Mastectomy

Fig. 4. Application of fibrin sealant (arrow points to spray head for applying two-component adhesives) at the time of mastectomy and axillary dissection to reduce seroma formation.

Currently, breast cancer is the most frequently diagnosed cancer in both white and African-American women. According to latest reports, of the 662,870 cancer cases reported for women in 2005, 32% were breast cancer. The incidence of breast cancer increased from 1 in 20 in 1960 to 1 in 8 today. More than 100,000 women per year require mastectomy for treatment, and every year 75% decide to have reconstmction. About half the number of these women select prostheses made of silica-reinforced silicone-rubber shell filled with silicone gel, while the other half have the same shell filled with physiological saline. Reportedly, gel-fiUed prostheses feel more natural, but are associated with true or perceived health problems and remain highly controversial. 

Local therapy of early-stage breast cancer consists of modified radical mastectomy or lumpectomy plus external-beam radiation therapy. The surgical approach to the ipsilateral axilla may consist of a full level I/II axillary lymph node dissection or a lymph node mapping procedure with sentinel lymph node biopsy. 

Large tumor volume in a woman with small breasts (better cosmetic results often can be obtained with mastectomy and reconstruction)... 

Breast cancer has a very high incidence in women. Breast cancer frequently develops into (or is) a systemic disease. The best way to reduce risk due to breast cancer is early tumor detection and surgical removal. The increase in detection rate of breast tumors that are < 1 cm in diameter over the past 10 years can be mostly attributed to improvements in the sensitivity and utilization of mammography. The main utility of CA 15-3 in breast cancer is to monitor patients after mastectomy (14). 

A 50- year-old female had a radical mastectomy three years ago for hormone-dependent breast adenocarcinoma. She is now complaining of shortness of breath, and chest X-ray shows diffuse lung metastases. As part of her therapeutic regimen, she is given intramuscular hormone replacement therapy (1IRT). 

Breast-conserving therapy (BCT) is appropriate primary therapy for most women with stage I and II disease it is preferable to modified radical mastectomy because it produces equivalent survival rates with cosmetically superior results. BCT consists of lumpectomy (i.e., excision of the primary tumor and adjacent breast tissue) followed by radiation therapy (RT) to prevent local recurrence. 

Simple or total mastectomy involves removal of the entire breast without dissection of underlying muscle or axillary nodes. This procedure is used for carcinoma in situ where the incidence of axillary node involvement is only 1% or with local recurrence following breast conservation therapy. 

Auquier A, RutqvistLE, Rotstein S, ArriogadaR. Post-mastectomy megavoltage radiotherapy the Oslo and Stockholm trials. EurJ Cancer 1992 28 433 437. 

With regard to the 5-FU/RT trial, with a median follow-up of 5 yr, OS of the entire group of patients is 74% and DFS is 58%. With the limitations associated with the small number of patients in this study (35 patients), it is reassuring to note that postponing anthracycline-based treatment after mastectomy did not compromise DFS and OS among these women with large LABC, as shown in Table 2. 

Fields, 1989 (42) 37 CAF X 2-3 cycles — XRT - mastectomy -> maintenance chemo 5 yr DFS 37%, OS 48% Patients had much better survival than historical controls that received RT. Mastectomy associated with improved local control and survival. 

Thoms, 1989 (43) 61 Doxorubicin-based induction - mastectomy -> adjuvant chemo -> RT 5 yr DFS 27% 39% of patients failed to respond to induction chemotherapy. Mastectomy not associated with improved local control or survival. 

Fatalities. Extract of the roasted seed, administered rectally to a 37-year-old woman with breast cancer after radical mastectomy and chemotherapy at a dose of 0.95 L/person four times daily, was active. Death was attributed to fluid and electrolyte imbalance. Sodium and chloride could not be detected. Extract of the roasted seed, administered rectally to a 46-year-old woman at a dose of 10-12 coffee enemas, three to four an hour, produced convulsive seizures and eventually death Decoction of the dark-roasted seed, on agar plate, was active on Staphylococcus aureus, with lethal doscjo of 16 mg/mL. Concentrations of 23, 35, and 40 mg/mL, were active on Escherichia coli. Decoction of the medium-roasted seed at concentrations of 29, 41, 50, and 52 mg/mL, were active on Escherichia coli. Decoction of the light-roasted seed at concentrations of 40, 46, 50, and 57 mg/mL, were active on Escherichia coli. Decoction of the roasted seed, on agar plate at concentrations of 28... 

Well. I think, truthfully, I am beginning to tire. I mean I m 75.1 don t think a woman at 7 5 should be expected to... and I ve had a double mastectomy. I ve had my two breasts off, you know, so I m beginning to feel...over a 23 year period that was since I had the cancer and eight year ago it came back. So, now I m feeling a wee bit as if I ve had enough you know. I truthfully think that I would love my daughter to be able to take her boys back and I think she is getting there. 

Pathological conditions in which capsaicin itself is not sufficiently active, but more potent vanilloids are expected to be of greater therapeutic value. For example diabetic neuropathy (Ross and Varipapa, 1989), postherpetic neuralgia (Watson et al., 1988 Bernstein et al., 1989), chronic distal painful polyneuropathy (Low et al., 1995), post-mastectomy pain syndrome (Watson et al., 1989), Guillain-Barre syndrome (Morgenlander et al., 1990), reflex sympathetic dystrophy (Cheshire and Snyder, 1990), vulvar vestibulitis (Friedrich, 1988). 

Watson, C.P., Evans, R.J., Watt, V.R., The post-mastectomy pain syndrome and the effect of topical capsaicin, Pain 1989, 38, 177-186. 

When ill-advisedly used to promote growth in boys by administration for some years, oxandrolone caused gynecomastia in a high proportion of subjects treated 23 of the 33 patients affected subsequently required mastectomy (70,71). 

A woman with hypertriglyceridemia and breast cancer was given tamoxifen and various lipid-regulating agents after mastectomy. She stopped the latter of her own accord after 2 years and had a recurrence of hypertriglyceridemia and pancreatitis. 

Kotake Y, Matsumoto M, Morisaki H, Takeda J. The effectiveness of continuous epidural infusion of low-dose fentanyl and mepivacaine in perioperative analgesia and hemodynamic control in mastectomy patients. 

Acts as an estrogen antagonist to decrease the recurrence of cancer following mastectomy or to reduce tumor growth in advanced stages of breast cancer... 

Cancer chemotherapy is only one method of treating neoplastic disease. The other primary weapons in the anticancer arsenal are surgery and radiation treatment.18,61 The choice of one or more of these techniques depends primarily on the patient, the type of cancer, and the tumor location. In many situations, chemotherapy may be the primary or sole form of treatment in neoplastic disease, especially for certain advanced or inoperable tumors, or in widely disseminated forms of cancer, such as leukemia or lymphoma.6 In other situations, chemotherapy is used in combination with other techniques, such as an adjuvant to surgery and radiation treatment.18,27 Primary examples of adjuvant cancer chemotherapy include using anticancer drugs following a mastectomy or surgical removal of other carcinomas.19,54,43,61... 

Brief History. R.J. is a 57-year-old woman who was diagnosed with metastatic breast cancer 1 year ago, at which time she underwent a modified radical mastectomy followed by antineoplastic drugs. The cancer, however, had evidently metastasized to other tissues, including bone. She recently developed pain in the lumbosacral region, which was attributed to metastatic skeletal lesions in the lower lumbar vertebrae. She was admitted to the hospital to pursue a course of radiation treatment to control pain and minimize bony... 

William Halstead was a founder of Johns Hopkins University, and the inventor of the radical mastectomy (removal of the breast). Halstead was also the first American surgeon to investigate cocaine as a local anaesthetic, a painkiller applied directly to the wound or other source of pain. Unfortunately, Halstead took his work home with him. 

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