Unilateral Mastectomy Research Articles

Impact of wearing external breast prosthesis on body posture of patients after unilateral mastectomy: a randomized controlled trial

IntroductionUnilateral mastectomy induces postural alterations; however, the resolution of this issue in clinical settings remains unknown. This study aimed to explore the effects of wearing external breast prosthesis on the posture of patients after unilateral mastectomy.MethodsA total of 240 patients who underwent unilateral mastectomy for breast cancer in our hospital’s breast surgery department from September 2020 to March 2021 were selected, and they were registered and randomized in a 1:1 ratio to receive one of two treatments: (1) the intervention group wearing a external breast prosthesis (similar in weight to the breast) and (2) the control group wearing a cotton breast prosthesis (almost no weight). The generalized estimating equation method was used to analyze the impact of wearing external breast prosthesis on the patients’ body posture 3 and 6 months after the intervention.ResultsStatistically significant differences were observed between the two groups regarding forward head posture, shoulder asymmetry, scapular tilt, and neck tilt (P < 0.05). However, the two groups had no significant differences in scapular adduction/abduction, pelvic tilt, and trunk inclination (P > 0.05). Over time, all degrees of deviation in postural abnormalities exhibited an upward trend, with postural abnormalities becoming increasingly serious.DiscussionExternal breast prosthesis can improve postural abnormalities in patients with forward head posture, shoulder asymmetry, and scapular and neck tilts. However, there was no significant improvement in the short-term body posture of the patients concerning scapular adduction/abduction, pelvic tilt, or trunk inclination, indicating that further research is required to understand the effects of wearing external breast prosthesis on patients’ body posture.China clinical trial registryhttps://www.chictr.org.cn/showproj.html?proj=56939, identifier ChiCTR2000040897.

Multimodal analgesia with thoracic paravertebral block decrease pain and side effects in mastectomy patients.

Multimodal analgesia with thoracic paravertebral block decrease pain and side effects in mastectomy patients.

Successful unilateral mastectomy for gangrenous mastitis in an Etawa goat: A case study

A Mastectomy is a type of surgery that involves removing the partial or entire mammary tissue and is commonly performed to treat chronic, gangrenous, suppurative mastitis or mammary tumors. As part of the reproductive system, the mammary glands play a crucial role in offspring nutrition and survival. Despite the mastectomy, the goat’s overall reproductive potential was maintained due to its good genetics. This study presents the clinical outcome of a unilateral mastectomy performed on an Etawa goat with gangrenous mastitis. Physical examination revealed asymmetrical udders, with the left udder displaying atrophy, hardness, necrotic tissue, and an associated ventral abdominal lesion. Hematological analysis showed leukocytosis, neutrophilia, lymphocytosis, and anemia. The affected left mammary gland was surgically excised, and the site was sutured—the anesthetic protocol using acepromazine and atropine and followed by ketamine. Post-operative treatment was enrofloxacin, tolfenamic acid, Peruvian balsam, topical antibiotics, and B-complex vitamins. The consistent observation of the area showed that the wound was healing well and indicated that this method effectively treats gangrenous mastitis in goats.

Assessment of Margin Status in Feline Mastectomy: Predictive Factors and Agreement Between Intraoperative Cytology and Histopathology

This study aimed to determine the agreement between margin status in feline mammary tumors’ surgery by comparing 3 margin assessment techniques and to determine the predictive value of prognostic clinical and histological parameters for margin status using intraoperative margin assessment techniques. During the intraoperative period, 69 surgical margins from 12 female cats undergoing unilateral radical mastectomy were assessed by imprint cytology (IC) and scrape cytology (SC), both intraoperative cytological techniques. The excised mastectomy specimens were then evaluated postoperatively by histopathology (HP). Cochran’s Q test was used to determine differences in positive margin detection for the three methods. The agreement between the three methods was assessed using the Fleiss kappa coefficient. A binary logistic regression model was used to assess whether clinical and histological prognostic parameters could predict intraoperative margin status. There was no significant difference in positive margins between the three methods (p = 0.174). The agreement between the three methods was poor (Fleiss kappa = −0.020; 95% CI −0.156 to 0.117). Lymphovascular invasion is a significant predictor of a positive intraoperative margin, with an OD of 18.652 (95% CI = 1.742–199.652). These findings suggest that IC and SC are viable methods for assessing the status of surgical margins during surgery for feline mammary tumors. Intraoperative cytology may be complementary to HP, particularly in cases of lymphovascular invasion.

The use of interfascial blocks for complex analgesia in the surgical resicrion of soft tissue tumors in the chest area in kompanion animals

Achieving satisfactory results of surgical treatment of cancer patients is impossible without pain control both intraoperatively and in the early postoperative period. The inclusion of regional anesthesia in multimodal pain control protocols can significantly improve the quality of analgesia and accelerate patient recovery after surgery. Nevertheless, each method of interfascial plane block has its own indications, contraindications, and complications. The purpose of our study was to show the validity and effectiveness of the use of regional anesthesia in the form of interfascial plane blocks during surgical resection of soft tissue tumors in the chest area in companion animals. The study were included 49 animals (30 dogs and 19 cats) who underwent surgery resection of soft tissue tumors in the chest area. The criterion for the inclusion of animals in the study was the use of regional anesthesia in the form of interfascial plane blocks in the anesthesia protocol. As a result of the study, it was revealed that the combination of several interfascial blocks provides a significantly better level of analgesia in resection of volumetric formations in the early postoperative period, however, when performing a unilateral mastectomy, the combination of a transversus abdominis plane block with a erector spinae plane block does not reduce the postoperative pain level. In mastectomies involving the cranial mammary glands, the best result for postoperative anesthesia is shown by the use of serratus anterior plane block. The inclusion of interfascial plane blocks in the anesthesia protocol for oncological patients makes it possible to significantly reduce or eliminate the use of narcotic analgesics in the perioperative period and, accordingly, avoid side effects and complications associated with the use of narcotic drugs, which is especially important for debilitated and geriatric patients.

Evaluating Body Image Disturbance and Its Influencing Factors in Breast Cancer Patients Following Unilateral Mastectomy.

Patients with unilateral breast loss after single mastectomy for breast cancer may have body image disorders such as surgical lymphedema, flap ischemia, and spinal deformity, resulting in negative emotions such as depression, inferiority, and social dysfunction. This study mainly investigated and analyzed the status quo and influencing factors of body image disorder in breast cancer patients after single mastectomy. This study is a cross-sectional study. Breast cancer patients admitted from May 2023 to April 2024 were selected as the research subjects. Data were collected with a general information questionnaire, the Body Image Scale (BIS), the Self-Image Scale, the Self-Acceptance Questionnaire, and the Perceived Social Support Scale. Based on the scores, the research subjects were divided into a body image disturbance group and a non-disturbance group. Univariate and multiple logistic regression analyses were conducted to analyze the influencing factors of body image disturbances in breast cancer patients. One hundred fifty questionnaires were distributed in this study, and 146 valid questionnaires were collected. Among the 146 patients, 51 (34.93%) experienced body image disturbances after surgery, while 95 (65.07%) did not. The results of univariate and multiple logistic regression analyses showed that educational level, lymphedema in the affected limb, intimate relationships, self-image, self-acceptance, and perceived social support scores were independent risk factors for body image disturbances in breast cancer patients after surgery (P < .05). Body image disturbances in breast cancer patients who undergo unilateral mastectomy need further improvement. Educational level, lymphedema in the affected limb, intimate relationships, self-image, self-acceptance, and perceived social support are the main influencing factors.

Comparison of Postoperative Breast Asymmetry Using Vectra 3D Imaging in Prepectoral Versus Subpectoral Implant-Based Breast Reconstruction.

Background/Objectives: Implant-based breast reconstruction (IBBR) is increasingly favored over autologous reconstruction due to its procedural simplicity and recovery benefits. Conducting this reconstruction using either the subpectoral or prepectoral planes has varied aesthetic outcomes. This study utilizes VECTRA XT 3D imaging to objectively assess breast symmetry differences between these surgical techniques. Methods: A retrospective cohort study was conducted analyzing data from patients undergoing unilateral total mastectomy followed by immediate silicone implant reconstruction via subpectoral or prepectoral techniques. The VECTRA XT 3D system provided measurements, including sternal-notch-to-nipple (SN-N), midline-to-nipple (ML-N), and nipple-to-inframammary fold (N-IMF) distances, as well as breast width, volume, and projection, taken more than a year postoperatively, to assess symmetry and aesthetic outcomes. Results: The study included 63 patients-29 in the subpectoral group and 38 in the prepectoral group. The SN-N ratio was 0.91 for the subpectoral group compared to 0.95 for the prepectoral group (p = 0.014). Among patients with a BMI of 25 or higher, the prepectoral group had an SN-N ratio significantly closer to 1 (0.97 ± 0.07) than the subpectoral group (0.89 ± 0.06) (p = 0.027). No statistically significant differences were found in metrics based on the surgical method across age categories divided at 50. Conclusions: The prepectoral IBBR technique shows improved nipple positioning and breast symmetry compared to subpectoral methods, as assessed via precise 3D imaging. This finding suggests potential advantages for surgical planning and patient satisfaction, indicating the need for large cohort studies to further investigate the factors influencing breast symmetry.

Isoproterenol and phenylephrine infusions following external pacing failure in an anaesthetised dog with sick sinus syndrome undergoing unilateral mastectomy

AbstractManaging anaesthesia in dogs with sick sinus syndrome poses significant challenges due to bradyarrhythmias and life‐threatening hypotension. An 8‐year‐old, mixed‐breed dog with sick sinus syndrome underwent general anaesthesia for unilateral mastectomy. Anaesthetic drugs with minimal cardiovascular impact and a multimodal analgesic approach, including loco‐regional techniques, were employed. Initially, transcutaneous pacing ensured stable cardiovascular parameters, but surgical repositioning led to pacing failure, causing a rapid drop in heart rate and mean arterial pressure. Immediate infusion of isoproterenol and phenylephrine successfully normalised the dog's haemodynamics, allowing the 100‐minute surgery to proceed with stable vital parameters. The infusions were discontinued at the end of anaesthesia, leading to an uneventful recovery. This case demonstrates the effectiveness of isoproterenol and phenylephrine infusions in managing an anaesthetised dog with sick sinus syndrome, highlighting the importance of preparedness and having alternative pharmacological interventions ready for device‐related challenges.

Disease recurrence in patients undergoing mastectomy for ductal carcinoma in situ.

With DCIS incidence on the rise, up to 30% of patients undergo mastectomy for Ductal carcinoma in situ (DCIS) (Nash and Hwang, in: Ann Surg Oncol 30(6):3206-3214, 2023). Local recurrence rates after mastectomy for DCIS are reportedly low, but risk factors for recurrence are not known (Kim et al., in: J Cancer Res Ther 16(6):1197-1202, 2020). We aim to define risk factors associated with ipsilateral breast cancer recurrence in patients undergoing mastectomy for DCIS. We aimed to identify risk factors that may contribute to recurrence of breast cancer following mastectomy for pure DCIS. We hypothesized that close or positive mastectomy margins, age at diagnosis, extent of breast disease and mutation carriers would be associated with increased risk of recurrence. We performed a retrospective chart review of patients who underwent unilateral or bilateral mastectomies for pure DCIS at a single academic tertiary referral center from 2013 to 2023. There were 165 patients who met inclusion criteria with an average length of follow-up of 39.9months. On final surgical pathology, the average span of DCIS was 33.7mm (± 24.6mm). Hormone receptor positive disease was identified in 80.6% of the patient cohort. For margin status, 23 patients (14%) had < 1mm margins on final pathology and of those, 1 received adjuvant radiation therapy and 4 returned to the OR for re-excision. Only 1 (0.6%) patient had ipsilateral disease recurrence during the study period. Recurrence after mastectomy for pure DCIS is a rare event and in our study sample, only one recurrence occurred. Risk factors for recurrence appear unrelated to margin status, age, extent of DCIS, or pathogenic mutation (ElSherif et al., in Am J Surg 226(5):646-651, 2023).

Reproducibility of Thermography for Measuring Skin Temperature of Upper Limbs in Breast Cancer Survivors.

Background/Objectives: Breast cancer-related lymphedema (BCRL) is a chronic condition that has early diagnosis as a critical component for proper treatment. Thermography, a non-invasive imaging method, is considered a promising complementary tool for the diagnosis and monitoring of BCRL, especially in subclinical stages. The present study aimed to evaluate the intra- and inter-examiner reproducibility of thermography for measuring the skin temperature of the upper limbs (UL) of women with and without BCRL. Methods: This study, conducted with women who underwent a unilateral mastectomy, assessed BCRL using indirect volumetry. Maximum, minimum, and mean skin temperatures were measured in five regions of interest (ROI) of each UL (C1, C2, C3, C4, and Cup) in four different postures. Reproducibility measures were assessed using an intraclass correlation coefficient, 95% confidence interval, and coefficient of variation. Results: The sample comprised 30 women; 14 were diagnosed with BCRL. A total of 120 thermograms were recorded in different postures, and 3600 ROI were analyzed in the UL with and without BRCL. The intraclass correlation coefficient of the analyses indicated intra- and inter-examiner reproducibility from good to excellent (0.82 to 1.00) for all skin temperatures evaluated (maximum, minimum, and mean). The coefficient of variation for all measures was below 10%, indicating low variability. Conclusions: Our findings demonstrate that thermography shows good-to-excellent reproducibility across multiple postures and regions of interest, reinforcing its potential as a non-invasive and reliable method for assessing lymphedema in breast cancer survivors. This study establishes a foundation for incorporating thermography into clinical practice for early BCRL detection, particularly in subclinical stages, thus improving patient management and outcomes.

Accuracy of Infrared Thermography in Diagnosing Breast Cancer-Related Lymphedema.

Background/Objectives: Infrared thermography (IRT) is an imaging technique used in clinical practice to detect changes in skin temperature caused by several dysfunctions, including breast cancer-related lymphedema (BCRL). Thus, the present study aimed to assess the reproducibility and accuracy of IRT in diagnosing BCRL. Methods: This cross-sectional study included participants who underwent a unilateral mastectomy and used indirect volumetry for lymphedema detection. IRT analysis was recorded in four positions, analyzing maximum, mean, and minimum temperatures, as well as the temperature differences between the upper limbs. The analysis encompassed reliability, agreement, accuracy, and the establishment of cut-off points for sensitivity and specificity. A total of 88 upper limbs were included; 176 thermograms were captured, and 1056 regions of interest were analyzed. Results: IRT presented excellent intra- and inter-rater reproducibility and reliability with excellent intraclass correlation coefficient values (0.99 to 1.00). In addition, this assessment reached a sensitivity of 85% and a specificity of 56%; the cut-off point considered a temperature difference of -0.45 °C. Conclusions: IRT was a reliable and reproducible assessment, and the temperature difference between the upper limbs evidenced moderate accuracy. Thus, IRT is recommended as a complementary technique for detecting BCRL.

Healthcare utilization and follow-up care in young adult breast cancer (BC) survivors.

363 Background: The incidence of BC in young adults is increasing; given their extended survivorship, characterizing healthcare utilization and adherence to surveillance guidelines can inform unmet health needs and gaps in care. Methods: The multi-center Young Women’s BC Cohort Study enrolled 1302 women ≤40 yrs with newly diagnosed (dx) BC from 2006-2016. Participants completed surveys every 6 mos for 3 yrs post-dx, then annually. The current analysis includes patients with Stage 0-III BC without recurrence who completed the 7-yr survey assessing survivorship care, including types of providers visited, BC surveillance, and other health maintenance practices. Multivariate logistic regression evaluated factors (clinical, demographics, concern about recurrence) associated with 1) full transition to a primary care provider (PCP) for follow-up; adherence to 2) mammography (among women who had a unilateral mastectomy or lumpectomy) and 3) bone density scans (among current hormonal therapy [HT] users), per ASCO/ACS guidelines. Results: Of 660 women with Stage 0-III BC, median age at dx was 37 (range: 17-40); 89% identified as White, 5%, Asian, 3%, Black, 3% as other/multiracial, and 4%, Hispanic. Most had received chemotherapy (75%) and radiation (61%) and 35% reported current HT; 12% had a BRCA1/2 mutation. For cancer-related follow-up, 57% reported seeing an oncology provider only, 12%, PCP only, and 29% saw a PCP + oncology provider. Among women with remaining breast(s) (n=348), 90% reported a mammogram in the last year. Adherence to other health maintenance practices varied: 68% reported having had a flu shot, 76% a pap test/pelvic exam, and 56% cholesterol screening within the last 2 yrs. Among current HT users (n=210), 46% reported a bone density scan within the last 2 yrs. In multivariate analyses assessing the odds of seeing a PCP only (vs. oncology + PCP), having stage 0 vs I disease (OR 2.74 95% CI 1.01-6.80) was associated with higher odds while any HT use (OR .31 95% CI .16-.58) and concern about recurrence (OR .23 95% CI .12-.47) were associated with lower odds. The table includes factors significantly associated with non-adherence to mammography and bone density scans. Conclusions: At 7-years post-dx, most young survivors participating in a cohort study receive cancer follow-up care from an oncology provider and have not fully transitioned their care to a PCP. Adherence to recommendations related to bone health among HT users was suboptimal. Additional research to identify barriers/facilitators to receipt of guideline-concordant follow-up care at the patient, provider, and systems levels may inform strategies to optimize survivorship in young BC survivors. Multivariable analysis: factors associated with non-adherence. MammogramOR 95% CI Bone density scanOR 95% CI Her2+ .38, .15 -.98 NS BRCA1/2 + 8.36, 1.38-50.47 .17, .05 -.62 Chemotherapy NS .22, .06 -.78 Unilateral mastectomy vs lumpectomy 6.64, 2.69-16.34 NS

Mastectomy in ten mares: indications, surgical technique, complications, and long-term outcome.

To describe the indications for and surgical technique of mastectomy of mares and to describe the outcome of 10 mares that underwent mastectomy in a retrospective case series. 10 mares having disease of one or both mammary glands. Medical records (1995 to 2022) from 2 university teaching hospitals were searched to identify mares that had undergone unilateral or bilateral mastectomy. Data regarding history, signalment, diagnostic tests, preoperative treatment, surgical procedure, and postoperative management were reviewed. Follow-up information was obtained by interviewing the owners by telephone. One (n = 4 mares) or both mammary glands (6 mares) were excised for the following reasons: chronic bacterial mastitis (4), neoplasia (3), lymphangiectasia (1), pythiosis (1), and lymphoid hamartoma (1). None of the mares experienced intraoperative complications. The surgical site was closed primarily in 2 mares and left unsutured in 8 mares. Both sutured wounds developed a seroma, and 1 dehisced. The owners reported that the surgical wound, whether sutured or unsutured, was healed within 3 months. All mares returned to use for their intended purpose, but 3 mares were euthanized 2 to 4 years after surgery due to progression of disease. One mare drowned 1 year after discharge. Mastectomy can be an effective treatment for mares suffering from disease of one or both mammary glands when the mare is refractory to medical treatment.

The Experience of Women Receiving Mastectomy Care in an Acute Surgical Ward: A Qualitative Study.

The research aim was to understand the inpatient experience of women who received postoperative care for mastectomy surgery in an acute surgical ward. A Qualitative Descriptive Research design was used. The lead researcher conducted individual semi-structured interviews with 10 women who received postoperative care following mastectomy surgery in an acute hospital surgical ward. The transcribed interview data was analysed using a thematic analysis. A mastectomy is a momentous event in any woman's life. In the initial post-operative phase, the physical intrusion of surgery, aesthetics of the ward, and mixed-gender rooms were all found to influence the women's journey towards holistic recovery. Therapeutic care from all in the healthcare team and a ward setting conducive to recovery were identified as favourable influences towards physical and emotional healing. Recognising that a mastectomy 'is not just physical' may help the breast care team optimise the first 24 h of postoperative care in preparation for the challenges the women may face on discharge. In an acute inpatient setting, a women's physical needs may be prioritised over the psychological and emotional ramifications of a mastectomy. Post-operative inpatient care for breast cancer surgery requires not only professional competency with clinical and technical tasks, but therapeutic nursing and communication skills to support women's psychological needs. The findings were drawn from 10 women, narrating their inpatient experience for breast cancer surgery. All women had undergone a unilateral or bilateral mastectomy following breast cancer.

ThP2.2 - Breast cancer in the very young

Abstract Aims A small proportion of breast cancer (BC) affects women under 35 years old: very young breast cancer (VYBC). We conducted a retrospective cohort study of VYBC treated by our breast unit with the aim of adding to the existing, limited literature. Methods All patients treated between January 2012 and July 2023 were included. Case notes, MDT outcomes, operative findings and histology reports were cross-referenced. The primary outcome assessed was overall survival. Other factors investigated were parity, genetics, treatment plans and some, specific, psychosocial concerns. Results There were 95 women with VYBC in this 11-year study period. The median age at diagnosis was 32 years, and median length of follow-up was 5 years. 81% of the cohort had early BC, and 28% of carcinomas were triple negative. Overall survival was 87%. 16% of women either presented with or developed distant metastases, with a survival rate of less than 27% in this group. BC recurrence affected 21% of women. Surgery was performed in 94% of patients, with 64% having at least a unilateral mastectomy. Ahead of treatment, fertility concerns were expressed by at least 45% of women. 85% of the cohort were genetically tested, revealing a genetic mutation in 20% of these patients. Conclusions This study demonstrates the outcomes of VYBC within our breast unit, which are comparable to published reports. It also highlights unique, psychosocial challenges faced by these women. Long term follow-up of this group is recommended.

248P Impact of unilateral mastectomy with or without immediate breast reconstruction on vertebral alignment

248P Impact of unilateral mastectomy with or without immediate breast reconstruction on vertebral alignment

Prediction model for intraoperative implant volume using the 3D surface imaging system (VECTRA XT 3D) in direct-to-implant breast reconstructions.

In direct-to-implant breast reconstruction, accurate preoperative breast volume estimation is crucial for surgeons to select the appropriate implant volume, considering the cosmetic outcomes during surgery. We proposed the prediction model for intraoperative implant volume based on the preoperative estimated volume of the contralateral breast obtained through a three-dimensional surface imaging system (3DSI) as surgeons usually choose the implant volume on the breast which should be reconstructed considering symmetricity with the contralateral breast. We enrolled 97 patients from our single institution who underwent unilateral mastectomy with immediate breast reconstruction using smooth silicone implants between October 2021 and January 2023. Preoperatively, plastic surgeons measured the volume of the contralateral breast using the VECTRA XT 3D imaging system. Data on implant volume and the types of acellular dermal matrix used during surgery, determined by a single surgeon to ensure symmetry, were also collected. Linear regression analysis was utilized to construct the predictive model. In the multiple linear regression analysis with preoperative contralateral breast volume, age, and body mass index as variables, the coefficient of determination of the model expressed as R squared (R2) was 0.554, and except for age, the other variables were statistically significant. When replaced by mastectomy volume instead of age, R2 increased to 0.723 and all variables were significant. 3DSI can be helpful for preoperative surgical planning and postoperative outcome simulation. With our multiple linear regression model, we can predict the intraoperative implant volume using preoperative contralateral breast volume measured by the 3D scans.

Effects of Local Wound Infiltration Post-Mastectomy Using Bupivacaine Alone, Bupivacaine With Ketamine, and Bupivacaine With Dexmedetomidine: A Randomized Double-Blind Study.

Background and aim While the infiltration of surgical incisions with local anesthetics is not a new practice, it remains a crucial component of contemporary multimodal analgesia protocols. This study aimed to evaluate the efficacy and safety of using adjuvants in combination with local anesthetic wound infiltration for pain management in patients undergoing mastectomy surgery. Methods Eighty-one patients aged 18-60 years, classified as American Society of Anesthesiologists (ASA) grade I or II, were scheduled for unilateral mastectomy and randomly assigned to three groups of 27 each. The groups were designated as Group C (bupivacaine alone), Group D (bupivacaine with dexmedetomidine), and Group K (bupivacaine with ketamine). Group C received 0.25% bupivacaine alone, Group D received 0.25% bupivacaine with 1 mcg/kg dexmedetomidine, and Group K received 0.25% bupivacaine with 1 mg/kg ketamine. The time to achieve a Visual Analogue Scale (VAS) score of 3 following local wound infiltration was recorded for each group. Additionally, total postoperative fentanyl intake during the first 24 hours, as measured by the patient-controlled analgesia (PCA) pump, was compared among the groups. Sedation levels were assessed using the Ramsay Sedation Scale (RSS). Data were analyzed using the Chi-Square test and one-way ANOVA in IBM SPSS Statistics for Windows, Version 28.0 (Released 2021; IBM Corp., Armonk, NY, USA). Results Demographic factors were similar across the three groups. Analysis of the VAS scores revealed that the ketamine group provided better postoperative pain control than the dexmedetomidine group (p < 0.001). Groups D (71.72 ± 71.73) and K (3.53 ± 13.42) had significantly lower 24-hour fentanyl intake (in mcg) compared to Group C (the control group), as measured by PCA. Additionally, Group C had a significantly lower RSS at the sixth hour (p = 0.003) compared to both Groups D and K. Conclusion Ketamine, when used as an adjuvant to bupivacaine for local infiltration, enhances the effectiveness and prolongs postoperative analgesia more effectively than dexmedetomidine in patients undergoing mastectomy.

Bilateral Mastectomy and Breast Cancer Mortality

The benefit of bilateral mastectomy for women with unilateral breast cancer in terms of deaths from breast cancer has not been shown. To estimate the 20-year cumulative risk of breast cancer mortality among women with stage 0 to stage III unilateral breast cancer according to the type of initial surgery performed. This cohort study used the Surveillance, Epidemiology, and End Results (SEER) Program registry database to identify women with unilateral breast cancer (invasive and ductal carcinoma in situ) who were diagnosed from 2000 to 2019. Three closely matched cohorts of equal size were generated using 1:1:1 matching according to surgical approach. The cohorts were followed up for 20 years for contralateral breast cancer and for breast cancer mortality. The analysis compared the 20-year cumulative risk of breast cancer mortality for women treated with lumpectomy vs unilateral mastectomy vs bilateral mastectomy. Data were analyzed from October 2023 to February 2024. Type of breast surgery performed (lumpectomy, unilateral mastectomy, or bilateral mastectomy). Contralateral breast cancer or breast cancer mortality during the 20-year follow-up period among the groups treated with lumpectomy vs unilateral mastectomy vs bilateral mastectomy. The study sample included 661 270 women with unilateral breast cancer (mean [SD] age, 58.7 [11.3] years). After matching, there were 36 028 women in each of the 3 treatment groups. During the 20-year follow-up, there were 766 contralateral breast cancers observed in the lumpectomy group, 728 contralateral breast cancers in the unilateral mastectomy group, and 97 contralateral cancers in the bilateral mastectomy group. The 20-year risk of contralateral breast cancer was 6.9% (95% CI, 6.1%-7.9%) in the lumpectomy-unilateral mastectomy group. The cumulative breast cancer mortality was 32.1% at 15 years after developing a contralateral cancer and was 14.5% for those who did not develop a contralateral cancer (hazard ratio, 4.00; 95% CI, 3.52-4.54, using contralateral breast cancer as a time-dependent covariate). Deaths from breast cancer totaled 3077 women (8.54%) in the lumpectomy group, 3269 women (9.07%) in the unilateral mastectomy group, and 3062 women (8.50%) in the bilateral mastectomy group. This cohort study indicates that the risk of dying of breast cancer increases substantially after experiencing a contralateral breast cancer. Women with breast cancer treated with bilateral mastectomy had a greatly diminished risk of contralateral breast cancer; however, they experienced similar mortality rates as patients treated with lumpectomy or unilateral mastectomy.

Study of heat steam induced skin damage prevention in robotic nipple-sparing mastectomy and immediate breast reconstruction using Da Vinci Robot

To explore the method of preventing heat steam induced skin damage in robotic nipple-sparing mastectomy and immediate breast reconstruction (R-NSM-IBR) using Da Vinci Robots. A clinical data of 128 female patients with breast cancer, who were treated with R-NSM-IBR between September 2022 and December 2023 and met the selection criteria, was retrospectively analyzed. During robotic nipple-sparing mastectomy, the breasts were covered with gauze cooled by ice water to reduce skin temperature in 99 cases (group A) and were not treated in 29 cases (group B). There was no significant difference in the age, affected side, body mass index, pathological type of breast cancer, and constituent ratios of adjuvant chemotherapy and neoadjuvant chemotherapy between the two groups ( P>0.05). Intraoperative breast skin temperature, unilateral robotic nipple-sparing mastectomy time, and the incidence of complications of breast heat steam induced skin damage were recorded. The time for unilateral robotic nipple-sparing mastectomy was (77.18±9.23) minutes in group A and (76.38±12.88) minutes in group B, with significant difference between the two groups ( P<0.05). The intraoperative breast skin temperature was significantly lower in group A than in group B [(25.61±0.91)℃ vs (33.38±1.14)℃; P<0.05]. Seven cases of heat steam skin damage occurred during operation, including 2 cases (2.0%) in group A and 5 cases (17.2%) in group B, with a significant difference in incidence between the two groups ( P<0.05). Among them, 1 patient in group B had a vesication rupture and infection, which eventually led to the removal of the implant; the rest of the patients were treated with postoperative interventions for skin recovery. The use of breast covered with gauze cooled by ice water during R-NSM-IBR can effectively reduce the risk of heat steam induced skin damage.