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Fulltext Skin-sparing mastectomy

Chan KY, Azlan NMN, Lo HL, Naqiyah I, Norlia A

Med J Malaysia, 2004 Oct;59(4):538-40.
PMID: 15779590 MyJurnal

Skin-sparing mastectomy is still in its infancy in Malaysia. The option of skin-sparing mastectomy is rarely given to patients as many general surgeons perform the conventional mastectomy. This could also be compounded by the lack of awareness amongst the local surgeons on the safety, surgical technique and treatment outcome of this relatively new procedure. This case report demonstrates the feasibility of this procedure performed on a Malaysian patient with a comparable outcome of those reported in the Western countries.

Matched MeSH terms: Mastectomy/methods*
Fulltext Enhancing Women's Quality of Life: Exploring the Impact of Mastectomy with and without Breast Reconstruction among Breast Cancer Survivors in Iraq

Hassan BAR, Mohammed AH, Ahmed AA, Al Zobair AA, Wayyes AM, Al-Jawadi HK, et al.

Asian Pac J Cancer Prev, 2024 Mar 01;25(3):1097-1105.
PMID: 38546092 DOI: 10.31557/APJCP.2024.25.3.1097

BACKGROUND AND AIMS: Mastectomy, a common intervention for breast cancer, has substantial implications for a woman's quality of life (QoL). However, the literature on QoL outcomes following mastectomy-with or without breast reconstruction (BR) is scant. This study aims to assess and compare the QoL among Iraqi women post-mastectomy, examining the impacts of undergoing BR.
METHODS: We conducted a comprehensive cross-sectional study across multiple centers in Iraq from April to September 2021. Our cohort consisted of 404 women who had a mastectomy for breast cancer treatment, 154 of whom also chose to have BR. Utilizing the European Organisation for Research and Treatment of Cancer's (EORTC) tools specifically, select domains from EORTC QLQ-BR23, QLQ-C30, and QLQ-BRECON23-we evaluated various facets of their QoL.
RESULTS: The mean QoL score was 54 out of 100, with patients who did not undergo BR reporting slightly higher scores (55) compared to those who did (52). Notably, social and sexual functioning scores were statistically superior in the non-BR group. Satisfaction with surgery, sexual function, and breast aesthetics were the lowest rated aspects among BR patients, indicating a considerable gap between expectations and outcomes. Marital status and the type of mastectomy notably influenced body image and sexual function. A significant portion of patients (100 out of 250) opted out of BR due to recurrence concerns, while 26.2% (106 out of 154) pursued BR to restore their pre-mastectomy physique.
CONCLUSION: Contrary to the anticipated benefits of BR, our findings suggest that women who underwent the procedure reported a lower QoL compared to those who did not. The outcomes highlight the discrepancy between expected and actual benefits of BR, suggesting a pressing need for comprehensive rehabilitation programs. These programs should aim to enhance the QoL for post-mastectomy patients and provide in-depth counseling to align expectations with the potential realities of BR.

Matched MeSH terms: Mastectomy/methods
Factors associated with alteration of nipple or skin sensation and impact of duration of time following nipple-sparing mastectomy (NSM): an analysis of 460 cases with comparison of conventional versus endoscopic- or robotic-assisted NSM

Lai HW, Chang YL, Chandrachamnong K, See MH, Huang HI, Lin SL, et al.

World J Surg Oncol, 2023 Jul 26;21(1):222.
PMID: 37491239 DOI: 10.1186/s12957-023-03107-5

BACKGROUND: The current study aims to evaluate the nipple and skin sensation following nipple-sparing mastectomy (NSM) and identify patient-, surgical-, or treatment-related factors affecting nipple or skin sensation in this cohort.
METHODS: Patients who received NSM with postoperative nipple and skin sensation test evaluation at a single institution over the past 10 years were retrospectively retrieved from a prospectively collected breast cancer surgery database.
RESULTS: A total of 460 NSM procedures were included in this current study, with the mean age of 48.3 ± 9.1. Three-hundred eighty-three (83.3%) patients had breast reconstructions. One-hundred seventy-four (37.8%) received conventional NSM (C-NSM), 195 (42.4%) endoscopic-assisted NSM (E-NSM), and 91 (19.8%) robotic-assisted NSM (R-NSM) procedures. For nipple sensation assessment, 15 (3.3%) were grade 0, 83 (18.2%) grade I, 229 (49.7%) grade II, and 133 (28.9%) grade III (normal sensation), respectively, with mean grade score of 2.1 ± 0.7. The preserved (grade III) nipple sensation rate was 36.2% (63/174) in the C-NSM group, 26.7% (52/195) in the E-NSM group, and 19.7% (18/91) in the R-NSM group (P = 0.06). The "time since surgery to last evaluation" was significantly longer in the C-NSM group (45.6 ± 34 months) or E-NSM group (44.7 ± 35.8 months) as compared to R-NSM group (31.8 ± 16 months, P 60 months vs. ≦ 12 months: nipple odds ratio (OR) = 5.75, P

Matched MeSH terms: Mastectomy/methods
Overall Survival and Local Recurrence Among Breast Cancer Patients in Hospital Sultanah Nora Ismail Batu Pahat, 2007-2013

Balasundram S, Salekan K, Ahmad Shariffuddin FN, Taib NA, Adnan TH

Asian Pac J Cancer Prev, 2018 Sep 26;19(9):2409-2415.
PMID: 30255693

Objective: To gauge surgical outcome in breast cancer patients with particular reference to overall survival and
recurrence free survival among breast cancer patients in Hospital Sultanah Nora Ismail Batu Pahat, Johor, Malaysia.
Methods: Patients undergoing ablative breast cancer surgery were identified and clinical records were assessed.
Inclusion criteria for enrolment were stage I-IV breast malignancy necessitating resection with or without radiotherapy/
chemotherapy from 2007 to 2013. All individuals had a pre-operative assessment. The post operative assessment period
ranged from 1 year to 5 years. Survival distributions were analyzed using Kaplan-Meier curves. Results: A total of
121 patients were included in this study, with an age range of 28-78 years. Some 98% had undergone local excision/
lumpectomy/ mastectomy with axillary clearance. While 81% of patients underwent chemotherapy, only 69% had
radiotherapy. Tumours were oestrogen receptor positive in 58% of cases and progesterone receptor positive in 62%.
Local recurrence was detected in 10%. The mean age at diagnosis was 51.3 + 10.4 years. The overall survival analysis
was based on 22 deaths among the 121 patients (18.2%). Three-year and five-year survival rates were 87.6% and 78.4%,
respectively. Analysis of recurrence-free-survival (RFS) was based on 12 events among 121 patients. The Kaplan-Meier
RFS analysis revealed that in 90% of the patients with recurrence, it occurred within 45 months. The five year RFS
rate was 84.5%. The median time taken from diagnosis to ablative surgery was 51 days (upper limit of 791 days).
Only distant metastasis was a significant factor that impacted on both overall survival and recurrence-free survival
(p<0.001). Conclusion: Overall survival among our breast cancer patients in our facility is comparable to other in
other tertiary centres in the country. A trend for earlier detection was noted.

Matched MeSH terms: Mastectomy/methods
Transforming care: Optimizing ERAS pathway in breast cancer surgery with latissimus dorsi flap

Lai LL, Teh MS, Beh ZY, Lim WL, Lim SM, Soh WQ, et al.

World J Surg, 2024 Dec;48(12):2799-2810.
PMID: 39444164 DOI: 10.1002/wjs.12364

INTRODUCTION: This study aims to establish, execute, and assess the effectiveness of a perioperative enhanced recovery after surgery (ERAS) clinical care pathway in breast reconstruction patients with LD flap breast cancer treatment. The goal is to improve early recovery outcomes, reduce hospitalization time, and enhance patient satisfaction by implementing a standardized approach to postoperative care.
METHODS: This study was conducted at the University of Malaya Medical Center. The outcomes of 21 breast cancer patients who underwent autologous reconstructive breast surgery with the latissimus dorsi (LD) flap within six months before the implementation of the ERAS pathway (pre-ERAS) were compared with 26 patients who underwent the same surgery with the ultrasound-guided erector spinae plane (ESP) block for the (ERAS protocol implementation) cohort. The study was conducted from November 2019 to October 2020. The length of hospital stay, amount of analgesic usage, and incidence of postoperative nausea vomiting (PONV) were recorded.
RESULTS: The implementation of the ERAS clinical care pathway resulted in shorter hospital stays compared with the preceding care. On average, ERAS patients were mostly discharged on Day 2 post-surgery, whereas pre-ERAS patients were mostly discharged on Day 7. ERAS patients had a lower incidence of PONV from Days 1 to 5, starting with 88.5% not experiencing the condition on Days 1 and 2 and increasing to 100% on Day 5. All pre-ERAS patients experienced PONV in the first 5 days post-surgery. Fewer ERAS patients required antiemetics post-surgery (88.5%) compared with pre-ERAS patients (42.9%).
CONCLUSION: The implementation of the ERAS protocol as part of clinical care in autologous reconstructive breast surgery with the LD flap can improve recovery by shortening hospital stay, decreasing the use of analgesia, and alleviating PONV.

Matched MeSH terms: Mastectomy/methods
Fulltext Does the pre-operative value of serum CA15-3 correlate with survival in breast cancer?

Velaiutham S, Taib NA, Ng KL, Yoong BK, Yip CH

Asian Pac J Cancer Prev, 2008 Jul-Sep;9(3):445-8.
PMID: 18990019

INTRODUCTION: CA15-3 is a well-known tumour marker for breast cancer. Currently it is not recommended for screening or diagnosis of breast cancer and its main application is in monitoring response to treatment in women with metastatic breast cancer. The aim of this study was to correlate serum CA15-3 at presentation with the stage of disease and overall survival in women with breast cancer in the University Malaya Medical Centre.

METHODS: This is a retrospective study of 437 women who had CA15-3 levels determined at initial presentation of breast cancer to UMMC between Jan 1999 and Oct 2003.

RESULTS: Of those patients who were adequately staged, CA15-3 was found to be elevated (defined as >51 U/ml) in 0% of Stage 1, 7.9% of Stage 2, 36.7% of Stage 3 and 68.6% of Stage 4 cases. In a subset of 331 patients with survival data, patients with normal CA15-3 had a 85% five year overall survival rate compared to 38% in their counterparts with elevation of the tumor marker. The level of elevation was also significantly related to survival; patients with values more than 200 U/ml exhibited only a 28% five year survival. The association of elevated CA15-3 at initial presentation with poor outcome was maintained over univariate and multivariate analyses.

CONCLUSION: Estimation of CA15-3 at presentation of breast cancer is important as it is an independent prognostic indicator and may prompt the physician to investigate for metastases if elevated.

Matched MeSH terms: Mastectomy/methods*
Fulltext Immediate breast reconstruction after mastectomy--why do women choose this option?

Shameem H, Yip CH, Fong E

Asian Pac J Cancer Prev, 2008 Jul-Sep;9(3):409-12.
PMID: 18990011

INTRODUCTION: Mastectomy is an essential but disfiguring operation in cancer treatment. The negative impact on body image can however be prevented by immediate reconstruction.
AIM: The aim of this study was to determine the reasons why patients choose to have or not to have immediate breast reconstruction.
METHODOLOGY: This is a cross sectional descriptive study of breast cancer patients post-mastectomy who had and had not undergone immediate breast reconstruction. The patients were asked a series of questions to ascertain the reasons why they chose or did not choose immediate breast reconstruction.
RESULTS: 136 patients in total were interviewed of which 23 had undergone immediate breast reconstruction. 36.8% of the patients had been offered reconstruction. In the non-reconstructed group, the main reason for not having reconstruction were fear of additional surgery. In the group that had reconstruction done, the main reason was to feel whole again. Low on the list were reasons such as trying to improve marital or sexual relations.
CONCLUSION: Only a third of patients undergoing mastectomy were offered immediate reconstruction. In public hospitals in developing countries, limited operating time and availability of plastic surgery services are major barriers to more women being offered the option.

Matched MeSH terms: Mastectomy/methods*
Prognostic role of adjuvant radiotherapy in triple-negative breast cancer: A historical cohort study

Bhoo-Pathy N, Verkooijen HM, Wong FY, Pignol JP, Kwong A, Tan EY, et al.

Int J Cancer, 2015 Nov 15;137(10):2504-12.
PMID: 26018878 DOI: 10.1002/ijc.29617

The value of adjuvant radiotherapy in triple-negative breast cancer (TNBC) is currently debated. We assessed the association between adjuvant radiotherapy and survival in a large cohort of Asian women with TNBC. Women diagnosed with TNBC from 2006 to 2011 in five Asian centers (N = 1,138) were included. Survival between patients receiving mastectomy only, breast-conserving therapy (BCT, lumpectomy and adjuvant radiotherapy) and mastectomy with radiotherapy were compared, and adjusted for demography, tumor characteristics and chemotherapy types. Median age at diagnosis was 53 years (range: 23-96 years). Median tumor size at diagnosis was 2.5 cm and most patients had lymph node-negative disease. The majority of patients received adjuvant chemotherapy (n = 861, 76%) comprising predominantly anthracycline-based regimes. In 775 women with T1-2, N0-1, M0 TNBCs, 5-year relative survival ratio (RSR) was highest in patients undergoing mastectomy only (94.7%, 95% CI: 88.8-98.8%), followed by BCT (90.8%, 95% CI: 85.0-94.7%), and mastectomy with radiotherapy (82.3%, 95% CI: 73.4-88.1%). The adjusted risks of mortality between the three groups were not significantly different. In 363 patients with T3-4, N2-3, M0 TNBCs, BCT was associated with highest 5-year RSR (94.1%, 95% CI: 81.3-99.4%), followed by mastectomy with radiotherapy (62.7%, 95% CI: 54.3-70.1%), and mastectomy only (58.6%, 95% CI: 43.5-71.6%). Following multivariable adjustment, BCT and mastectomy with radiotherapy remained significantly associated with lower mortality risk compared to mastectomy only. Overall, adjuvant radiotherapy was associated with higher survival in women aged <40 years, but not in older women. Adjuvant radiotherapy appears to be independently associated with a survival gain in locally advanced as well as in very young TNBC.

Matched MeSH terms: Mastectomy/methods
Breast cancer in South East Asia: comparison of presentation and outcome between a middle income and a high income country

Saxena N, Hartman M, Bhoo-Pathy N, Lim JN, Aw TC, Iau P, et al.

World J Surg, 2012 Dec;36(12):2838-46.
PMID: 22926282 DOI: 10.1007/s00268-012-1746-2

There are large differences in socio-economic growth within the region of South East Asia, leading to sharp contrasts in health-systems development between countries. This study compares breast cancer presentation and outcome between patients from a high income country (Singapore) and a middle income country (Malaysia) in South East Asia.

Matched MeSH terms: Mastectomy/methods