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Mastectomy and immediate breast reconstruction: follow-up of 74 cases
186 The Breast blood stem cells (PBSC) by lenograstim alone or chemotherapy and lenograstim, in order to define the optimal time for aphoresis and to examine bone marrow recovery following re-infusion of chemotherapy and lenograstim primed PBSC after CTCb. Preliminary results of this study indicate that the third dose level (4 cycles of FAC 500/75/500 mg/m* i.v. at 2-weekly intervals supported by lenograstim at 10 ug/kg/day S.C. from days 2-l 1) is the optimal intensive induction treatment resulting in 100% overall and 50% complete response. PBSC numbers collected during one aphoresis were within the acceptable values for autologous transplantation and PBSC rescue after CTCb (5000/800/800 mg/m’) resulted in accelerated bone marrow recovery. This approach to achieve a higher complete remission rate is promising and the advantage of intensive induction chemo-
therapy with lenograstim support followed by high-dose consolidation chemotherapy to enhance survival rate in advanced breast cancer warrants further studies. 4 Immediate reconstruction after radical
mastectomy: our experience G. Pagano, M. Santoni, S. Carones St Joseph Hospital, Albano, Rome, Italy The woman recovering from a mastectomy undergoes a mutilation syndrome with social, physical and psychological alterations. In our study we relate our experience and we point out the advantages of an immediate reconstruction, carried out by the same surgical team, after mastectomy, with Becker prothesis. We performed only 31 immediate reconstructions, with 33 other women refusing such treatment. Other reconstructions were not possible for legal problems related to silicone protheses. The semi-expansible prothesis is placed in a muscular pocket which is not drained. The results, assessed by softness, mobility and symmetry, according to the surgeon’s valuation, are: very good 30%; good 40%; not too good 20% and poor 10%. Women’s valuation of the results are: very good 60% and good 40%. We conclude that reconstruction should be offerred to all women undergoing mastectomy. 5 Mastectomy and immediate breast reconstruction: follow-up of 74 cases
S. Modena, M. Mainente,
A. Zanza, C. Benassuli, Serio, A. Molino, M. Turazza, L. Sperotto Verona University, Italy
G.
Immediate breast reconstruction is nowadays an important procedure in the treatment of breast cancer. Between 1985 and 1992 we have performed 74 operations, in 72 patients, of mastectomy and immediate breast reconstruction. The mean age was 47.5 year with a range between 33 and 65.47 women were premenopausal and 25 postmenopausal. The average follow-up was 30 months with a maximum of 97 and a minimum of 3. In all the cases a modified radical mastectomy was performed. The reconstruction was performed using a tissue and skin expander in 53 cases, definitive prosthesis in 2, latissimus dorsi myocutaneous flap in 15 and rectus abdominus myocutaneous flap in 4 cases. A controlateral mastopexy was added for symmetry in 46 cases. In 1 patient it was impossible to define the size of the tumour; 37 patients were T2, 30 T3, 4 T3 and 2 T4. The axillary nodes were negative in 51 cases and positive in 21. Oestrogen receptors were positive in 42, negative in 11 and not available in 19 cases. 20 patients were submitted to adjuvant chemotherapy with no interference with the presence of a mammary implant. To 19 patients tamoxifen was prescribed. 1 patient had axillary local relapse, 1 patient has
controlateral tumour, 2 developed distant metastasis, 1 controlateral tumour and then distant metastasis; 2 patients died of distant metastasis. The reconstruction complications were capsular contracture in 10 cases, necrosis in 4. infection in 5 and dislocation of the implant in 3 cases. Finally the aesthetic result was judged good in 49 cases, medium in 14 and poor in 11. This experience indicates that immediate breast reconstruction does not interfere with the natural history and the treatment of the disease and gives the patient important psycological advantages.
6 Mastoplasty in conservative surgery G. Pagano, M. Santoni, S. Carones St Joseph Hospital, Albano, Rome, Italy The improvement of the diagnostic techniques, the diffusion of the mass screening and the increase of women’s compliance determined an early breast cancer detection. Conservative surgery has become an accepted treatment for breast cancer less than 2 cm in diameter. Quadrantectomy and axillary dissection offers the additional advantage of preserving the breast, usually with highly satisfactory cosmetic results, expecially if it is completed with reconstruction. In our centre, since 1989, we have practiced conservative surgery completed with reconstruction on 87 women of the 197 we operated on. After radiotherapy we have performed mastopexy of the contralateral breast. We have performed 48 outer upper quadrantectomies through a semi-circular incision of the breast and a S axillary incision, 15 central upper and 5 upper inner quadrates with T mastopexy; 2 central quadrant with cylindrical glandular flap and L mastopexy. We also performed 10 outer lower quadrates completed with L mastopexy and 7 inner and central lower quadrantes with upset T mastopexy. The final valuation according to volume, to symmetry and alignment of the nipples very good in 20%, good in 70%, not so good in 5% and poor in 5% of the cases. These data show that conservative surgery is to be associated with aesthetical value of the remaining breast.
7 Screening the at risk patient: family history D. M. Sibbering, P. Holland, A. K. Mitchell, R. W. Blarney City Hospital, Nottingham, UK Family history is recognised as an important risk factor for breast cancer. This unit offers breast screening to women with a family history of breast cancer (at least one first degree relative or multiple other family members affected). We recommend that screening starts at age 40, or at an age 10 years younger than that at which the woman’s relative developed breast cancer, whichever is sooner. At age 50 women enter the National Screening Programme unless they have an exceptionally strong family history. The women screened undergo annual clinical examination, with 2-yearly mammography from the age of 35 years. Women under 35 have a baseline mammogram taken at the age of 30. 491 women have attended for family history screening to date. Their familv histories are summarized below: No. of first dkgree relatives Women screened affected 1 419 (mother 72%, sister 27.5%. daughter 0.5%) 2 46 3 6 4 2
therapy with lenograstim support followed by high-dose consolidation chemotherapy to enhance survival rate in advanced breast cancer warrants further studies. 4 Immediate reconstruction after radical
mastectomy: our experience G. Pagano, M. Santoni, S. Carones St Joseph Hospital, Albano, Rome, Italy The woman recovering from a mastectomy undergoes a mutilation syndrome with social, physical and psychological alterations. In our study we relate our experience and we point out the advantages of an immediate reconstruction, carried out by the same surgical team, after mastectomy, with Becker prothesis. We performed only 31 immediate reconstructions, with 33 other women refusing such treatment. Other reconstructions were not possible for legal problems related to silicone protheses. The semi-expansible prothesis is placed in a muscular pocket which is not drained. The results, assessed by softness, mobility and symmetry, according to the surgeon’s valuation, are: very good 30%; good 40%; not too good 20% and poor 10%. Women’s valuation of the results are: very good 60% and good 40%. We conclude that reconstruction should be offerred to all women undergoing mastectomy. 5 Mastectomy and immediate breast reconstruction: follow-up of 74 cases
S. Modena, M. Mainente,
A. Zanza, C. Benassuli, Serio, A. Molino, M. Turazza, L. Sperotto Verona University, Italy
G.
Immediate breast reconstruction is nowadays an important procedure in the treatment of breast cancer. Between 1985 and 1992 we have performed 74 operations, in 72 patients, of mastectomy and immediate breast reconstruction. The mean age was 47.5 year with a range between 33 and 65.47 women were premenopausal and 25 postmenopausal. The average follow-up was 30 months with a maximum of 97 and a minimum of 3. In all the cases a modified radical mastectomy was performed. The reconstruction was performed using a tissue and skin expander in 53 cases, definitive prosthesis in 2, latissimus dorsi myocutaneous flap in 15 and rectus abdominus myocutaneous flap in 4 cases. A controlateral mastopexy was added for symmetry in 46 cases. In 1 patient it was impossible to define the size of the tumour; 37 patients were T2, 30 T3, 4 T3 and 2 T4. The axillary nodes were negative in 51 cases and positive in 21. Oestrogen receptors were positive in 42, negative in 11 and not available in 19 cases. 20 patients were submitted to adjuvant chemotherapy with no interference with the presence of a mammary implant. To 19 patients tamoxifen was prescribed. 1 patient had axillary local relapse, 1 patient has
controlateral tumour, 2 developed distant metastasis, 1 controlateral tumour and then distant metastasis; 2 patients died of distant metastasis. The reconstruction complications were capsular contracture in 10 cases, necrosis in 4. infection in 5 and dislocation of the implant in 3 cases. Finally the aesthetic result was judged good in 49 cases, medium in 14 and poor in 11. This experience indicates that immediate breast reconstruction does not interfere with the natural history and the treatment of the disease and gives the patient important psycological advantages.
6 Mastoplasty in conservative surgery G. Pagano, M. Santoni, S. Carones St Joseph Hospital, Albano, Rome, Italy The improvement of the diagnostic techniques, the diffusion of the mass screening and the increase of women’s compliance determined an early breast cancer detection. Conservative surgery has become an accepted treatment for breast cancer less than 2 cm in diameter. Quadrantectomy and axillary dissection offers the additional advantage of preserving the breast, usually with highly satisfactory cosmetic results, expecially if it is completed with reconstruction. In our centre, since 1989, we have practiced conservative surgery completed with reconstruction on 87 women of the 197 we operated on. After radiotherapy we have performed mastopexy of the contralateral breast. We have performed 48 outer upper quadrantectomies through a semi-circular incision of the breast and a S axillary incision, 15 central upper and 5 upper inner quadrates with T mastopexy; 2 central quadrant with cylindrical glandular flap and L mastopexy. We also performed 10 outer lower quadrates completed with L mastopexy and 7 inner and central lower quadrantes with upset T mastopexy. The final valuation according to volume, to symmetry and alignment of the nipples very good in 20%, good in 70%, not so good in 5% and poor in 5% of the cases. These data show that conservative surgery is to be associated with aesthetical value of the remaining breast.
7 Screening the at risk patient: family history D. M. Sibbering, P. Holland, A. K. Mitchell, R. W. Blarney City Hospital, Nottingham, UK Family history is recognised as an important risk factor for breast cancer. This unit offers breast screening to women with a family history of breast cancer (at least one first degree relative or multiple other family members affected). We recommend that screening starts at age 40, or at an age 10 years younger than that at which the woman’s relative developed breast cancer, whichever is sooner. At age 50 women enter the National Screening Programme unless they have an exceptionally strong family history. The women screened undergo annual clinical examination, with 2-yearly mammography from the age of 35 years. Women under 35 have a baseline mammogram taken at the age of 30. 491 women have attended for family history screening to date. Their familv histories are summarized below: No. of first dkgree relatives Women screened affected 1 419 (mother 72%, sister 27.5%. daughter 0.5%) 2 46 3 6 4 2