Aim: To provide an up-to-date review of the literature on skin-sparing mastectomy (SSM) for breast cancer (BC). The article also reviews the oncological safety, effects of radiotherapy (RT) on immediate breast reconst...Aim: To provide an up-to-date review of the literature on skin-sparing mastectomy (SSM) for breast cancer (BC). The article also reviews the oncological safety, effects of radiotherapy (RT) on immediate breast reconstruction (IBR), the indications for preserving the nipple-areola complex (NAC) and the emerging role of allogenic grafts as adjuncts to implant in IBR. Methods: Review of the English literature from 1965 to 2013 was carried out using Medline and PubMed research engines. Results: SSM is oncologically safe in appropriately selected cases of invasive breast cancer (IBC) and ductal carcinoma in-situ (DCIS) including IBC 5 cm, multi-centric tumours, DCIS and for risk-reduction surgery. Inflammatory breast cancer and tumours with extensive skin involvement represent contra-indications to SSM due to an unacceptable risk of local recurrence. Prior breast irradiation or the need for post-mastectomy radiotherapy (PMRT) do not preclude SSM with IBR, however the aesthetic outcome may be compromised by radiation. Preservation of the nipple-areola complex (NAC) has aesthetic and psychological benefits and is safe for peripherally located node negative unifocal tumours. An intraoperative frozen section protocol for the retro-areolar tissue should be performed when NAC preservation is considered. The advent of acellular dermal matrix has enhanced the scope of implant-based immediate reconstruction following SSM. Cell-assisted fat transfer is emerging as a promising technique to optimise the aesthetics outcome. There is no sufficient evidence to support the role of endoscopic mastectomy in clinical practice. Conclusion: Numerous retrospective and prospective studies show that SSM is oncolgically safe in appropriately selected cases and is aesthetically superior to non-SSM mastectomy. New tech-niques such as the use of acellular dermal matrix (ADM) and cell-assisted fat transfer have increased the use of implants for volume replacement following SSM. In the absence of randomized clinical trials, an updated systematic meta-analysis of published studies is required in order to consolidate the evidence.展开更多
Background: Advantages of various mastectomy techniques include skin reduction and favorable aesthetics in Wise-pattern closures, and less visible scars in nipple-sparing mastectomies (NSM). This study compares postop...Background: Advantages of various mastectomy techniques include skin reduction and favorable aesthetics in Wise-pattern closures, and less visible scars in nipple-sparing mastectomies (NSM). This study compares postoperative complication profiles between Wise-pattern and nipple-sparing mastectomies in the obese population. Methods: A retrospective chart review of obese patients (BMI ≥ 30) who underwent staged breast reconstruction following Wise-pattern and nipple-sparing mastectomies at our institution between February 2016 and January 2020 was conducted. Complications between cohorts were analyzed using the independent samples t-test (2-sided) and the χ2 test. Results: A total of 232 breasts (163 Wise-pattern, 69 NSM) were re-constructed in 123 obese female patients (85 Wise-pattern, 38 NSM). Complication rates in both the Wise-pattern and NSM patient cohorts were similar following stage 1 (Wise-pattern: 30.7%, NSM: 39.1%, p = 0.212) and stage 2 (Wise-pattern: 16.6%, NSM: 15.9%, p = 0.907) of reconstruction. No statistically significant differences in rates of infection, dehiscence, seroma, hematoma or malposition of tissue expander (TE)/implant following stage 1 or stage 2 were found between cohorts. Conclusions: There were no significant differences in postoperative complication rates between the Wise-pattern and NSM cohorts of obese patients. NSM can be a viable surgical option in carefully selected obese patients and offer the advantage of concealed scarring.展开更多
Aim:While skin-sparing mastectomy(SSM)can be performed in patients with stage II-III breast cancer,the impact of neoadjuvant chemotherapy(NAC)on SSM rates and reconstructive modalities in these patients is not known.M...Aim:While skin-sparing mastectomy(SSM)can be performed in patients with stage II-III breast cancer,the impact of neoadjuvant chemotherapy(NAC)on SSM rates and reconstructive modalities in these patients is not known.Methods:Between January 2007 and December 2009,409 immediate breast reconstructions(IBRs)were performed in patients with Stage II-III breast cancer.Data were collected on preoperative,operative,and postoperative factors.Results:There was a statistically significant relationship between clinical stage of disease and the utilization of SSM or non-SSM(P<0.0001).Seventy-five percent of all patients with stage II disease and 50%of patients with stage III disease underwent SSM;similarly,75.5%of patients with stage II and 49.1%of patients with stage III disease who received NAC underwent SSM with immediate reconstruction,in spite of having a greater proportion of stage III patients(P<0.01).In addition,patients who received NAC followed by SSM with IBR had larger tumors(mean,3.5 cm vs.3.1 cm,P<0.001).The type of IBR,and size of skin defect was significantly affected by whether the patient underwent SSM or non-SSM(P=0.001,P<0.01,respectively).Conclusion:We are increasingly considering NAC to be an important tool to potentially reduce the morbidity of mastectomy,including the need to resect breast skin,which can subsequently enhance reconstructive outcomes in patients with clinical stage II and III breast cancer.Specifically,our data suggest that NAC patients with stage II and III breast cancer and larger tumors can reliably and safely undergo SSM in nearly half of cases,thus improving reconstructive outcomes and patient well-being.展开更多
This systematic literature review examines the impact of breast cancer treatment experiences, with a focus on mastectomy, on the psychosocial well-being of women. While previous studies have shown that mastectomy is a...This systematic literature review examines the impact of breast cancer treatment experiences, with a focus on mastectomy, on the psychosocial well-being of women. While previous studies have shown that mastectomy is associated with negative psychological outcomes such as anxiety, depression, and a loss of femininity, a new body of literature suggests that it can also be a catalyst for post-traumatic growth and personal transformation. The article argues that mastectomy experiences can initiate an individuation process that leads to a more empowered sense of self and a higher quality of life. The review identified 25 studies that employed qualitative methods and analyzed data from interviews, focus groups, and surveys. The article discusses the application of Jung’s individuation theory to categorize the experiences of women with breast cancer and links breast cancer diagnosis and treatment to the death-experience stage of the theory. The content highlights the importance of movement, contemplation, and spirituality in the healing process, and how they can help women connect with their bodies and develop a new sense of identity. Additionally, the content discusses the role of spirituality in enhancing growth and healing among indigenous native women patients with breast cancer. Overall, this article provides insights into how breast cancer treatment experiences can shape women’s identity, enhance resilience, and provide opportunities for personal growth and transformation.展开更多
Background: Breast cancer is increasingly common in society and post-mastectomy pain is a striking condition associated with surgery, both intra and postoperatively. The post-mastectomy syndrome is characterized by th...Background: Breast cancer is increasingly common in society and post-mastectomy pain is a striking condition associated with surgery, both intra and postoperatively. The post-mastectomy syndrome is characterized by the persistence of pain for more than 3 months after the procedure. It is mostly of neuropathic origin and is highly refractory to treatments, which vary from clinical to surgical measures and alternative techniques. In this context, it is essential to understand the possible approaches to these patients. Objective: Understand alternatives for pain management in patients undergoing mastectomy, especially in those in whom pain persists for more than 3 months. Methods: Systematic literature review, conducted in the Virtual Health Library databases includes: Lilacs, SciELO, Medline, PubMed and Cochrane between 2018 and 2023, restricted to articles in English with the descriptors: Mastectomy, chronic Pain, Nerve Blocks and Breast Cancer. 317 articles were found involving the descriptors presented, all in English. After reading the abstracts, 28 articles were selected. Results: This review analyzed 28 scientific studies that rigorously met the previously established characteristics in the sample selection. The synthesis included the following aspects: author/year of publication, article title, objective, type of study and database. Conclusion: It was concluded that, according to the analyzed studies, post-mastectomy pain is a problem that has increased its incidence and that needs the attention of health professionals. The use of antineuropathic medications, nerve blocks, fat grafting, lymph node transplantation, therapy, physical activity and acupuncture are some examples of therapeutic approaches for these women. Therefore, the team must assist the patients, seeking to provide a better prognosis, quality of life and comfort.展开更多
文摘Aim: To provide an up-to-date review of the literature on skin-sparing mastectomy (SSM) for breast cancer (BC). The article also reviews the oncological safety, effects of radiotherapy (RT) on immediate breast reconstruction (IBR), the indications for preserving the nipple-areola complex (NAC) and the emerging role of allogenic grafts as adjuncts to implant in IBR. Methods: Review of the English literature from 1965 to 2013 was carried out using Medline and PubMed research engines. Results: SSM is oncologically safe in appropriately selected cases of invasive breast cancer (IBC) and ductal carcinoma in-situ (DCIS) including IBC 5 cm, multi-centric tumours, DCIS and for risk-reduction surgery. Inflammatory breast cancer and tumours with extensive skin involvement represent contra-indications to SSM due to an unacceptable risk of local recurrence. Prior breast irradiation or the need for post-mastectomy radiotherapy (PMRT) do not preclude SSM with IBR, however the aesthetic outcome may be compromised by radiation. Preservation of the nipple-areola complex (NAC) has aesthetic and psychological benefits and is safe for peripherally located node negative unifocal tumours. An intraoperative frozen section protocol for the retro-areolar tissue should be performed when NAC preservation is considered. The advent of acellular dermal matrix has enhanced the scope of implant-based immediate reconstruction following SSM. Cell-assisted fat transfer is emerging as a promising technique to optimise the aesthetics outcome. There is no sufficient evidence to support the role of endoscopic mastectomy in clinical practice. Conclusion: Numerous retrospective and prospective studies show that SSM is oncolgically safe in appropriately selected cases and is aesthetically superior to non-SSM mastectomy. New tech-niques such as the use of acellular dermal matrix (ADM) and cell-assisted fat transfer have increased the use of implants for volume replacement following SSM. In the absence of randomized clinical trials, an updated systematic meta-analysis of published studies is required in order to consolidate the evidence.
文摘Background: Advantages of various mastectomy techniques include skin reduction and favorable aesthetics in Wise-pattern closures, and less visible scars in nipple-sparing mastectomies (NSM). This study compares postoperative complication profiles between Wise-pattern and nipple-sparing mastectomies in the obese population. Methods: A retrospective chart review of obese patients (BMI ≥ 30) who underwent staged breast reconstruction following Wise-pattern and nipple-sparing mastectomies at our institution between February 2016 and January 2020 was conducted. Complications between cohorts were analyzed using the independent samples t-test (2-sided) and the χ2 test. Results: A total of 232 breasts (163 Wise-pattern, 69 NSM) were re-constructed in 123 obese female patients (85 Wise-pattern, 38 NSM). Complication rates in both the Wise-pattern and NSM patient cohorts were similar following stage 1 (Wise-pattern: 30.7%, NSM: 39.1%, p = 0.212) and stage 2 (Wise-pattern: 16.6%, NSM: 15.9%, p = 0.907) of reconstruction. No statistically significant differences in rates of infection, dehiscence, seroma, hematoma or malposition of tissue expander (TE)/implant following stage 1 or stage 2 were found between cohorts. Conclusions: There were no significant differences in postoperative complication rates between the Wise-pattern and NSM cohorts of obese patients. NSM can be a viable surgical option in carefully selected obese patients and offer the advantage of concealed scarring.
文摘Aim:While skin-sparing mastectomy(SSM)can be performed in patients with stage II-III breast cancer,the impact of neoadjuvant chemotherapy(NAC)on SSM rates and reconstructive modalities in these patients is not known.Methods:Between January 2007 and December 2009,409 immediate breast reconstructions(IBRs)were performed in patients with Stage II-III breast cancer.Data were collected on preoperative,operative,and postoperative factors.Results:There was a statistically significant relationship between clinical stage of disease and the utilization of SSM or non-SSM(P<0.0001).Seventy-five percent of all patients with stage II disease and 50%of patients with stage III disease underwent SSM;similarly,75.5%of patients with stage II and 49.1%of patients with stage III disease who received NAC underwent SSM with immediate reconstruction,in spite of having a greater proportion of stage III patients(P<0.01).In addition,patients who received NAC followed by SSM with IBR had larger tumors(mean,3.5 cm vs.3.1 cm,P<0.001).The type of IBR,and size of skin defect was significantly affected by whether the patient underwent SSM or non-SSM(P=0.001,P<0.01,respectively).Conclusion:We are increasingly considering NAC to be an important tool to potentially reduce the morbidity of mastectomy,including the need to resect breast skin,which can subsequently enhance reconstructive outcomes in patients with clinical stage II and III breast cancer.Specifically,our data suggest that NAC patients with stage II and III breast cancer and larger tumors can reliably and safely undergo SSM in nearly half of cases,thus improving reconstructive outcomes and patient well-being.
文摘This systematic literature review examines the impact of breast cancer treatment experiences, with a focus on mastectomy, on the psychosocial well-being of women. While previous studies have shown that mastectomy is associated with negative psychological outcomes such as anxiety, depression, and a loss of femininity, a new body of literature suggests that it can also be a catalyst for post-traumatic growth and personal transformation. The article argues that mastectomy experiences can initiate an individuation process that leads to a more empowered sense of self and a higher quality of life. The review identified 25 studies that employed qualitative methods and analyzed data from interviews, focus groups, and surveys. The article discusses the application of Jung’s individuation theory to categorize the experiences of women with breast cancer and links breast cancer diagnosis and treatment to the death-experience stage of the theory. The content highlights the importance of movement, contemplation, and spirituality in the healing process, and how they can help women connect with their bodies and develop a new sense of identity. Additionally, the content discusses the role of spirituality in enhancing growth and healing among indigenous native women patients with breast cancer. Overall, this article provides insights into how breast cancer treatment experiences can shape women’s identity, enhance resilience, and provide opportunities for personal growth and transformation.
文摘Background: Breast cancer is increasingly common in society and post-mastectomy pain is a striking condition associated with surgery, both intra and postoperatively. The post-mastectomy syndrome is characterized by the persistence of pain for more than 3 months after the procedure. It is mostly of neuropathic origin and is highly refractory to treatments, which vary from clinical to surgical measures and alternative techniques. In this context, it is essential to understand the possible approaches to these patients. Objective: Understand alternatives for pain management in patients undergoing mastectomy, especially in those in whom pain persists for more than 3 months. Methods: Systematic literature review, conducted in the Virtual Health Library databases includes: Lilacs, SciELO, Medline, PubMed and Cochrane between 2018 and 2023, restricted to articles in English with the descriptors: Mastectomy, chronic Pain, Nerve Blocks and Breast Cancer. 317 articles were found involving the descriptors presented, all in English. After reading the abstracts, 28 articles were selected. Results: This review analyzed 28 scientific studies that rigorously met the previously established characteristics in the sample selection. The synthesis included the following aspects: author/year of publication, article title, objective, type of study and database. Conclusion: It was concluded that, according to the analyzed studies, post-mastectomy pain is a problem that has increased its incidence and that needs the attention of health professionals. The use of antineuropathic medications, nerve blocks, fat grafting, lymph node transplantation, therapy, physical activity and acupuncture are some examples of therapeutic approaches for these women. Therefore, the team must assist the patients, seeking to provide a better prognosis, quality of life and comfort.
