, and a bilateral paraneoplastic pleural effusion.

SYNCHRONOUS BILATERAL BREAST CANCER RIGHT HER 2 POSITIVE AND LEFT HER 2 NEGETIVE- A CASE REPORT

Bilateral breast cancers (BBCs) represent 2–11% of breast cancers. The diagnosis of breast cancer at the same time or up to 6 months in both breasts is known as Synchronous bilateral breast cancer (s-BBC).[1,2]In about 15% to 20% of breast cancers, the cancer cells make too much of a growth-promoting protein known as HER2. These cancers, known as HER2-positive breast cancers, tend to grow and spread more aggressively than HER2-negative breast cancers. Targeted drug therapy uses medicines that are directed at (target) proteins on breast cancer cells that help them grow, spread, and live longer. Anti-HER2 therapies (also called as HER2 inhibitors or HER2 targeted therapies) are a class of medicines used to treat all stages of HER2-positive breast cancer and certain HER2-low breast cancers.Trastuzumab is currently used sequentially after completion of anthracycline-based chemotherapy as a single agent or in combination with taxanes. In this case report we present a female 51 year old patient with synchronous bilateral breast cancer Left breast wasHER2 negative cT2N0M0, stage I and Right breast was HER2 positive cT2N2M0 stage Ia, both breast cancers were hormone receptor positive. The patient was administered six cycles of Inj. genexol-PM, Inj. carboplatin, Inj. pertuzumab, Inj. trastuzumab, Inj. Pegasta as NAC, Followed by bilateral radical mastectomy, patient showed a complete tumor reduction with residual node in right breast contrary to left breast which showed partial response. (Left breast ypT1N0 (sn)M0 and right breast ypT0N1aM0).

Improvement in Vagal Function in a Post Breast Cancer Patient Receiving Chiropractic Care: A Case Study

Heart rate variability (HRV) is widely used to demonstrate the vagal function and sympathetic function of the autonomic nervous system and evaluate autonomic dysregulation. Current literature demonstrated that the HRV of women who have gone through breast cancer, surgery and chemotherapy stays low for possibly up to a year or more. The purpose of this paper was to chronicle the consistent improvements in salutogenesis, measured through HRV, in a 43-year-old woman post breast cancer following a course of chiropractic care focused on vertebral subluxation correction. Chiropractic care was provided to a 43-year-old woman following bilateral radical mastectomy and chemotherapy for management of breast cancer. Chiropractic care was focused on the assessment and correction of vertebral subluxation. The parameter numbers used were the standard interbeat interval (Sd IBI) from the heart rate analysis. Chiropractic care was provided over a period of 34 weeks. HRV assessment was performed at the initiation of care and again at weeks 4, 6, 13 and 34. The Sd IBI measurements recorded during the respective assessment visits indicated significant improvement compared to normative data for the same population. A course of chiropractic care focused on the assessment and correction of vertebral subluxation was associated with a salutogenic response in a woman post breast cancer, as measured via HRV. J Med Cases. 2019;10(6):171-178 doi: https://doi.org/10.14740/jmc3306

Improvement in Vagal Function in a Post Breast Cancer Patient Receiving Chiropractic Care: A Case Study

Heart rate variability (HRV) is widely used to demonstrate the vagal function and sympathetic function of the autonomic nervous system and evaluate autonomic dysregulation. Current literature demonstrated that the HRV of women who have gone through breast cancer, surgery and chemotherapy stays low for possibly up to a year or more. The purpose of this paper was to chronicle the consistent improvements in salutogenesis, measured through HRV, in a 43-year-old woman post breast cancer following a course of chiropractic care focused on vertebral subluxation correction. Chiropractic care was provided to a 43-year-old woman following bilateral radical mastectomy and chemotherapy for management of breast cancer. Chiropractic care was focused on the assessment and correction of vertebral subluxation. The parameter numbers used were the standard interbeat interval (Sd IBI) from the heart rate analysis. Chiropractic care was provided over a period of 34 weeks. HRV assessment was performed at the initiation of care and again at weeks 4, 6, 13 and 34. The Sd IBI measurements recorded during the respective assessment visits indicated significant improvement compared to normative data for the same population. A course of chiropractic care focused on the assessment and correction of vertebral subluxation was associated with a salutogenic response in a woman post breast cancer, as measured via HRV. J Med Cases. 2019;10(6):171-178 doi: https://doi.org/10.14740/jmc3306

COMPARISON OF ONSITE INFILTRATION AND CONSTANT RATE INFUSION FOR POSTOPERATIVE ANALGESIA IN DOGS WITH MAMMARY TUMORS UNDERGOING BILATERAL RADICAL MASTECTOMY AND OVARIOHYSTERECTOMY

Analgesia of the wide surgical excision region in surgeries such as bilateral radical mastectomy plays an important role in postoperative care. Opioids are effective in alleviating pain; however, they are sometimes difficult to obtain in most local veterinary hospitals. The objective of this research was to compare the efficacies of (1) onsite infiltration analgesia with lidocaine and bupivacaine (group I, [Formula: see text]) and intravenous injection with buprenorphine and (2) constant rate infusions (CRIs) of fentanyl and ketamine (group II, [Formula: see text]) for postoperative analgesia after bilateral radical mastectomy and ovariohysterectomy in dogs with mammary tumors. The results showed that a combination of infiltration with lidocaine and bupivacaine and intravenous injection with buprenorphine was as effective as CRIs of fentanyl and ketamine. Infiltration analgesia with lidocaine and bupivacaine may be an option for analgesia in dogs undergoing bilateral mastectomy and ovariohysterectomy and may help reducing pure [Formula: see text]-opioid requirements.

Abstract P2-09-15: Rapid BRCA analysis: Experience of a single institution

Abstract The interest of rapid BRCA analysis, even before the initial treatment could modify the surgical indications (ie total mastectomy and immediate reconstruction even in case where tumorectomy would be suitable). The aim of this study was to evaluate the indications and consequences of this rapid determination of BRCA status in our institution. Patients Rapid BRCA analysis was conducted in 129 patients (pts) treated for breast cancer and addressed to the genetician at Oscar Lambret Center between 2009 and 2014: in 98 pts to discuss breast and axilla surgical modalities, in 4 cases to discuss oophorectomy, in 3 cases to have access to PARP inhibitors. In the other 24 pts, the reasons were debatable: patient leaving abroad, patient requiring reproductive assisted technology..... Results 38 deleterious mutations (29,4%) were identified (31 BRCA1, 7 BRCA2) in 38 pts. Cancer treatment was on going for 107 pts, programmed for 12 pts and finished for 10. The median time between cancer diagnosis and genetic counseling was 81 days (5-5160), between blood sample collection and BRCAs analysis 37 days (13-132), between availability of the laboratory results and the information to the patient: 39 days (1-234); 7 pts (5.4%) never came to obtain the laboratory results. Treatment was modified after genetic counselling for 8 pts out of 119 (7%). Six of them had BRCA1 deleterious mutations. Three decided subsequent radical mastectomy and adjuvant radiation was cancelled, another had a radical mastectomy before radiation, another treated for bilateral breast cancer had a bilateral radical mastectomy before radiation and the last treated for unilateral breast cancer had a bilateral radical mastectomy before radiation. Out of these 8 pts, two did not have a deleterious mutation. One had a bilateral radical mastectomy before laboratory result and one with BRCA variant of unknown significance had a homolateral radical mastectomy. Conclusion discussion Our experience shows that rapid BRCA analysis is feasible. In this selected population the mutation rate is very high. However, first, it appears that indications for rapid BRCA analysis were variable and not always relevant. Second, genetic result impacts on treatment only in 7% of pts. Indications could be justified by the use of PARP inhibitors. Up to now, the indications of rapid genetic analysis are rare. Citation Format: Mailliez A, Herin H, Revillion F, Adenis C, Peyrat J-P, Bonneterre J. Rapid BRCA analysis: Experience of a single institution. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-09-15.

Botulinum toxin type A as an adjunct in postoperative pain management in dogs undergoing radical mastectomy

The aim of this randomised placebo-controlled, observer-blinded study was to evaluate the analgesic effects of botulinum toxin type A (BoNT-A) as an adjunct for postoperative pain control in dogs. Sixteen...

Effects of surgical wound infiltration with bupivacaine on postoperative analgesia in cats undergoing bilateral mastectomy.

The analgesic effect of wound infiltration with bupivacaine was evaluated in cats undergoing bilateral mastectomy. Twenty-one female cats with mammary gland tumors were anesthetized with propofol and oxygen-isoflurane anesthesia following premedication with atropine. In the trial group (Group I; n=11), 30 ml of saline containing 2 mg/kg of bupivacaine was infiltrated topically into the surgical wound right after removal of the mammary glands, whereas only saline solution was infiltrated in the control group (Group II; n=10). At the same time, carprofen (4 mg/kg) was also administered subcutaneously in both groups. Behavioral signs of pain were monitored during the recovery period after general anesthesia. In order to examine the behavioral changes associated with acute pain, a questionnaire was prepared and given to the owners to be completed 4 hr and then 10 hr after the operation. According to the owners’ anwers to the questionnaire, a pain score was specified using a “numerical rating scale” for each cat. Although some cats showed mild to moderate pain, the pain score recorded at 4 hr after the operation was significantly lower in Group I (P<0.001). No significant difference was found at 10 hr after the operation between the groups. The incidence of vocalization, aggression and convulsion within 2 hr after the operation was also lower in Group I. In conclusion, wound infiltration with bupivacaine before incisional closure provided reliable analgesia at least 4 hr after bilateral radical mastectomy in cats.

Lobular Invasive Carcinoma of the Male Breast: A Case Report of An Uncommon Disease

INTRODUCTION: The male breast cancer is rare, representing 1% of all breast cancers. The most common invasive subtype is infiltrating ductal carcinoma (85% of tumors). Invasive Lobular Carcinoma (ILC) is very unusual in men, representing 1% of male breast cancers. This probably occurs because lobules are not found in normal male breast tissue. The lobular development is associated to progesterone and estrogen action during menstrual cycles in the women breast. In a database with 843 patients diagnosed with ILC treated in INCA (Brazilian National Cancer Institute) between 2000 and 2009 we have found only one male patient. Here we report a case of ILC in a man that was previously treated with cyproterone. CASE REPORT: A 70 year old male patient was admitted to INCA in 2001 referring increased bilateral breast volume and ulceration of the left papilla. The patient had a prostate cancer story treated with surgery followed by radiotherapy and cyproterone acetate one year earlier. Physical examination revealed a 9.5 cm mass occupying the entire right breast and an ulcerated lesion measuring 12.5 cm in the left breast with bilateral linfonodal involvement (Stage IIIb). Mammography showed increased breast volume with bilateral densification, skin thickening and bilateral retraction of the nipple-areolar complex. Incisional biopsy showed poorly differentiated invasive carcinoma. Tamoxifen was prescribed for two months with no response. He started neoadjuvant chemotherapy (Adriamycin and Cyclophosphamide) but the disease remained stable after 3 cycles. It was performed bilateral Modified Radical Mastectomy on July 2000. Histopathological examination of surgical specimens revealed bilateral ILC, histologic grade II Elston. The left breast showed a 10.5 cm tumor and metastatic carcinoma to 4 lymph nodes from 15 isolated nodes. The right breast showed a 5.5 cm tumor and metastatic carcinoma to 2 lymph nodes from 10 isolated nodes. E-cadherin and hormone receptors were negative in both breasts. In March 2001, he presented cutaneous nodules in his left plastron. Lesion’s biopsy showed metastatic ILC. On May 2001 it was diagnosed bone metastasis. Palliative chemotherapy (5-Fluorouracil and Pamidronate) was started. He developed neutropenic fever and was hospitalized for treatment, but died from sepsis on August 2001. DISCUSSION: One of the most important risk factors to male breast cancer is an abnormal balance between estrogen and androgen. In this case, the patient used cyproterone, a steroid with progestin-like and antiandrogenic activity. This possibly could explain the development of lobules and consequently an increased risk of lobular carcinoma. Cyproterone is notoriously associated to gynecomastia, benign nodular breast hyperplasia and galactorrhea. Futhermore, there are reports of bladder and hepatic carcinoma related to it’s use. However there is still no well-established relationship between the use of cyproterone and breast cancer.

The Development of New, Primary, Noninvasive Carcinoma of the Breast 29 Years after Bilateral Radical Mastectomy

: We present the case of a patient with a new, primary noninvasive breast carcinoma arising in residual breast tissue 29 years after radical mastectomy. The patient, a 75-year-old black woman with no family history of breast or ovarian cancer, had undergone left radical mastectomy in 1956 (age 35) and right radical mastectomy in 1965 (age 44). Examination revealed a 3-mm nodule in the right anterior axillary line. On excision, the lesion was a 1.5-mm intracystic papillary ductal carcinoma in situ arising in a background of atypical ductal hyperplasia (representing residual breast tissue). The patient has not agreed to testing for BRCA1 or BRCA2 mutations. The theoretical risk of new primary breast cancers arising in residual breast tissue has been suggested as a reason why prophylactic mastectomy may not be completely effective. This case suggests that even after what appeared to be aggressive radical mastectomy, enough breast tissue remained so that the patient was at risk for recurrent breast cancer.

Prognosis of bilateral breast cancer

Bilateral breast cancer accounts for 3.1% of 3272 cases of malignant breast tumors observed during the period 1956–1965. Of the 104 cases of bilateral cancer selected 12 were synchronous and 92 asynchronous. The treatment was radical mastectomy, followed by radiotherapy in cases with metastatic involvement of the axillary lymph-nodes: in 6 cases not amenable to radical surgery the treatment was tumorectomy plus radiotherapy. As to the 12 patients with synchronous bilateral cancer 6 were alive and free of disease 5 years after the treatment: only 1 case was alive after 10 years. The median survival figure was 7.3 years. For the 92 patients treated for successive bilateral cancer the 5- and 10-year survival rate was 78.5% and 64.5% when calculated from the observation of the first tumor: the correspondent figures calculated from the observation of the second tumor were 48.5% and 33% respectively. The median survival figure was 12.7 and 4.8 years respectively. Survival rates for successive bilateral cancer must be calculated from the observation of the second tumor in order to avoid misleading evaluations: the authors do not consider that bilateral cancer has a prognosis similar or even better than unilateral breast cancer. As to treatment, although there are no unequivocal criteria for regarding bilateral cancer as independent tumors, bilateral radical mastectomy is justified and is the treatment of choice.

Tubular carcinoma of the breast: a clinicopathologic study of 35 cases.

This is a report of 35 cases of tubular carcinoma of the breast treated at Memorial Sloan-Kettering Cancer Center from 1938 to 1971. This type of cancer is also known as well-differentiated carcinoma. Ages of patients were 31-75 years with a mean of 50.8 years. In 27 cases the presenting symptom was a mass which had usually been present more than 2 months. In 19 cases the tumor was in the upper outer quadrant of the breast. In 2 cases the cancer was bilateral. Mammograms made for 13 patients were positive in only 6 and questionable in 2 others. In 2 cases small tumors had been incorrectly diagnosed as benign lesions. In 1 fibroadenoma was also present. In 80% of cases other forms of breast carcinoma were also present in the same breast. Of the 35 cases 23(65%) also had foci of intraductal papillary carcinoma. The prognosis is dependent on the associated cancer. In 3 cases (9%) the tubular carcinoma had spread to the axillary nodes. Treatment was by radical mastectomy in 27 instances modified radical in 6 and local excision in 1. Internal mammary resection was done in 1 case. Bilateral radical mastectomy was done in 5. Postoperative radiation was given to 4 patients. Follow-up information of from 1-32 years was available for 23 patients. Local recurrences were found in 2 and 1 there were metastases to the lumbar spine. No deaths were considered due to the tubular cancers. The modified radical mastectomy is considered adequate for most cases.