Mastectomy Patients Research Articles

Breast Cancer and Mental Health: Incidence and Influencing Factors—A Claims Data Analysis from Germany

Background/Objectives: With breast cancer (BC) survival improving due to optimized therapy, enhancing quality of life has become increasingly important. Both diagnosis and treatment, with their potential side effects, pose risks to mental well-being. Our study aimed to analyze the incidence and potential risk factors for mental disorders in BC patients. Methods: This retrospective analysis used claims data from AOK Baden-Wuerttemberg, including 11,553 BC patients diagnosed via ICD code C50 between 2010 and 2020 and 31,944 age-matched controls. Patients with mental disorders in the 12 months prior to diagnosis were excluded. Mental disorders were categorized into eight groups based on ICD codes: anxiety, obsessive compulsive disorder, adjustment disorder, dissociative disorder, hypochondriac disorder, affective disorder, mania, and other neuroses. Results: Mental disorders were significantly more common in BC patients than in controls (64.2% vs. 38.1%, p < 0.01, OR 2.91, 95%CI [2.79, 3.04]). In particular, hypochondriac, anxiety, affective, and adjustment disorders occurred significantly more often in BC patients. No differences were found for mania, bipolar disease, other neuroses, obsessive compulsive-, or dissociative disorders. Furthermore, endocrine therapy was associated with psychological comorbidities (OR 1.69, p < 0.001, 95%CI [1.53, 1.86]), while primarily metastasized patients (stage C) had a lower risk than adjuvant patients in stage A (OR 0.55, p < 0.0001, 95%CI [0.49, 0.61]). Regarding surgical treatment, mastectomy patients showed lower rates of mental illnesses (61.2%) than those with breast-conserving treatment (71.6%), or especially breast reconstruction (78.4%, p < 0.01). Breast reconstruction was also associated with more hypochondriac (p < 0.01) and adjustment disorders (p < 0.01). Conclusions: So, BC patients experience significantly more mental disorders than controls, particularly when treated with endocrine therapy and breast reconstructive surgery.

Racial Differences in Incidence of Anxiety and Depression Among Mastectomy and Breast Reconstruction Patients Using the All of Us Database

Background: Breast reconstruction after mastectomy may improve psychological sequelae for patients. The objective of this study is to characterize differences in depression and anxiety rates for mastectomy and breast reconstruction (BR) patients by race. Methods: The All of Us database was utilized for patients who underwent mastectomy and BR post-mastectomy. Anxiety and depression rates and self-identified race were extracted from DatasetV7. Results: Of mastectomy patients, 2398 were White and 472 were Black. Black patients had the greatest difference in depression rates between mastectomy (44.5%) and BR patients (28.8%) (OR = 0.46, 95% CI 0.26–0.82). White patients had lower depression rates (40.4%) for mastectomy than Black patients. Asian patients had the lowest rates of depression for mastectomy (OR = 0.43, 95% CI 0.22–0.84) and for mastectomy and BR (OR = 0.35). Black patients had a decrease in anxiety rates from mastectomy (49.4%) to BR (40.9%) (OR = 0.67). Conclusions: Anxiety and depression varied significantly by race for mastectomy and BR patients. Black mastectomy patients had the highest rates of depression and anxiety, which decreased after receiving BR. Lower rates of anxiety and depression were found amongst Asian mastectomy patients. These data highlight the need to identify and treat races vulnerable to depression and anxiety before and after mastectomy/BR.

Staged Nipple Delay Procedure Expands Candidacy for Nipple-Sparing Mastectomy.

Nipple delay (ND) is a staged procedure that improves nipple-areolar complex (NAC) viability in nipple-sparing mastectomy (NSM) patients who are high-risk for NAC or skin-flap necrosis. This study compared postoperative outcomes and risk factors between patients treated with ND-NSM and NSM alone. Patient demographics, risk factors for NAC or skin-flap necrosis, tumor characteristics, and operative outcomes were compared between ND-NSM and NSM groups from 2009 to 2023. Univariate and multivariate analyses were performed to identify significant variables associated with NAC or skin-flap necrosis. Overall, 71 ND-NSM patients and 537 NSM patients were compared. ND-NSM patients had larger breasts (p<0.01), body mass index ≥ 30 (p=0.01), prior breast/chest wall radiation (XRT) [p<0.01], prior breast operations (p<0.01), less axillary surgery (p<0.01), more autologous tissue reconstruction over implant-based reconstruction compared with NSM patients (p=0.02), and more prophylaxis (p<0.01). There were no statistically significant differences between groups in regard to infection, skin-flap necrosis, NAC necrosis, seromas, and hematomas. No patients in the ND-NSM group had NAC necrosis and 1 patient had skin-flap necrosis, compared with 17 and 13 patients in the NSM group, respectively (p=0.24). On univariate analysis, prior XRT was associated with increased risk for skin-flap necrosis (p=0.02). Multivariate analysis showed XRT was associated with skin-flap necrosis (p=0.02) and any necrosis (p=0.01). Breast size was associated with NAC or skin-flap necrosis (p=0.04). Larger breasts and XRT were risk factors for NAC or skin-flap necrosis; however, despite having more risk factors, ND-NSM patients had very low rates of necrosis. Notably, no nipples were lost. A shared decision should be made with patients regarding the risks and benefits of ND-NSM.

ASO Author Reflections: Immediate Implant-Based Versus Autologous-Based Breast Reconstruction After Mastectomy in Patients with Breast Cancer.

ASO Author Reflections: Immediate Implant-Based Versus Autologous-Based Breast Reconstruction After Mastectomy in Patients with Breast Cancer.

Predictors of mastectomy in breast cancer patients with complete remission of primary tumor after neoadjuvant therapy: A retrospective study

IntroductionNeoadjuvant therapy (NAT) should increase the rate of breast-conserving surgery (BCS) in non-metastatic breast cancer (BC) patients, especially in those achieving tumor shrinkage. Still, the conversion from a pre-planned mastectomy to BCS in patients responding to NAT is not a widespread standard. We aimed to identify factors influencing surgical choices in this setting. Materials and methodsWe retrospectively collected data of BC patients with complete remission of primitive tumor (ypT0) after NAT, treated with BCS or mastectomy in two Italian breast units. Predictors of mastectomy were explored using logistic regression. Distant recurrence and event-free survival were assessed in the BCS and mastectomy cohort. Results243 patients were included, 147 (60.5 %) treated with BCS and 96 (39.5 %) treated with mastectomy. In the mastectomy group, there were more centrally-located, multiple and larger tumors. At univariate regression analysis, central location, baseline tumor extension on ultrasound (US) and magnetic resonance imaging (MRI), multiple foci and clinical stage were significantly associated with the chance of receiving mastectomy. At multivariate analysis, only baseline focality on US and extension on MRI retained significance as predictors of mastectomy. Distant recurrence and event-free survival were significantly longer in patients undergoing BCS. ConclusionBaseline tumor extension and focality were the main predictors of mastectomy in patients with ypT0 after NAT. However, BCS did not negatively affect survival outcomes in our cohort. An effort should be made to avoid potentially unnecessary mastectomy in this population, aiming at minimizing surgery-associated toxicities and improving patients’ quality of life.

Analysis of the Ultrasensitive C-Reactive Protein and Homocysteine Biomarkers after Photobiomodulation Therapy in Hormone Blocker-Treated Mastectomized Women: A Randomized, Blind, and Controlled Clinical Study.

Main: The pharmacological treatment of cancer can lead to undesirable hemodynamic adverse effects. Laser therapy may promote hemodynamic balance in these patients. This study aimed to analyze the values of the biomarkers ultrasensitive C-reactive protein (PCR_us) and Homocysteine (HCy) after the use of intravascular laser irradiation of blood (ILIB) in mastectomized patients using hormonal blockers Tamoxifen and Aromatase Inhibitors. Methods: This was an experimental, placebo-controlled, randomized clinical trial with experimental (G1) and control (G2) groups. In G1, patients were irradiated with ILIB using a red laser at 660 nm on the carotid artery, while G2 received a placebo treatment. Blood collection for HCy and us-CRP biomarker evaluation was conducted monthly for 4 months. Statistical analysis was performed using R Studio 4.4.2 and JAMOVI, with a significance level of 5%. Results: A total of 21 patients participated in the study, with 12 in G1 and 9 in G2. There were no differences in age, systolic, diastolic blood pressure, and heart rate between the groups. The initial and final mean PCR_us levels for G1 were 6.8 and 3.8 mg/dL, and for HCy were 14.2 and 12.1 µmol/L, respectively. While for G2 initial and final mean PCR_us levels were 9.40 and 7.60 mg/dL, and for HCy were 14.33 and 16.69 µmol/L. There was no statistical difference for PCR_us. However, a significant difference between the groups (p < 0.05) for HCy in the 3rd and 4th months. Conclusion: During ILIB Therapy, there was a reduction in HCy, which may favor the improvement of cardiovascular function in these patients undergoing anticancer therapies.

Assessment of knowledge levels amongst pre-operative patients regarding the importance of postmastectomy exercises for optimal outcome: ACross-sectional study

Background: Post-operative exercises play a crucial role in the recovery process for mastectomy patients. Assessing preoperative knowledge can guide effective educational interventions. Aim: The primary objective of the study was to evaluate the knowledge levels of pre-operative breast cancer patients regarding post-operative exercises. Materials and Methods: A descriptive cross-sectional study was conducted from March 2021 to March 2022 at Female District Hospital and Satish Pandey Memorial (SCPM) Multi-Specialty Hospital, Gonda, Uttar Pradesh. Using a purposive sampling technique, 150 pre-operative breast cancer patients were selected. Data were collected via questionnaires assessing demographic variables and knowledge of post-operative exercises. Statistical analysis was conducted using SPSS, with significance set at 95% confidence interval. Results: Findings showed 27.3% of patients had no knowledge, 33.3% had inadequate knowledge, 27.3% had moderate knowledge, and 12% had adequate knowledge, with a mean score of 2.24 (SD = 0.98). Chi-square analysis indicated significant associations between knowledge levels and demographic factors such as age, education, occupation, family type, and living area, (p&lt;0.05). Conclusion: The study highlights varied knowledge levels regarding post-operative exercises among mastectomy patients, with many showing inadequate understanding. Educational programs are essential to improve knowledge and promote better recovery outcomes.

Magnetic lymphatic tracing for omission of sentinel lymph node biopsies in mastectomy patients: a community cancer center experience.

Patients with ductal carcinoma in situ (DCIS) and patients undergoing risk reduction mastectomy may undergo sentinel lymph node biopsy (SLNB) at the time of mastectomy to complete axillary staging were an underlying invasive malignancy to be found on final pathology. Among patients with DCIS undergoing mastectomy, 15-29% of patients will have invasive disease on final pathology; therefore, approximately 70-85% of patients may benefit from avoiding SLNB. Superparamagnetic tracers (SPMT) have been proven to be non-inferior to the standard radioisotope and blue dye combination. SPMT remains active for several weeks, allowing a large proportion of DCIS and genetic carrier patients to potentially avoid SLNB in the setting of mastectomy. We hypothesize the use of SPMT will reduce the number of SLNB performed in patients undergoing mastectomy for DCIS and risk reduction, ultimately reducing the number of complications associated with axillary surgery. We seek to report our community cancer center's experience with SPMT and omission of SLNB in the DCIS and prophylactic mastectomy patient population. We performed a retrospective review of 52 female patients with DCIS or known genetic predisposition undergoing mastectomy. SPMT (Magtrace®, Endomag Ltd, Cambridge, UK) was injected ipsilateral to DCIS and bilaterally for prophylactic mastectomy patients. Our primary outcome was rate of return to the operating room (OR) for delayed SLNB. Secondary outcomes included post-operative complications within 30days of surgery and operative time. We compared outcomes to a control group of 28 women undergoing mastectomy for DCIS or for risk reduction who underwent SLNB at their index operation in traditional fashion. Continuous variables were reported using median and interquartile ranges (IQR) and were compared using the Mann-Whitney U test. Categorical data were reported using frequency and percent and were compared using Pearson's Chi-Square or Fisher's Exact test, as appropriate. Alpha was set to 0.05 to determine statistical significance. There was a total of 80 patients (52 SPMT, 28 control). Median age of SPMT patients was 49.5 (IQR 40-60.75) vs. 54.5 (48 - 65) in the traditional tracer group. vs. control group. 57.7% of SPMT patients underwent mastectomy for DCIS vs. 89.3% in the control group. Eight SPMT patients (15.4%) had invasive ductal carcinoma (IDC) on final pathology and seven of those patients underwent delayed SLNB (87.5%). None of the delayed SLNB were positive for metastatic disease. Rates of post-operative complications were similar between the two groups, including hematoma, seroma, and surgical site infection. OR times were also similar with median OR time 202min (min) for the SPMT group vs. 195min for the control group. Use of SPMT avoided SLNB in 84.6% of our patients. We found no difference in rates of post-operative complications or operative times in patients using SPMT for omission of SLNB at time of mastectomy compared to the control group. Our findings suggest SLNB can be avoided in a majority of patients undergoing mastectomy for DCIS or risk reduction in the setting of genetic predisposition.

Management of Ipsilateral Breast Tumor Recurrence Following Breast Conservation Surgery for Ductal Carcinoma In Situ: A Data-Poor Zone.

Breast conserving surgery (BCS) is well established for the management of ductal carcinoma in situ (DCIS), but neither randomized trials nor guidelines address management of ipsilateral breast tumor recurrence (IBTR) after BCS for DCIS. We identified women treated with BCS for DCIS who developed IBTR as a first event. Between those treated with mastectomy versus re-BCS, we compare the clinicopathologic characteristics, the use of adjuvant radiotherapy (RT) both upfront ("primary RT") and post IBTR ("secondary RT"), of tamoxifen, the rate of third events (local, regional, distant), and both breast cancer specific (BCSS) and overall survival (OS). Of 3001 women treated with BCS for DCIS (1978-2010), 383 developed an IBTR as a first event (1983-2023) and were treated by mastectomy (51%) versus re-BCS (49%). Compared with re-BCS, mastectomy patients at initial treatment were higher grade (74% versus 59%, p = 0.004), with more frequent primary RT (61% versus 21%, p < 0.001). Third local events were more frequent for re-BCS than mastectomy (16% versus 3%, p = 0.001), but there were no differences in breast cancer specific or overall survival. For isolated IBTR following BCS for DCIS and treated by mastectomy versus re-BCS (1) mastectomy was associated with less favorable initial pathology and more frequent use of primary RT, (2) re- recurrence was more frequent with re-BCS, and (3) BCSS and OS were comparable. Our data suggest a wider role for re-BCS and further study of the relationship between secondary RT and the rate of third breast events.

Randomised controlled trials on radiation dose fractionation in breast cancer: systematic review and meta-analysis with emphasis on side effects and cosmesis

ObjectiveTo provide a comprehensive assessment of various fractionation schemes in radiation therapy for breast cancer, with a focus on side effects, cosmesis, quality of life, risks of recurrence, and survival...

ThP1.2 - Management of breast cancer sentinel lymph node macrometastasis in the axilla; audit of current unit practice and evaluation of factors that influence patient management

Abstract Aims Detection of sentinel lymph node (SLN) macrometastasis for breast cancer no longer mandates further axillary surgery. Association of Breast Surgery (ABS) guideline provides recommendation to optimise patient management. It also acknowledges management uncertainties in specific patient groups. We aimed to examine our unit practice against national guideline and evaluate potential factors that influence axillary management. Methods Retrospective analysis of prospectively maintained electronic database determined clinico-pathological characteristics on patients diagnosed with SLN macrometastasis (n=127) at the Leeds Breast Unit (2020-2022). Axillary management was compared against ABS guideline. Results 56 (44.1%) received completion axillary node clearance (cANC), 37 (29.1%) axillary radiotherapy (aRT), and 34 (26.8%) no further axillary treatment. 80.3% had one macrometastasis. As per guideline, all patients who had &amp;gt;3 macrometastasis (n=10) underwent cANC. Type of breast surgery (mastectomy vs. breast conserving surgery; BCS) did not affect further axillary treatment rate (76.7% vs. 70.1%). Type of further axillary treatment varied with cANC commonest for mastectomy patients (78.3%) and aRT commonest for BCS patients (57.4%). In contrast to the guideline, 58% of post-menopausal BCS patients with ER+HER2- T1 tumours (n=12) received further axillary treatment. Where guideline stated management uncertainty, further axillary treatment was frequent; pre-menopausal patients (82%), T2 tumours (73%), lymphovascular invasion (74%), and extranodal spread (77%). Conclusion Our unit’s SLN macrometastasis management is mostly in line with national guideline but further work is required to avoid overtreatment. Where management uncertainty exists, patients commonly received further axillary treatment. Further research is required in these patient groups to optimise axillary management.

Factors influencing prophylactic surgical intervention in women with genetic predisposition for breast cancer.

In the United States, 5%-10% of breast cancer cases are due to genetic predisposition. Among this population, prophylactic mastectomy is viable risk-reducing option. The objective of this study is to understand the timing to prophylactic mastectomy in patients with genetic predisposition to breast cancer and uncover factors influencing this decision. This study is a retrospective review of patients diagnosed with genetic predisposition for breast cancer from 2010 to 2020. In a cohort of 506 patients with genetic predisposition for breast cancer, 154 (30.4%) underwent prophylactic mastectomy, the remainder opted for surveillance alone. The median time from diagnosis to mastectomy was 1.1 years (IQR, 0.5-3.1 years). During the surveillance period, 118 patients (33.5%) underwent breast biopsy. Of the patients with benign or atypical findings, 35 (36.8%) pursued prophylactic mastectomy, a median of 0.5 years (IQR, 0.2-1.6 years) after their gene diagnosis. The most common factor impacting the decision to undergo prophylactic mastectomy was having a family member with cancer (54.7%) followed by a personal diagnosis of other cancer(s) (27.5%). Understanding the factors influencing the decision to undergo prophylactic surgery will allow for more effective shared decision-making for primary care providers, breast surgeons, and reconstructive surgeons.

Tissue expansion mitigates radiation-induced skin fibrosis in a porcine model

Tissue expansion (TE) is the primary method for breast reconstruction after mastectomy. In many cases, mastectomy patients undergo radiation treatment (XR). Radiation is known to induce skin fibrosis and is one of the main causes for complications during post-mastectomy breast reconstruction. TE, on the other hand, induces a pro-regenerative response that culminates in growth of new skin. However, the combined effect of XR and TE on skin mechanics is unknown. Here we used the porcine model of TE to study the effect of radiation on skin fibrosis through biaxial testing, histological analysis, and kinematic analysis of skin deformation over time. We found that XR leads to stiffening of skin compared to control based on a shift in the transition stretch (transition between a low stiffness and an exponential stress-strain region characteristic of collagenous tissue) and an increase in the high modulus (modulus computed with stress-stretch data past the transition point). The change in transition stretch can be explained by thicker, more aligned collagen fiber bundles measured in histology images. Skin subjected to both XR+TE showed similar microstructure to controls as well as similar biaxial response, suggesting that physiological remodeling of collagen induced by TE partially counteracts pro-fibrotic XR effects. Skin growth was indirectly assessed with a kinematic approach that quantified increase in permanent area changes without reduction in thickness, suggesting production of new tissue driven by TE even in the presence of radiation treatment. Future work will focus on the detailed biological mechanisms by which TE counteracts radiation induced fibrosis. Statement of significanceBreast cancer is the most prevalent in women and its treatment often results in total breast removal (mastectomy), followed by reconstruction using tissue expanders. Radiation, which is used in about a third of breast reconstruction cases, can lead to significant complications. The timing of radiation treatment remains controversial. Radiation is known to cause immediate skin damage and long-term fibrosis. Tissue expansion leads to a pro-regenerative response involving collagen remodeling. Here we show that tissue expansion immediately prior to radiation can reduce the level of radiation-induced fibrosis. Thus, we anticipate that this new evidence will open up new avenues of investigation into how the collagen remodeling and pro-regenerative effects of tissue expansion can be leverage to prevent radiation-induced fibrosis.

Acute and persistent post-operative pain following mastectomy: a descriptive study in a tertiary hospital cohort.

Post mastectomy pain syndrome (PMPS) can have significant negative effects on patients' quality of life after mastectomy. The estimated prevalence of PMPS varies widely and there is little data from a New Zealand population. This limits clinicians' ability to meaningfully describe and discuss pain-related complications of mastectomy peri-operatively. We designed a single-centre, retrospective study to describe acute post-operative analgesic requirements after mastectomy, to describe the prevalence of PMPS at least 1 year after surgery, and to identify associated risk factors for this complication. One hundred and thirty mastectomy patients met inclusion criteria and 59 were willing and able to participate in 12-month follow-up. Acute post-operative pain was generally well managed with modest doses of oral analgesics. Sixty-six percent (n=39) of women reported some form of persistent pain symptoms post-mastectomy; this was associated with younger age, axillary surgery and chemotherapy. Only 5% of patients (n=3) met consensus criteria for PMPS, which limited identification of risk factors for this more severe complication. Despite PMPS occurring infrequently, post-operative pain of a less severe nature after mastectomy occurs commonly. Clinicians should remain vigilant to possible risk factors for this post-operative complication and counsel patients appropriately.

Hypofractionated vs Conventionally Fractionated Postmastectomy Radiation After Implant-Based Reconstruction

Postmastectomy radiation therapy (PMRT) improves local-regional disease control and patient survival. Hypofractionation (HF) regimens have comparable efficacy and complication rates with improved quality of life compared with conventional fractionation (CF) schedules. However, the use of HF after mastectomy in patients undergoing breast reconstruction has not been prospectively examined. To compare HF and CF PMRT outcomes after implant-based reconstruction. This randomized clinical trial assessed patients 18 years or older undergoing mastectomy and immediate expander or implant reconstruction for breast cancer (Tis, TX, or T1-3) and unilateral PMRT from March 8, 2018, to November 3, 2021 (median [range] follow-up, 40.4 [15.4-63.0] months), at 16 US cancer centers or hospitals. Analyses were conducted between September and December 2023. Patients were randomized 1:1 to HF or CF PMRT. Chest wall doses were 4256 cGy for 16 fractions for HF and 5000 cGy for 25 fractions for CF. Chest wall toxic effects were defined as a grade 3 or higher adverse event. The primary outcome was the change in physical well-being (PWB) domain of the Functional Assessment of Cancer Therapy-Breast (FACT-B) quality-of-life assessment tool at 6 months after starting PMRT, controlling for age. Secondary outcomes included toxic effects and cancer recurrence. Of 400 women (201 in the CF arm and 199 in the HF arm; median [range] age, 47 [23-79] years), 330 patients had PWB scores at baseline and at 6 months. There was no difference in the change in PWB between the study arms (estimate, 0.13; 95% CI, -0.86 to 1.11; P = .80), but there was a significant interaction between age group and study arm (P = .03 for interaction). Patients younger than 45 years had higher 6-month absolute PWB scores if treated with HF rather than CF regimens (23.6 [95% CI, 22.7-24.6] vs 22.0 [95% CI, 20.7-23.3]; P = .047) and reported being less bothered by adverse effects (mean [SD], 3.0 [0.9] in the HF arm and 2.6 [1.2] in the CF arm; P = .02) or nausea (mean [SD], 3.8 [0.4] in the HF arm and 3.6 [0.8] in the CF arm; P = .04). In the as-treated cohort, there were 23 distant (11 in the HF arm and 12 in the CF arm) and 2 local-regional (1 in the HF arm and 1 in the CF arm) recurrences. Chest wall toxic effects occurred in 39 patients (20 in the HF arm and 19 in the CF arm) at a median (IQR) of 7.2 (1.8-12.9) months. Fractionation was not associated with chest wall toxic effects on multivariate analysis (HF arm: hazard ratio, 1.02; 95% CI, 0.52-2.00; P = .95). Fewer patients undergoing HF vs CF regimens had a treatment break (5 [2.7%] vs 15 [7.7%]; P = .03) or required unpaid time off from work (17 [8.5%] vs 34 [16.9%]; P = .02). In this randomized clinical trial, the HF regimen did not significantly improve change in PWB compared with the CF regimen. These data add to the increasing experience with HF PMRT in patients with implant-based reconstruction. ClinicalTrials.gov Identifier: NCT03422003.

Axillary Recurrence in Sentinel Lymph Node Negative Mastectomy Patients at 16 Years Median Follow Up: Natural History in the Absence of Radiation

BackgroundAxillary recurrence following lumpectomy with a negative sentinel lymph node biopsy (SLNB) is rare, possibly due to routine use of whole breast radiation. In this study, we characterized the rate of any axillary recurrence among mastectomy patients with a negative SLNB and no adjuvant radiation therapy. MethodsWe identified women who underwent mastectomy with SLNB for early-stage breast cancer (1999-2005) and included patients with pathologically negative nodes and no axillary dissection or adjuvant radiation. The primary outcome was ipsilateral axillary recurrence. ResultsA total of 234 women, median age 50 years, underwent 242 mastectomies. Histology showed 112 (46%) invasive cancers, 16 (7%) ductal carcinoma in-situ (DCIS) with microinvasion, and 114 (47%) pure DCIS. Cancers were predominantly estrogen receptor positive (59%) and moderate (41%) or high grade (32%). A mean of 2 final sentinel nodes were excised (range 1-6) and 21 patients (9%) had isolated tumor cells on SLNB pathology. At 16 years median follow up (range 1-22 years), 3 patients (1.2%) developed an isolated axillary failure, and 1 had concurrent axillary and chest wall recurrences (total axillary recurrence rate 1.7%). Three of four axillary recurrences occurred in patients with moderate or high-grade estrogen receptor-positive DCIS without invasion on mastectomy histology. Median time to axillary recurrence was 70.5 months (range 29-132 months). ConclusionsAxillary recurrence is rare after a negative SLNB, even in the absence of adjuvant radiation. This supports the safety of forgoing additional surgery or radiation to the axilla in the early-stage breast cancer and a negative SLNB.

The use of incisional negative pressure wound therapy on high-risk breast cancer mastectomy patients

BackgroundThe main complications seen in patients who have undergone modified radical mastectomy (MRM) are seroma, surgical site infection, hematoma, wound dehiscence, flap necrosis, and nerve damage. While these complications lead to some problems the most feared effect in the early period is that they cause a delay in adjuvant treatment. Incisional Negative Pressure Wound Therapy (iNPWT) decreases wound dehiscence by reducing oedema and tension, especially in the incision line. This study aim to compare recovery times and wound site complications between patients treated with conventional wound dressings and patients treated with iNPWT after MRM. MethodsA retrospective screening was made of the data of 50 patients who underwent MRM because of breast cancer in the General Surgery Clinic of XXX Hospital between 2018 and 2022, and were at high-risk of wound site complications. Two groups were formed as 30 patients applied with iNPWT and 20 patients applied with conventional dressings. ResultsThe mean age of the 50 female patients was 53.58 years (range, 30–80 years). The most frequently seen complications were seroma (20 patients) and partial flap ischaemia (14 patients). The mean number of iNPWT applications was 1.30 (range, 1–2), and the mean number of days of application was 4.47 (range, 2–9). Postoperative seroma was observed in 8 patients in the iNPWT group and in 12 patients in the conventional dressings group (p = 0.018). Flap ischaemia and the probability of dehiscence was determined at a statistically significantly higher rate in the patients in the conventional dressings groups (p = 0.005, p = 0.021). ConclusionThe results of this study demonstrated that the use of iNPWT significantly reduced the amount of postoperative drainage, thereby contributing to early drain removal. Furthermore, iNPWT significantly reduced postoperative seroma, flap ischaemia, and flap dehiscence compared to conventional dressings.

Breast Conservation Project: Clinical Outcomes of Extreme Oncoplastic Breast-Conserving Therapy Versus Mastectomy for Large and Multiple Lesions.

Patients with multiple or large malignant breast lesions are classically considered mastectomy candidates, but extreme oncoplastic breast-conservation surgery (eOBCS) has become an alternative approach. There is a paucity of outcomes data comparing eOBCS with mastectomy. We reviewed our prospectively maintained, single-institution database. We included patients with non-metastatic breast cancer with multiple ipsilateral or single large (≥ 5cm) malignant breast lesions identified preoperatively who underwent either eOBCS or mastectomy. Patient demographics, clinicopathologic features, and surgical, oncologic, and cosmetic outcomes were evaluated. Seventy-six (88%) patients underwent eOBCS and 10 (12%) underwent mastectomy. Median follow-up was 24.8months. Mastectomy patients had larger lesions than eOBCS patients (median 70mm vs. 32.5mm; p = 0.06). Six (60%) index mastectomy patients underwent at least one additional surgery. For eOBCS patients, 34 (44%) required re-excision, 7 of whom underwent more than one subsequent surgery to obtain negative margins, and 6 (7.9%) ultimately underwent mastectomy. For patients undergoing additional surgery (n = 40), median time between index and final operation was 315days for mastectomy versus 21days for eOBCS patients (p < 0.001). Mastectomy patients more frequently experienced complications (p = 0.001) and underwent cosmetic revision (p < 0.001). There was no difference in cosmetic scores, and eOBCS patients reported less pain (p = 0.009). There were two local and three distant recurrences in the eOBCS cohort and one distant recurrence in the mastectomy group. Breast conservation was attainable in over 90% of eOBCS patients. Increased postoperative complications and discomfort and longer duration of surgical treatment in mastectomy patients without oncologic superiority should drive informed patient discussions.

Awareness of External Breast Prosthesis, it’s availability and affordability in Eastern Nigeria

The major impact of mastectomy is on the self-image and the mental status of patients, which may negatively affect their quality of life. External breast prosthesis (EBP) gives the woman a better shape as it takes the shape of the lost breast. This improves her confidence, looks and general disposition. We assessed EBP awareness among mastectomy patients, its availability and affordability in the Eastern region of Nigeria. The survey was conducted among mastectomy patients attending clinics at University of Nigeria Teaching Hospital Enugu, Federal Medical Centre Owerri and Federal Medical Centre Umuahia, all in South East Nigeria. A total of 32 mastectomy patients filled out questionnaires designed to obtain relevant data on knowledge of existence, availability and affordability of EBP in three big cities in South Eastern Nigeria. Data were analysed using the Statistical Analysis Software Version 8.2. Result showed only half (50%) of the participants were aware of the existence of EBP. Out of 32 patients, 23 (71.9%) were not using EBP and only 9 (28.1%) were currently using EBP. The majority of the participants (85.7%) do not know where and how to get EBP and therefore do not have access to EBP, while 4.8% cannot afford EBP.Contribution: There is poor awareness of the existence of EBP among breast cancer survivors. Consequently, there is poor usage of this device which otherwise, would help to restore self esteem in this population. The study exposed the need for awareness creation on the existence of EBP.

Comparison of locoregional recurrence risk among nipple-sparing mastectomy, skin-sparing mastectomy, and simple mastectomy in patients with ductal carcinoma in situ: a single-center study.

In invasive breast cancer, there are no differences among the mid- and long-term oncological safety results of nipple-sparing mastectomy (NSM), skin-sparing mastectomy (SSM), and simple mastectomy (SM). There are several reports comparing NSM and SSM with SM in the context of ductal carcinoma in situ (DCIS); however, the eligibility criteria vary among institutions, and there are no reports that compare all three surgical methods simultaneously within the same institution. This study aimed to compare the local recurrence and survival rates of the three techniques (NSM, SSM, and SM) in Japanese patients undergoing mastectomy for DCIS. Patients undergoing NSM, SSM, or SM at our institution between 2006 and 2015 were identified, and their outcomes were analyzed. The mean follow-up period was 80.4months (standard deviation [SD]: 37.1months). NSM was performed in 152 cases, SSM in 49, and SM in 44. Five of 245 patients developed local recurrences. Four of these patients had invasive cancer. The primary endpoints of 5-year cumulative local recurrence were 2.4% (95% confidence interval [CI]: 0.0-5.0) for NSM, 2.2% (95% CI: 0.0-6.3) for SSM, and 0% (95% CI: 0.0-0.0) for SM. There were no significant differences among the 5-year local recurrence rates. In this single-center, retrospective study, the oncological safety of SSM and NSM for DCIS was comparable to that of conventional SM.