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Breast Cancer: Surgical Perspectives
Published in Raymond Taillefer, Iraj Khalkhali, Alan D. Waxman, Hans J. Biersack, Radionuclide Imaging of the Breast, 2021
Patricia J. Eubanks, Hernan I. Vargas, Stanley R. Klein
We advocate modified radical mastectomy (MRM) for those patients who: Request itHave large ulcerating tumorsHave large bulky tumors unresponsive to neoadjuvant chemotherapy or unwilling to undergo neoadjuvant chemotherapyHave multiple sites of cancer on mammographyHave had prior irradiation to the breastAre in the first or second trimester of pregnancyDo not want radiation therapy A small study by Leopold et al. found that two or more separate primary tumors in the breast may be associated with a higher incidence of local recurrence after BCT [40]. Prior irradiation to the breast is considered a contraindication to breast-conserving treatment. Usually this is the case in patients who develop a recurrence after previous lumpectomy and AND. Thus, patients with recurrent breast carcinoma should undergo modified radical mastectomy.
Hereditary Breast and Ovarian Cancer
Published in Dongyou Liu, Handbook of Tumor Syndromes, 2020
For breast cancer patients, surgery includes (i) breast-conserving surgery (or lumpectomy, partial mastectomy, segmental mastectomy, quadrantectomy, or breast-sparing surgery) for removing the cancer and some normal tissue around it, but not the breast itself; (ii) total mastectomy (or simple mastectomy) for removing the whole breast that has cancer; breast reconstruction with the patient's own (nonbreast) tissue or by using implants filled with saline or silicone gel may be undertaken at the time of the mastectomy or at some time after; (iii) modified radical mastectomy for removing the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes part of the chest wall muscles.
The Breast
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
Occasionally, a patient may present with an enlarged axillary lymph node(s), and no palpable breast masses. In such case, it is preferable to obtain a mammogram prior to biopsy of the lymph node. If the mammogram shows a suspicious lesion in the breast, this must be localized and biopsied first. However, if the mammogram reveals no suspicious lesions, the lymph node is then biopsied to rule out hyperplasia or lymphoma. If metastatic adenocarcinoma is diagnosed, the pathologist must be consulted for possible sites of origin, and the patient must be worked-up for other sites of primaries especially lung, GI tract, and possibly the kidneys. If no primary is identified in any of these sites, then the probability still exists that the breast is the site of the primary. The situation must then be explained to the patient with the recommendations of carrying out a modified radical mastectomy. It will also be necessary to alert the pathologist and ask for close sectioning of the breast in the hope of identifying the primary site.
Effect of Pretreatment of S-Ketamine On Postoperative Depression for Breast Cancer Patients
Published in Journal of Investigative Surgery, 2021
Peirong Liu, Pengyi Li, Qingyang Li, Hongzhu Yan, Xiaowei Shi, Chunliang Liu, Yu Zhang, Sheng Peng
The present randomized, double-blinded controlled trial included a total of 303 breast cancer patients who received modified radical mastectomy from June 2017 to June 2018. All patients were consecutively enrolled during the study period, and were randomly divided into different groups according to different analgesia strategies. Furthermore, these patients were randomized into different groups through a computer-generated randomized list using the SPSS software (SPSS Inc., Chicago, USA). The diagnosis of these patients was all confirmed by imaging and histological methods. The Hamilton Rating Scale for Depression (HAMD-17) score was measured for all patients before the surgery, and patients with HAMD-17 scores within 8-24 were included into the study. All patients were within 18-65 years old, and had an American Society of Anesthesiologists (ASA) score of I-II. Patients with HAMD-17 scores ≥24 or ≤7 before surgery, patients with other mental diseases, such as schizophrenia and mania, or with a psychiatric history before the study, patients who previously received psychotropic substances, and patients with other severe system diseases, including severe heart, renal and liver diseases, were excluded from the study. Since studies have shown that immediate breast reconstruction might enhance the surgical complication and surgical failure rate, these patients were not recommended to receive immediate breast reconstruction [15,16]. An informed consent was obtained from all patients. The present study was approved by the Ethics Committee of the hospital.
Assessment of the onset of radiation-induced cardiac damage after radiotherapy of breast cancer patients
Published in Alexandria Journal of Medicine, 2018
Ebtsam Zaher, Enayat Fahmy, Kamal Mahmoud, Yasser El Kerm, Mohammad Auf
The study included 80 females in three groups; 30 left-sided BC patients, 30 right-sided BC patients and 20 normal healthy females of matched age. A local ethics committee approved the study and each subject signed an informed consent before being enrolled. Exclusion criteria included patients with ischemic or valvulary heart disease, baseline LVEF < 50%, hypertension and cardiac tumor. Patients were treated by modified radical mastectomy followed by FAC-based chemotherapy, radiotherapy and hormone therapy according to their clinical condition. Radiotherapy included isocentrically irradiating the chest wall by two tangential beams with selective multi-leaf blocking to protect organs that might be at risk, the regimen of radiation delivery used were conventional 50 Gy/25-fractions or hypo-fractionation 42 Gy/16 fractions. Internal mammary lymph nodes (IMLN), if indicated, were included in the tangential beams. The two arms (left- and right BC patients) were kept balanced, where each arm contained 30 patients; 11 received 50 Gy/25 fractions and 9 received 42 Gy/16 fractions, with 8 receiving IMLN radiotherapy. Patients were followed up for 12 months after completing radiotherapy.
Ultrasound-guided serratus anterior block versus instillation of local anaesthetic through surgical drain in modified radical mastectomy: A randomized controlled study
Published in Egyptian Journal of Anaesthesia, 2022
Rabab S. S. Mahrous, Haytham Awad Fayed, Abdelrahman Mohamed Kamal
Breast cancer is one of the most diagnosed cancer worldwide. [1] This resulted in improvements in screening techniques for early detection and management. Surgery, chemotherapy, radiation, and hormonal therapy are used to treat it. [2] In most cases, a combination of these approaches yields the best results, allowing for the early and complete eradication of tumor cells while also improving both quality of life and survival. Modified radical mastectomy (MRM), either with or without axillary lymph node clearance, is one of the surgical options for treating breast cancer. [3] This procedure results in a significant surgical scar and intense pain after surgery. It is imperative that this pain be effectively handled so that no negative outcomes result.