Postoperative Mastectomy Research Articles

Impact of mastectomy flap necrosis on prepectoral reconstructive outcomes

IntroductionAs reconstructive surgeons have increasingly transitioned to the pre-pectoral plane for prosthetic breast reconstruction, the implications of mastectomy skin flap necrosis have become more concerning. Our goal was to evaluate the effect of skin flap necrosis on reconstructive outcomes in patients undergoing immediate pre-pectoral breast reconstruction. MethodsA retrospective review was conducted of patients undergoing immediate two-stage pre-pectoral reconstruction at a single center with at least 3-month follow-up. Postoperative complication, reconstructive outcome, and time to final implant were compared between patients with and without mastectomy skin necrosis. ResultsA total of 301 patients underwent 509 pre-pectoral breast reconstructions. Forty-four patients (14.6%) experienced postoperative mastectomy skin flap necrosis. Demographic and reconstructive characteristics were similar between the necrosis and no necrosis cohorts. Patients with skin necrosis were more likely to undergo reoperation after tissue expander (64% vs 19%, p<0.01) and undergo expander replacement (13.6% vs 3.5%, p=0.02). However, rates of reconstructive failure (6.8% vs 6.2%), major infection (9.1% vs 9.0%), and minor infection (13.6% vs 17.5%) after expander placement were statistically similar. Patients with skin necrosis trended towards longer time before final implant placement, though not statistically significant (6.5 vs 5.0 months, p=0.08). There was no difference in complication rates between the necrosis and no necrosis cohort after final implant placement. There was a higher rate of revision surgery after implant placement in the necrosis cohort (12.5% vs 4.1%, p=0.047). ConclusionMastectomy skin flap necrosis is a concerning postoperative event, particularly in patients with pre-pectoral prostheses. We observed that patients with skin necrosis experience higher reoperation rates in the expander period, yet have similar infection rates and achieve similar final reconstructive outcomes compared to patients without necrosis.

Effect of Early Physical Therapy of the Upper Arm on Recovery Post-operative Mastectomy Patients in Medan City Hospital, Indonesia

Effect of Early Physical Therapy of the Upper Arm on Recovery Post-operative Mastectomy Patients in Medan City Hospital, Indonesia

Factors Affecting the Outcome of Breast Reconstruction Surgery in Modified Radical Mastectomy Procedure

Background: Breast cancer is the leading cause of death in women caused by cancer. The primary treatment for breast cancer is surgery, where several recommended surgical methods are breast-conserving surgery or mastectomy. Postoperative mastectomy reconstruction has provided an opportunity to overcome the emotional and aesthetic burden of malignancy.&#x0D; Methods: This research is a descriptive observational study with a retrospective approach. The sample was 45 breast cancer patients who had undergone a modified radical mastectomy operation at Dr. Kariadi General Hospital for January 2019 - April 2023. The data were processed using SPSS for Windows software, and a descriptive analysis was carried out.&#x0D; Results: Most of the patients who underwent post-MRM breast reconstruction were in the age group &gt;40 years (71.1%), had stage 2 mammary carcinoma (44.4%) and stage 3 (40%), featured invasive ductal carcinoma (84 .4%), breast on the right side (64.4%). Some suffer from hypertension (13.3%) or diabetes mellitus (22.2%). The most used type of reconstruction was STSG (82.2%). A small proportion of patients experienced dehiscence (17.8%). In the Karnofsky score assessment, the highest score was 70 (64.4%), followed by 60 (17.8%), 80 (11.1%), 50 (4.4%), and 40 (2.2%).&#x0D; Conclusion: The patients undergoing MRM are dominated by the age group &gt; 40 years, not suffering from hypertension or diabetes mellitus, stage 2, histopathology of invasive ductal carcinoma, right-sided breast. STSG dominates the choice of reconstruction with postoperative complications in the form of dehiscence in a small proportion of patients. The Karnofsky score is dominated by a score of 70.

Role of Transamin in Reduction of Seroma in Post-Operative Mastectomy

Objective:The purpose of this study to determine the effectiveness of transamin in reduction of seroma in post-operative mastectomy. Study Design:Retrospective study Place and Duration: District Headquarter Hospital Attock and Medicare Hospital, Attock. September 2021-July 2022. Methods: There were 40 females had breast cancer with age 20-65 years were included. Patients were underwent for mastectomy and admitted to hospital. After obtaining informed written consent detailed demographics of enrolled cases included age, body mass index and socio-economic status was recorded. After surgery patients received injection of tranexamic acid. Outcomes among all patients were assessed in terms of reduction in seroma formation, wound infection, amount of drainage and time of drainage. SPSS 22.0 was used to analyze all data. Results: We found that 7 (20%) patients had age 21-30 years, 12 (30%) cases had age 31-40 years, 17 (42.5%) cases had age 41-50 years and 4 (10%) cases had age 51-65 years. 26 (65%) patients had BMI &gt;25kg/m2 and 14 (35%) had BMI &lt;25kg/m2. There were 22 (55%) patients had poor socio-economic status. Mean amount of drainage was 812.7±99.24 ml and mean time of drainage was 7.5±12.40 days. Frequency of seroma formation was found in 5 (12.5%) cases in which mostly had BMI &gt;25kg/m2 and had increased age. Wound infection found in 3 (7.5%) cases. Conclusion:We concluded in this study use of tranexamic acid among patients undergoing mastectomy was affective and useful in terms of reduction in seroma formation and lower number of wound infection. Except this duration and volume of drainage was also seen lower in our study. Keywords: Breast Cancer, Mastectomy, Seroma, Tranexamic Acid, Complications

Comparative Effects of Pre-Operative Versus Post Operative Shoulder Rehabilitation Program Mastectomy Patients; A Cross Sectional Survey

Breast cancer is ranked the top in types of cancer that affects internationally. It affects up to 1 in 13 women during their lifetime. Physiotherapy is one of the major sources of recovery in patients of Mastectomy in terms of pain, ranges, and function. OBJECTIVE: To compare the effects of pre-operative shoulder rehabilitation program versus post-operative mastectomy patients. METHODS: This was a randomized clinical trial. The study setting was Oncology Department, Mayo Hospital Lahore, Shokat Khanum and Gulab Devi Hospital Lahore. The study was completed in 6 months. Total 50 subjects were allocated in two groups using lottery method of randomization. Patient with age less than 40 years, diagnosed with breast cancer were included, while those with associated signs of musculoskeletal problems, autoimmune systemic disease and advanced medical problem was excluded. Group A received set of exercises comprised of range of motion exercises and lymph edema education pre and post operatively. Group B received post rehabilitation exercises only. Data was analyzed by SPSS 16.0. Independent t test was applied to analyze between group differences and paired sample t test to see within group improvement. Descriptive statistics was in form of mean, variance and appropriate graphs. RESULTS: Independent sample test results regarding post interventional disability of arm, shoulder, and hand (DASH) score showed significant p value 0.000 with a mean difference of 23.28000 while assuming equal variances. The mean and standard deviation of pain score was 3.76 (SD+0.778) pre/post combination group and post-operative rehabilitation program alone 4.1200 (SD+0.78102) with a statistically equal improvement in both groups (0.109). CONCLUSION: The study concluded that there was significant difference with better outcomes in terms of improvement in function, pain and range in patients having combination protocol i.e. pre-operative and post-operative rehab protocol in patient of mastectomy as compared to post-operative rehabilitation protocol alone.

Perioperative Hyperspectral Imaging to Assess Mastectomy Skin Flap and DIEP Flap Perfusion in Immediate Autologous Breast Reconstruction: A Pilot Study.

Mastectomy skin flap necrosis (MSFN) and partial DIEP (deep inferior epigastric artery perforator) flap loss represent two frequently reported complications in immediate autologous breast reconstruction. These complications could be prevented when areas of insufficient tissue perfusion are detected intraoperatively. Hyperspectral imaging (HSI) is a relatively novel, non-invasive imaging technique, which could be used to objectively assess tissue perfusion through analysis of tissue oxygenation patterns (StO2%), near-infrared (NIR%), tissue hemoglobin (THI%), and tissue water (TWI%) perfusion indices. This prospective clinical pilot study aimed to evaluate the efficacy of HSI for tissue perfusion assessment and to identify a cut-off value for flap necrosis. Ten patients with a mean age of 55.4 years underwent immediate unilateral autologous breast reconstruction. Prior, during and up to 72 h after surgery, a total of 19 hyperspectral images per patient were acquired. MSFN was observed in 3 out of 10 patients. No DIEP flap necrosis was observed. In all MSFN cases, an increased THI% and decreased StO2%, NIR%, and TWI% were observed when compared to the vital group. StO2% was found to be the most sensitive parameter to detect MSFN with a statistically significant lower mean StO2% (51% in the vital group versus 32% in the necrosis group, p < 0.0001) and a cut-off value of 36.29% for flap necrosis. HSI has the potential to accurately assess mastectomy skin flap perfusion and discriminate between vital and necrotic skin flap during the early postoperative period prior to clinical observation. Although the results should be confirmed in future studies, including DIEP flap necrosis specifically, these findings suggest that HSI can aid clinicians in postoperative mastectomy skin flap and DIEP flap monitoring.

Effect of Postoperative Mastectomy Exercise Adherence on Pain and Wound healing

Effect of Postoperative Mastectomy Exercise Adherence on Pain and Wound healing

Comparison of Efficacy of I/V Tramadol and Bupivacaine Irrigation through Drains after Modified Radical Mastectomy

Background: Severe postsurgical pain continues to be hard to manage in patients who experience breast cancer surgery. Badly managed pain can lead to meager patient satisfaction, prolonged hospital stay, and increased risk of complication by analgesics, and may be a reason in the development of long-lasting pain. Aim: To compare the efficacy of Intravenous Tramadol and Bupivacaine irrigation through surgical drains after Modified Radical Mastectomy in patients with carcinoma breast. Methods: This was a randomized controlled trial conducted in the Department of Anesthesia, Mayo Hospital Lahore. Total 70 female patients aged 18-70 years undergoing radical mastectomy for CA breast diagnosed on histopathology were selected. Patients were divided into two groups A and B through simple random sampling technique. Group A received intravenous Tramadol. Group B received Bupivacaine through surgical drains. Results: At 0, 2, 4 and 6 hour postoperatively no significant difference was seen in severity of pain in both treatment groups. In Group-A at 0, 2, 4 and 6 hour postoperatively, 68.8%, 71.4%, 57.1% and 60% respectively had reported no pain while in Group-B at 0, 2, 4 and 6 hour postoperatively, 48.6%, 65.7%, 45.7% and 54.3% patients had reported no pain. Complaints of Nausea, vomiting, sedation, urinary retention was higher in patients in Tramadol Group as compared to Bupivacaine Group. Conclusion: Results of this study demonstrated that bupivacaine administrated through surgical drain was equally effective as intravenous tramadol for controlling postoperative mastectomy pain with less side effects. Keyword: Breast Cancer, Acute Pain, Analgesia, Tramadol, Bupivacaine, Radical Mastectomy, Nausea, Vomiting, Sedation, Urinary retention, Hypotension

A Case Study: Murotal Distraction to Reduce Pain Level among Post-Mastectomy Patients

Carcinoma mammae or breast cancer is a malignant disease that originates from the parenchyma. Women who suffer from this disease will choose treatment using mastectomy. Mastectomy treatment is a process of removing all breast tissue that can inhibit the development of cancer cells. Post-operative mastectomy pain can be relieved by non-pharmacological therapy, one of which is murotal therapy. This case study aims to present the results of applying evidence-based murotal treatment to reduce pain scales in post-mastectomy surgery patients. Physical examination was performed using the head-to-toe method in post-operative patients. The North American Nursing Diagnosis Association is used to determine nursing diagnoses. Meanwhile, nursing intervention refers to the Nursing Intervention Classification and Nursing Outcome Classification. The intervention was carried out in five stages of evidence-based nursing implementation in nursing practice, with complementary therapy in murotal therapy and progressive application for 6 days for post-mastectomy surgery patients. As a result, giving murotal therapy intervention for 6 days showed a reduction in the pain scale from a scale of 4 (1-10) to 1 (1-10). The implementation of EBN murotal therapy proved to be effective in reducing the intensity of the pain scale in post-mastectomy surgery patients

Correlation of Serum HER-2/neu Levels with Clinico-Pathological Variables and Tissue Immunohistochemistry in Breast Carcinoma

Introduction: Serum levels of HER-2/neu protein is raised in primary as well as metastatic breast cancer and decreased serum HER-2/neu concentration in patients treated with HER- 2/neu inhibitors like trastuzumab is a good prognostic indicator in metastatic cases. Aims: To evaluate the concordance of serum HER-2/neu concentration with tissue HER-2/neu immunohistochemistry and determine its relationship with various prognostic indicators like age, size of tumour, lymph node status, grade, and stage of tumour. Materials and methods: The preoperative serum samples of 56 clinically and cytologically diagnosed cases of breast carcinoma were taken and postoperative mastectomy specimens were examined for the histologic type, lympho-vascular invasion, stage, and grade of the tumour. Immunohistochemical study of HER-2/neu xpression and HER-2/neu serum biochemistry was studied. Results: Age of the patients ranged from 25-75 years. Twenty-three cases (41.1%) were premenopausal while 33 cases (58.9%) postmenopausal. Forty-seven cases (83.9%) were of the infiltrating ductal carcinoma (NOS) type. Serum positivity for HER-2/neu was noted in 29 (51.8%) cases. Serum HER-2/neu levels showed a positive correlation with increase in tumour size, grade, stage of tumour and lymph node involvement. Serum HER-2/neu positivity was seen in 20 (68.9%) IHC positive patients and 9 (33.3%) IHC negative patients, with a statistically significant correlation (p=0.005). Conclusions: Serum HER-2/neu levels directly correlate with prognostic factors like tumour size, grade, stage of the tumour and lymph node metastasis and can be used as a complimentary tool to tissue HER-2/neu immunohistochemistry.

Immediate breast reconstruction surgery with expander/direct implant and use of acellular dermal matrix: Does hormone therapy increases the risk of infection?

The use of hormone therapy (tamoxifen and aromatase inhibitors) has been shown to increase venous thromboembolism. However, while estrogens play a crucial role in wound healing, no study has assessed the impact of tamoxifen or aromatase inhibitors on other postoperative breast reconstruction complications, including infections, necrosis, capsular contracture and seroma. As breast cancer patients undergoing Implants-ADMs breast reconstruction are often receiving hormone therapy, it is unclear whether this increased infection risk is associated with increased infections cases. A prospective study was performed on patients undergoing breast reconstruction at an academic institution from 2013 to 2016. Patients were divided by use of hormone therapy at the time of surgery. Complication rates, including infections, necrosis, seroma and hematomas, were compared and analyzed using univariate and logistic regression models. Among a total of 112 patients (183breasts), 58 patients (91 breasts) were receiving hormone therapy and 54 patients (92 breasts) were not. The hormone therapy group had a higher incidence of postoperative mastectomy skin infection (20.7% versus 7.4%; P=0.0447), we didn't find any significant differences in necrosis. Hormone therapy was associated with a higher incidence of Infections after breast reconstruction with ADMs and implants. The authors propose an individualized approach to the preoperative cessation of tamoxifen or aromatase inhibitors. Immediate breast reconstruction surgery with expander/direct implant and use of acellular dermal matrix: does hormone therapy increases the risk of infection?

Indocyanine green angiography for preventing postoperative mastectomy skin flap necrosis in immediate breast reconstruction.

Indocyanine green angiography for preventing postoperative mastectomy skin flap necrosis in immediate breast reconstruction.

EFEITOS DO DEEP RUNNING SOBRE A AMPLITUDE DE MOVIMENTO E A CAPACIDADE FUNCIONAL DOS MEMBROS SUPERIORES DE MULHERES MASTECTOMIZADAS: RELATO DE CASOS

Introduction: Breast cancer is the most common type of cancer among women in Brazil and in the worl. The surgical treatment procedure may cause severe morbidity in the upper limb homolateral to surgery, including the reduction of the range of motion, with consequent impairment of function. A physiotherapeutic approach has an important role in the recover range of motion and the functionality of these women, guaranteeing the occupational, domestestic, familiar and conjugated activities, and, in this way, also improving the quality of life. Objectives: To analyse chances in the shoulder's range of motion and the functional capacity of the upper limbs, promoted by the deep running procedure in women with late postoperative mastectomy. Methods: All the patients were submitted to an evaluation in the beginning and end of the treatment, including: goniometry of flexion, extension, abduction, adduction, internal and external rotation of the shoulder joint; and function capacity analysis in activities that involve the upper members by DASH questionnaire. The treatment protocol includes twelve sessions of deep running, realized twice a week, in deep pool, for 20-minute during six weeks. Results: Were submitted to treatment a total of 4 patients. Despite the improvement in the numerical values, statistically significant differences were not found on the range of movements and in the functional capacity of upper members before and after the deep running sessions in post-mastectomy women. Conclusion: Deep running had effects on the numerical values of range of movement and upper limb functionality in women in the late postoperative period of the mastectomy procedure, but without statistically significant differences.

Delayed-immediate hybrid breast reconstruction-Increasing patient input and precision in breast reconstruction.

The benefits of breast reconstruction via free tissue transfer with simultaneous implant placement, that is, hybrid breast reconstruction, in select patients are well-known. Challenges exist, however, and are related to proper implant selection as well as postoperative mastectomy skin necrosis. Here, the authors present an approach that increases reconstructive precision while minimizing postoperative mastectomy skin necrosis. A retrospective analysis of patients who underwent immediate prepectoral tissue expander placement (stage 1) followed by delayed-immediate hybrid breast reconstruction (stage 2) was performed. Parameters of interest included patient demographics, postoperative complications, and revision rates. A total of 31 patients with a mean age of 48.7years (range, 30-67years) and a mean BMI of 26.3kg/m2 (range, 21.0-35.3kg/m2 ) who underwent bilateral breast reconstruction were included. Of the 62 free abdominal flaps, 45 (72.6%) and 17 (27.4%) were MS-TRAM and DIEP flaps, respectively. The most common implant volume was 240cc (range, 140-445cc). Following stage 1, minor and major complications were observed in nine (29%) and one (3.2%) patients, respectively. No major complications were noted after stage 2. Of note, no patient developed mastectomy skin necrosis or requested a change in implant size following stage 2. Delayed-immediate hybrid breast reconstruction improves the ability to more precisely match patient expectations related to breast size and is associated with a reduction in the rate of mastectomy skin necrosis following the critical second stage of reconstruction.

Indocyanine green angiography for preventing postoperative mastectomy skin flap necrosis in immediate breast reconstruction

Indocyanine green angiography for preventing postoperative mastectomy skin flap necrosis in immediate breast reconstruction

Range of motion and upper limb function in postoperative mastectomy compared to quadrantectomy

Breast cancer is worldwide incident among women, whose surgery is frequent and associated with numerous functional changes. To assess the range of motion and upper limb function postoperatively before and after physiotherapy intervention of women who underwent mastectomy and quadrantectomy. This is interventional study, descriptive and exploratory, quantitative approach, with 64 women undergoing conservative surgery and mastectomy with follow-up at the gynecology outpatient clinic and referred for physical therapy at the Hospital das Clinicas, UNESP. Was performed goniometry of flexion/extension, abduction/adduction and internal rotation/side, measures performed before and three months after the therapy. The Chi 2 test with 0.005 significance level showed that quadrantectomy or mastectomy, not differentiated in relation to the variables; schooling, family income, color, marital status, religion, breast affected, clinical staging, menarche, body mass index and contraceptive methods. There was no association between type of surgery and the median age (type 1: 55 [37–57] × 2 type: 54 [37–82], P = 0.331 by Mann–Whitney). After physiotherapy, the flexion of the homo- and contralateral arm, as well as the homolateral abduction and homolateral extension increased significantly in both surgeries. The contralateral abduction was maintained in both surgeries. The physiotherapeutic intervention provided a significant improvement in the range of movements.

Networked Scars: Tattooed Bodies after Breast Cancer

This paper investigates the growing trend of mastectomy tattoos as an alternative to reconstruction and their implication on the (de)regulation of women's bodies in the digital context. I explore how tattoos are incorporated into a "breast cancer culture" (King, 2010) as a form of self-care in the recreation of areola pigmentation after breast reconstructive surgery and in cosmetic masking of post-operative mastectomy scars. I am concerned with how online discourses of tattooing practices are drawing women's bodies into an emergent 'biopolitics' (Foucault, 1990; Rose, 2001), a productive type of power concerned with the risk management of a 'biomedicalized subject' where women are encouraged to care for their health through informed decisions via online media (Pitts, 2004) and through consumption and beautification techniques in line with normative femininity (King, 2006). Yet, online media can potentially operate as a site for the creation of new publics wherein women can retell the stories of their bodies through new practices of inscription outside of medicalized and masculinist reconstruction narratives. I perform a discourse analysis of Canadian expert and popular discourses in health websites, plastic surgery and cosmetic service websites, tattoo parlour websites and in social media, including P.ink, (an organization that supports mastectomy tattoos). I argue that within digital media competing medical, pop cultural and feminist narratives intersect in ways that can contribute to an "awkward feminist politics" (Smith-Prei &amp; Stehle, 2016) where women's hybridized medical, digital, tattooed bodies can operate as material obstacles to normative correlations between health, femininity and sexuality.

Networked Scars: Tattooed Bodies after Breast Cancer

This paper investigates the growing trend of mastectomy tattoos as an alternative to reconstruction and their implication on the (de)regulation of women's bodies in the digital context. I explore how tattoos are incorporated into a "breast cancer culture" (King, 2010) as a form of self-care in the recreation of areola pigmentation after breast reconstructive surgery and in cosmetic masking of post-operative mastectomy scars. I am concerned with how online discourses of tattooing practices are drawing women's bodies into an emergent 'biopolitics' (Foucault, 1990; Rose, 2001), a productive type of power concerned with the risk management of a 'biomedicalized subject' where women are encouraged to care for their health through informed decisions via online media (Pitts, 2004) and through consumption and beautification techniques in line with normative femininity (King, 2006). Yet, online media can potentially operate as a site for the creation of new publics wherein women can retell the stories of their bodies through new practices of inscription outside of medicalized and masculinist reconstruction narratives. I perform a discourse analysis of Canadian expert and popular discourses in health websites, plastic surgery and cosmetic service websites, tattoo parlour websites and in social media, including P.ink, (an organization that supports mastectomy tattoos). I argue that within digital media competing medical, pop cultural and feminist narratives intersect in ways that can contribute to an "awkward feminist politics" (Smith-Prei &amp; Stehle, 2016) where women's hybridized medical, digital, tattooed bodies can operate as material obstacles to normative correlations between health, femininity and sexuality.

Abstract P3-11-03: Use of real-time patient reported outcomes to improve performance in breast surgery

Abstract P3-11-03: Use of real-time patient reported outcomes to improve performance in breast surgery

Lack of Validity of the American College of Surgeons National Surgical Quality Improvement Program Database for Alloplastic Immediate Postmastectomy Reconstruction.

The American College of Surgeons National Surgical Quality Improvement Program is an outcomes-based program with the objective of improving quality of surgical care. With its size and validity, the database has been mined by both general and plastic surgery clinical researchers to provide information for possible risk reduction strategies and patient counseling. However, the 30-day window of the program's database may be inappropriately brief in documentation of complications for some operative procedures. The authors' hypothesis was that the database underestimated complications in alloplastic reconstruction, particularly prosthesis loss. A cohort of 346 patients and 511 immediate postmastectomy reconstructions was analyzed for reconstruction failure. The inclusion criterion was patients who underwent reconstruction with tissue expanders followed by removal because of complications of infection and/or exposure. The hiatus between surgery (postmastectomy reconstruction) and loss of the tissue expander was recorded. Demographic data and risk factors and postoperative complications of mastectomy skin necrosis and seroma were tabulated. Fifty-five tissue expanders were explanted in the postoperative period secondary to infection and/or exposure. Of the total, 19 tissue expanders were explanted within 30 days, 36 after the 30-day window (mean, 62 days; median, 43 days). Approximately 65 percent of the tissue expanders destined for eventual loss were still in situ at 30 days. No significant difference existed between the two groups, early and late, regarding risk factors or postoperative mastectomy skin necrosis and seroma. The American College of Surgeons National Surgical Quality Improvement Program database significantly underestimates the risk of tissue expander loss because of the 30-day limitation in data accrual. Therapeutic, III.