Curative Mastectomy Research Articles

A case report: role of curative toilet mastectomy with latissimus dorsi flap recostruction in locally advanced breast cancer

Breast Cancer is a systemic disease with rising incidence all over World. In India where most of the patients present with advanced stage. Multimodal treatment with evolving research in breast cancer showed an evidence of increase in survival in Locally Advanced Breast Cancer (LABC). Based on this selected patients with LABC which are inoperable may have a survival benefit with Local Surgery and Adjuvant treatment. We present a case from Semi-Urban locality in India where facilities are poor. A Case Report of curative Mastectomy in Fungating Breast Cancer which progressed on Chemotherapy from a tier- 2 city with limited resources showed increased survival which can be taken as pilot study for advanced trials and research.

Abstract PS1-66: Current practice in implant-based breast reconstruction: A french long-term follow-up study

Abstract Background: There is a lack of data on the use of breast implants and the path of patients reconstructed after breast cancer in France. This study aims to identify the paths of patients reconstructed by breast implant in France and assess their impact on survival, but also estimate the quality of the reconstruction, determined by early removal or replacement of implants.Methods : We performed a multicentric retrospective cohort study on women who underwent immediate or delayed implant-based reconstruction after curative or prophylactic mastectomy between 2002 and 2010 in three French private health institutions of public interest.Results : We identified 9 care pathways according to the type of disease, the type of surgery, the addition or not of adjuvant radiotherapy, and the timing of reconstruction. Theses courses concern 2,499 patients, and 3,191 breasts on which at least one implant has been placed. Five implant brands were mainly used during this period: PIP, Mentor, Allergan, Sebbin, and Perthese - with a total of 4,106 implants. The median of follow-up is 6 years [0 ;12 ;1]. The number of implants per breast is significantly different according to the reconstruction pathways (p<0.001). The overall survival and removal incidence of implants are significantly different according to the differents profiles of reconstruction (Log-Rank test: p <0.001).Conclusion : The profiles of patients reconstructed by implants are very heterogeneous, according to their disease, their surgery, the adjunction of adjuvant radiotherapy, and the reconstruction time. This leads to very differents overall survival and breast implants removal rates. By identifying specific pathways despite the heterogeneity of the population, this study makes it possible to identify patients at risk more precisely and to have a more global vision on implant reconstruction in France in the 2000s, over a decade of PIP breast implant use. Citation Format: Lea Pauly, Benoit Couturaud, Fabien Reyal. Current practice in implant-based breast reconstruction: A french long-term follow-up study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-66.

Abstract PS1-65: What lessons can be learned from the poly implant prothese scandal ? A french retrospective study

Abstract Background : Silicone breast implants from the French manufacturer Poly Implant Prothese (PIP) were recalled from the French market after the use of a non-medical silicone filler has been established. The systematic explantation of the implants had been proposed to women with PIP implants in France, a preventive measure concerning approximately 30,000 patients.Objectives : This study aimed to evaluate the consequences of having at least one PIP breast implant on overall and disease-free survival after breast reconstruction for cancer or prophylactic surgery.Materials and Methods : We performed a multicentric retrospective cohort study on women who underwent immediate or delayed implant-based reconstruction after curative or prophylactic mastectomy between January 01,2002 and March 30,2010 in three French private health institutions of public interest. These dates correspond respectively to the arrival of PIP breast implants on the French market and the decision to withdraw them by the French government. The primary endpoints were disease-free and overall survival, depending on whether or not having a PIP breast implant used during breast reconstruction of prophylactic surgery.Results : We identified 2499 patients with the use of 4106 breast implants between 2002 and 2010.The median age of cancer diagnosis was 47 years (19-77). This patient population selected for breast reconstruction had good prognosis criteria (77% T1 and 68% N0). PIP was the most common brand used between 2002 and 2010 and represented 45% of all breast implants (1764 implants). PIP has been preferentially used in courses with immediate breast reconstruction. On the 1764 PIP, 1408 (80%) were removed, mainly after the preventive measure recommending systematic explantation. Censored data on March 30, 2010, showed that the incidence of PIP implants removal is lower than other brands (Log-rank test : p<0.001). Overall survival of patients who had at least on PIP was no different from that of patients who never had a PIP (Log-rank test : p=0.2). Disease-free survival was also similar between these two populations (Log-rank test : p=0.12).Conclusion : We did not identify any increase in local-regional recurrence or overall mortality associated with the use of PIP. Citation Format: Lea Pauly, Benoit Couturaud, Fabien Reyal. What lessons can be learned from the poly implant prothese scandal ? A french retrospective study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-65.

Residual glandular tissue (RGT) in BRCA1/2 germline mutation carriers with unilateral and bilateral prophylactic mastectomies

BackgroundProphylactic mastectomy (PME) is increasingly performed in women carrying deleterious BRCA1 and BRCA2 germline mutations. The oncologic risk resulting from residual fibroglandular tissue (RGT) is unknown. MethodsAll women who had received a mastectomy and at least one postoperative breast MRI, between 2006 and 2016 were extracted from the register of the Center for Hereditary Breast and Ovarian Cancer Cologne (CHBOC). The index MRI was evaluated in terms of basic clinical data and the morphological criteria of RGT. The RGT volume was measured in diameter and was semi-automatically evaluated using software. ResultsWe identified 169 women carrying BRCA1/2 mutations who underwent prophylactic and curative mastectomy: a total of 338 breasts. RGT was found in 128 of the 338 breasts (37.9%). 68 of the 128 breasts (53.1%) were related to bilateral PME, 37 (28.9%) to unilateral PME and 23 (18.0%) to curative mastectomy. RGT was predominantly unifocal and located in the retroareolar breast region. RGT was observed more often after bilateral PME (p < 0.0001). In this subgroup, the nipple-sparing mastectomy dominated (108 of 136, 79.4%), in contrast to 23 standard mastectomies (23 of 94, 24.5%) in the subgroup of curative mastectomy (23%). There was a trend towards higher amounts of RGT in surgical units with fewer mastectomies performed. During follow-up, two breast cancers were detected after bilateral and unilateral PME, respectively. ConclusionsOur results suggest that the indication for surgery and in particular the selected surgical procedure affect the surgical outcome with respect to RGT. Oncological safety should not be neglected, especially in the high-risk group of BRCA1/2 mutation carriers.

Skin-sparing mastectomy with immediate nipple reconstruction during autologous latissimus dorsi breast reconstruction: A review of patient satisfaction.

BackgroundNipple-areolar complex (NAC) reconstruction following curative mastectomy is traditionally performed as a second-stage procedure several months after initial breast reconstruction. The recent literature has documented the increasing popularity of immediate nipple reconstruction carried out simultaneously during autologous reconstruction. The aim of this study was to evaluate the surgical outcomes and patient satisfaction with immediate breast and nipple reconstruction performed in a single stage after skin-sparing mastectomy.MethodsAll patients who underwent a skin-sparing mastectomy with immediate latissimus dorsi flap breast and NAC reconstruction as a single-stage procedure from 2007 to 2015 were included. Patient demographics, oncologic details, and surgical outcomes were recorded. The BREAST-Q questionnaire was administered to patients to assess the impact and effectiveness of this reconstructive strategy.ResultsDuring the study period, 34 breast and NAC reconstructions in 29 patients were performed at Cork University Hospital. The majority of our patient cohort were non-smokers (93.1%) and did not receive adjuvant radiotherapy. Postoperative complications were infrequent, with no cases of partial necrosis or complete loss of the nipple. The response rate to the BREAST-Q was 62% (n=18). Patients reported high levels of satisfaction with the reconstructed breast (62±4), nipple reconstruction (61±4.8), overall outcome (74.3±5), and psychosocialwell-being (77.7±3.2).ConclusionsSkin-sparing mastectomy with immediate nipple reconstruction during autologous latissimus dorsi reconstruction was demonstrated to be a safe and aesthetically reliable procedure in our cohort, yielding high levels of psychological and physical well-being. A single-stage procedure promotes psychosocial well-being involving issues that are intrinsically linked with breast cancer surgery.

INCIDENCE AND RISK FACTORS OF ARM OEDEMA FOLLOWING MODIFIED MASTECTTOMY OF BREAST CANCER

Background: Lymphoedema after curative mastectomy related breast cancer is a late complication with estimates of incidence ranging from 6-70%. Lymphoedema may present immediately or years after treatment, majority of cases occur during the first 18 months. Objective: Investigate the incidence arm lymphedema and relation of age, tumor size, axillary node status, chemotherapy, radiation therapy for breast cancer- related arm lymphedema. Patients and methods: From 1/2014 to 12/2016, eligible patients including 164 breast cancer patient, clinically stage I,II,III, have been treated with surgery, adjuvant chemotherapy, radiation therapy and hormonotherapy accoding to stage of disease and follow-up at Hue University Hospital. Method: Prospective, observational study, with arm-circumference measurement of pre-operatively and at regular intervals post-operatively. Results: The incidence of lymphedema post-operatively is 38.4% including: mild lymphedema 19.5%, moderate 13.4% and severe 5.5%. Related factors including tumor size, axillary node status, chemotherapy and radiation therapy were statistically significantly associated with lymphoedema. Conclusion: Lymphoedema was a late complication, affected of quality of life of breast cancer patients. More systematic surveillance for early detection and appropriate treatment. Key words: Breast cancer, lymphoedema, arm oedema

Breast reconstruction after mastectomy: does it decrease depression at the long-term?

Depression is associated with breast cancer survivors in 22%. Although breast reconstruction (BR) is intended to provide psychological improvements such as reducing depression, literature is inconclusive and without long-term follow-up. The objective is to evaluate the impact of BR after breast cancer related mastectomy on the long-term depression risk and assess predictive factors for depression. Women who underwent a curative mastectomy between 1999 and 2009 were included. After a mean follow-up of more than 6 years after operation, the Beck Depression Inventory-13 (BDI-13) evaluated depressive symptoms. Multivariable regression analysis provided predictors for depression. A total of 139 patients, 34 (24.5%) with and 105 (75.5%) without BR, were analyzed. Seventy-seven patients (48.2%) were at high risk for mild (n=58), moderate (n=5) or severe (n=4) depression. There was a trend for slightly better BDI-13 outcomes for women who underwent BR (2 vs. 4; P=0.06). Living alone [odds ratio (OR): 2.16; P=0.04], low educational level (OR: 3.70; P<0.01) and adjuvant hormonal/endocrine-therapy (OR: 2.36; P=0.02) were associated with an increased depression risk. BR has no clear influence on depressive symptoms on the long-term. Predictive factors should alert clinicians to assess depressive symptoms in specific breast cancer patients during follow-up.

Different types of implants for reconstructive breast surgery.

Different types of implants for reconstructive breast surgery.

Elovl6 is a poor prognostic predictor in breast cancer.

Elongation of long chain fatty acids family member 6 (Elovl6) has been demonstrated to be involved in insulin resistance, obesity and lipogenesis. In addition, it has been reported that the protein is upregulated in human hepatocellular carcinoma and is implicated in nonalcoholic steatohepatitis-associated liver carcinogenesis. Excess body weight has been associated with an increased risk of postmenopausal breast cancer and poor prognosis. However, the connection between Elovl6 expression and outcome of breast cancer remains uncertain. Therefore, the present study used immunohistochemical analysis to investigate the expression of Elovl6 in breast cancer tissues from patients who had undergone curative mastectomy. Out of a total of 70 patients, 37.1% of patients exhibited positive Elovl6 expression in breast cancer tissue, whilst 62.9% were considered as negative. Positive Elov16 expression correlated with positive lymph node involvement and shorter recurrence-free survival. However, Elovl6 expression had no association with primary tumor size, lymph node metastasis, stage, grade, estrogen receptor, progesterone receptor, HER2 and age. Therefore, positive Elovl6 expression is a poor prognostic factor in patients with breast cancer that have previously undergone surgery, and may function as a potential therapeutic approach in the future, particularly in the scope of obesity related disease.

Relationships between serum HER2 ECD, TIMP-1 and clinical outcomes in Taiwanese breast cancer

BackgroundSerum levels of the extracellular domain of HER2/neu (HER2 ECD) have been demonstrated to be associated with clinical outcomes. A disintegrin and metalloproteinase-10, a sheddase of HER2/neu, can drive cancer progression and its activity is inhibited by tissue inhibitor of metalloproteinase-1 (TIMP-1). However, elevated TIMP-1 expression has been associated with a poor prognosis of breast cancer. Therefore, this study was performed to explore the relationships between serum HER2 ECD, TIMP-1 and clinical outcomes.MethodsOne hundred and eighty-five female breast cancer patients, who received curative mastectomy without neo-adjuvant chemotherapy at Chang-Gung Memorial Hospital, were recruited with informed consent for this study. Pre-operative serum levels of HER2 ECD and TIMP-1 were measured using an enzyme-linked immunosorbent assay.ResultsTwenty-three cases (12.4%) were classified HER2 ECD positive. HER2 ECD positivity was significantly associated with age, lymph node involvement, histological grade, estrogen receptor status, progesterone receptor status, tissue HER2/neu overexpression, and disease-free survival (DFS). In an age, stage, ER and HER2/neu status matched subgroup (N = 41), the serum level of TIMP-1 was significantly associated with HER2 ECD positivity and DFS.ConclusionsA high serum TIMP-1 was significantly associated with HER2 ECD positivity and a poorer DFS among Taiwanese primary breast cancer patients with HER2 overexpression.

Reply: The Favorable Psychological Approach of Single-Stage Curative and Prophylactic Skin-Reducing Mastectomy in Patients with Macromastia

Reply: The Favorable Psychological Approach of Single-Stage Curative and Prophylactic Skin-Reducing Mastectomy in Patients with Macromastia

Treatment Outcomes for PET Positive Clinical N3 Breast Cancer Patients after Neoadjuvant Chemotherapy, Surgery, and Regional Lymph Nodes Radiotherapy

Materials/Methods: Initially PET positive 55 patients with ipsilateral infraclavicular (ICL) or internal mammary (IMN) or supraclavicular lymph nodes (SCL) without distant metastases were retrospectively analyzed. The clinical nodal stage at diagnosis (2002 AJCC) was cN3a in 14 (25.5%), cN3b in 12 (21.8%) and cN3c in 29 (52.7%) of the patients. All patients were treated with curative intent NEO, mastectomy or breast-conserving surgery (BCS), and radiotherapy (RT). RT was comprised of 60.4 Gy to the ipsilateral breast or 50.4 Gy to chest wall combined with 45-50.4 Gy to SCL for all patients. Additional 5-20 Gy boost RT was done to PET involved SCL. RT coverage of PET involved IMN was performed at physician’s discretion. All hormone receptor-positive patients received hormonal therapy. Results: At a median follow-up of 38 months (range, 9-80 months), 20 patients (36.4%) had developed treatment failures. All treatment failures included distant metastases, among which one ipsilateral breast recurrence (IBR), six regional failures (RF) and one both IBR and RF were combined. Only 3 patients (7.2%) failed at initial PET positive cN3 lymph nodes. The 5-year locoregional relapse-free survival (LRRFS), disease-free survival (DFS), and overall survival rate was 80.1%, 59.6%, and 78.5%, respectively. Estrogen receptor-positive patients showed better 5-year DFS (79.7% vs. 47.4%, p = 0.05). Positive axillary nodes $ 10 after NEO was associated with worse 5-year DFS (69.4% vs. 38.5%, p = 0.009). The SCL dose . 55 Gy for cN3c patients did not affect 5-year SCL-relapse free survival and DFS, as did not those with RT coverage of IMN for cN3b patients (p . 0.05). Conclusions: RT including regional lymph nodes after NEO and surgery achieved excellent locoregional control for patients with PET positive cN3 breast cancer patients. Additional boost RT to PET positive SCL or coverage of PET positive IMN did not show the additional gain in LRRFS or DFS.

Persistent Mobility Disability After Neurotoxic Chemotherapy

The impact of cancer and its treatments on balance and functional mobility in older adults remains unknown but is increasingly important, given the evolution of cancer treatments. Subacute and more persistent side effects such as chemotherapy-induced peripheral neuropathy are on the rise, and the effects on mobility and balance, as well as the prognosis for resolution of any functional deficits, must be established before interventions can be trialed. The purpose of this case report is to describe the severity and long-term persistence of mobility decline in an older adult who received neurotoxic chemotherapy. To our knowledge, this is the first case report to describe an older adult with chemotherapy-induced peripheral neuropathy using results of standardized balance and mobility tests and to focus on prognosis by repeating these measures more than 2 years after chemotherapy. An 81-year-old woman received a neurotoxic agent (paclitaxel) after curative mastectomy for breast cancer. Baseline testing prior to taxane therapy revealed a socially active woman with no reported functional deficits or neuropathic symptoms, 1.2-m/s gait speed, and performance at the ceiling on balance and gait portions of a standardized mobility measure. After 3 cycles, paclitaxel therapy was stopped by the oncologist because of neurotoxicity. Declines as large as 50% were seen in performance-based measures at 12 weeks and persisted at 2.5 years, and the patient reported recurrent falls, cane use, and mobility-related disability. This case highlights the extent to which function can decline in an older individual receiving neurotoxic chemotherapy, the potential for these deficits to persist years after treatment is stopped, and the need for physical therapy intervention and further research in this population.

Use of sequential FDG-PET/CT to guide extent of axillay lymph node dissection in breast cancer receiving neoadjuvant chemotherapy.

588 Background: The involvement of axially lymph nodes (ALN) might be changed by neoadjuvant chemotherapy (NAC). The purpose of this study is to investigate the usefulness of sequential FDG-PET/CT for prediction of axillary nodal status after NAC. Methods: A total of 78 stage II or III breast cancer patients who received neoadjuvant docetaxel/doxorubicin chemotherapy were enrolled in this prospective study. The patients received 3 cycles of NAC followed by curative surgery, either breast-conserving surgery or mastectomy with level II or III ALN dissection. FDG-PET/CTs were acquired before chemotherapy and after the first cycle of chemotherapy for early metabolic response and nodal prediction. We obtained chest CTs twice, before and after 3 cycles of NAC. Results: The overall response rate to NAC was 82.1%. Pathologic nodal complete responses (pN0) were obtained in 22 patients (28.3%). Patients with pN0 showed significantly lower post-NAC ALN SUV than those who were pN+ (1.22 ± 1.43 in pN0 vs. 2.13 ± 1.99 ...

Proliferative genes dominate malignancy-risk gene signature in histologically-normal breast tissue

Historical data have indicated the potential for the histologically-normal breast to harbor pre-malignant changes at the molecular level. We postulated that a histologically-normal tissue with "tumor-like" gene expression pattern might harbor substantial risk for future cancer development. Genes associated with these high-risk tissues were considered to be "malignancy-risk genes". From a total of 90 breast cancer patients, we collected a set of 143 histologically-normal breast tissues derived from patients harboring breast cancer who underwent curative mastectomy, as well as a set of 42 invasive ductal carcinomas (IDC) of various histologic grades. All samples were assessed for global gene expression differences using microarray analysis. For the purpose of this study we defined normal breast tissue to include histologically normal and benign lesions. Here we report the discovery of a "malignancy-risk" gene signature that may portend risk of breast cancer development in benign, but molecularly-abnormal, breast tissue. Pathway analysis showed that the malignancy-risk signature had a dramatic enrichment for genes with proliferative function, but appears to be independent of ER, PR, and HER2 status. The signature was validated by RT-PCR, with a high correlation (Pearson correlation = 0.95 with P < 0.0001) with microarray data. These results suggest a predictive role for the malignancy-risk signature in normal breast tissue. Proliferative biology dominates the earliest stages of tumor development.

Hamartoma pulmonar como diagnóstico diferencial de metástase de carcinoma de mama: relato de caso

We present the case of a 60-year-old female patient who had been in menopause for 14 years and presented a pulmonary nodule on chest X-ray diagnosed in the postoperative follow-up evaluation of breast cancer. The patient had a history of mastectomy and ipsilateral axillary lymphadenectomy for invasive ductal breast carcinoma, as well as of hormone therapy, chemotherapy, and adjuvant radiotherapy. After thoracoscopic nodulectomy, the frozen section analysis revealed a pulmonary hamartoma. Recent studies show that 75% of patients who undergo surgery for pulmonary nodules after a curative mastectomy for breast cancer present lung metastases, 11.5% present primary lung cancer, and 13.5% present benign lesions, including hamartoma.

Cardiac surgery in patients with previous carcinoma of the breast and mediastinal irradiation: is the internal thoracic artery graft obsolete?

The increasing number of patients of more advanced age undergoing cardiac surgery means the number of those with previous curative (relapse free) mastectomy and irradiation of the chest is also increasing. A higher incidence of postoperative complications such as sternal infection in these patients is considered possible. Furthermore the question of whether mediastinal irradiation leads to a relevant internal thoracic artery (ITA) gaft damage remains unclear. In this context the benefit of arterial revascularization (CABG) using one or both ITAs is not sufficiently proven by data available from clinical studies. 70 patients (49-85 years) with previous mastectomy or Hodgkin/non-Hodgkin's disease and mediastinal irradiation underwent CABG (n = 59) or an aortic valve replacement (AVR, n = 11). 20 patients received bilateral internal thoracic artery grafts, 34 a single internal thoracic artery graft, and in 16 patients an internal thoracic artery was not used. Perioperative data and data concerning postoperative complications such as mortality, myocardial infarction, and sternal infection or refixation was gathered and compared with all other patients receiving CABG (n = 5102). An histological investigation of ITA segments was done in 12 patients. There was no significant enhancement of the perioperative risk in comparison with other patients of a corresponding age group. Internal thoracic artery damage induced by irradiation was not present. There was no increased incidence of sternal instability requiring refixation observed. In the patient cohort investigated there is in general no need for restrictive use of the ITA in CABG.

A CASE OF RESECTABLE SIMPLE LIVER METASTASES FROM BREAST CANCER AFTER A 10-YEAR DISEASE FREE INTERVAL

A 58-year-old woman undergone an extended radical mastectomy for a left breast cancer in Stage IIIa in 1985 had been followed postoperatively with every 3 months analyses of blood chemistries and tumor markers, and with annual ultrasonography or an ambulant basis. The patient became to complain of epigastralgia in September 1995. In December, 1995, she was admitted to the hospital because of an abnormal mass, showing a bull's eye sign in the left lobe of the liver (S4) on ultrasonography. With a diagnosis of possible liver metastasis of breast cancer, Hro (S4) was perfomed in July, 1996. No obvious postoperative complications were noted. A microscopic histological examination revealed solid tubular adenocarcinoma of the liver, metastatic breast cancer. The patient received chemotherapy with CAF postoperatively. The patient is disease free and remains alive for 12 years after the initial breast surgery or for 2 years and 3 months after the liver surgery. Metastases of breast cancer to the liver often appear in multiple lesions and are associated with other organ metastases. In general, these hepatic metastases are uncommonly indicated hepatectomy. And there have been no such cases as 1 solid liver metastasis occurs after a 10-year disease free interval. We think, however, that aggressive hepatectomy is a useful option for the liver metastases, if it is possible, and that a long-term follow-up after curative mastectomy is important, even if more than 10 years elapse.

Metastatic mammary carcinoma in the eyelid with histiocytoid appearance.

A clinicopathologic study of 13 cases of carcinoma of the breast with metastasis to the eyelids has been made. Seven of these presented diagnostic problems for several reasons: 1. because the lesion in the lid became symptomatic before the primary tumor of the breast was detected; 2. because it was the first sign of metastasis at least 2 years after an apparently curative mastectomy, and/or 3. because of a peculiar histiocytoid pattern of the metastatic tumor that mimicked a benign histiocytic lesion. The histiocytoid pattern, however, once recogognized, is highly suggestive of a metastasis from a primary mammary carcinoma. Of the 13 metastatic tumors in the lid, only 3 had the histopathologic pattern of a typical infiltrating ductal carcinoma. Two had sufficiently pleomorphic patterns that the diagnosis of malignancy was inescapable. Eight tumors had the histiocytoid pattern, and seven of these had presented diagnostic problems histopathologically, the misinterpretations resulting in diagnoses of xanthelasma, xanthoma, histiocytoma, histiocytosis, granular cell myoblastoma, and possible blastomycosis, all of which reflect the histiocytic appearance of these mucus-secreting metastatic adenocarcinomas.