[The choice of reconstructive operation in the treatment of patients with breast cancer].

170 patients, operated on the reason of breast cancer, received reconstructive surgery. Of them 63 had simultaneous organ preserving surgery with extramammary tissues translocation; 52 had organ preserving operation with the use of reductional mammoplasty and 55 patients had subcutaneous mastectomy with nipple preservation. Results of the study demonstrate that the method of organ preserving surgery with extramammary tissues translocation has more possibilities. The second place is occupied by the method of subcutaneous mastectomy with nipple preservation or in combination with muscular thoracodorsal flap replantation. The most complicated and giving the worst cosmetic result is the use of TRAM plasty. The algorithm of choice of the reconstructive operation for patients with breast cancer was worked out. Long term follow up showed the tumor progression in 29 (17.1%), remote metastases in 15 (8.8%) and local recurrence in 6 (3.5%) patients after organpreserving surgery and in 2 (1.2%) patients after subcutaneous mastectomy.

Effects of music therapy on anxiety of patients with breast cancer after radical mastectomy: a randomized clinical trial.

AIM: This paper is a report of a clinical trial of the effects of music therapy on anxiety of female breast cancer patients following radical mastectomy. BACKGROUND: There is insufficient evidence on the effects of music therapy on state anxiety of breast cancer patients following radical mastectomy. METHODS: A Hall's Core, Care, and Cure Model-based clinical trial was conducted in 120 female breast cancer patients from March to November 2009. A randomized controlled design was utilized. The patients were randomly allocated to the experimental group (n = 60) received music therapy in addition to routine nursing care, and the control group (n = 60) only received routine nursing care. A standardized questionnaire and the State Anxiety Inventory were applied. The primary endpoint was the state anxiety score measured at pretest (on the day before radical mastectomy) and at three post-tests (on the day before patients were discharged from hospital, the second and third time of admission to hospital for chemotherapy respectively). RESULTS: The pretest score revealed that the majority of the patients had a moderate level (77·5%) and 15% had severe level of state anxiety. The repeated-measure ancova model analysis indicated that the mean state anxiety score was significantly lower in the experimental group than those in the control group at each of the three post-test measurements. The mean difference between the experimental and control group together with 95% confidence intervals were -4·57 (-6·33, -2·82), -8·91 (-10·75, -7·08) and -9·69 (-11·52, -7·85) at the 1st post-test, 2nd post-test and 3rd post-test respectively. CONCLUSION: Music therapy is found to have positive effects on decreasing state anxiety score.

[Evaluation of the risk of developing lymphoedema of the upper limb in women subjected to motor rehabilitation after radical mastectomy]. / Ocena ryzyka rozwoju obrzeku limfatycznego konczyny górnej u kobiet poddanych rehabilitacji ruchowej po radykalnej mastektomii.

The analysis included 86 women in whom lymphoedema occurred in the upper limn (ULL) after radical mastectomy. The analysis were carried out in this group of patients, as well as in a control group (patients without ULL) 14 somatic parameters were examined. These parameters were evaluated before the intervention. It was established that among the anthropometric traits examined, only the body mass, hip width, hip-shoulder index, Chest flattening index, BMI index, WHR index, Quetelet's index, Rohrer's index, Pignet-Verwaeck's index assume average values in women with ULL in the preoperative period (statistically significantly different from those which occur in women without this complication(. It was shown that the dispensary group of women ill with breast cancer with a statistically significantly high risk of developing ULL was made up of patients with a large mass (>69.2 kg), WHR (>0.94), Quetele's (>448.7), Rohrer's (>1.76) and Pignet-Verwaeck's (107.7). A slim body build and low indexe values appear to be a factor protecting from this occurrence of the complication.

Quality of life among breast cancer patients undergoing autologous breast reconstruction versus breast conserving therapy.

PURPOSE: Besides the quality of the aesthetic results, the quality of life after surgery is one of the most important criteria when reviewing different operation methods, especially in oncologic diseases. This study was performed to evaluate the difference in the health-related quality of life following breast conserving surgery and autologous breast reconstruction after mastectomy. PATIENTS AND METHODS: Hundred and forty-four breast cancer patients were included in this study. Sixty seven patients underwent breast conserving surgery followed by radiotherapy. In 77 patients a mastectomy was performed with immediate or late reconstruction. To evaluate the health-related quality of life we used the SF-36 self-administered questionnaire. RESULTS: A significant difference was found in quality of life in the subscale "physical functioning" showing better results in the breast reconstruction group (P = 0.01). No significant difference was found in the other subscales, but there was a tendency to a better "emotional role" among the breast reconstruction patients. CONCLUSION: Our study demonstrated that autologous tissue breast reconstruction in breast cancer patients did not affect adversely the health-related quality of life compared to breast conserving therapy when the quality of life is assessed by the standardized questionnaire SF-36. In particular, the physical function is not reported to be significantly influenced negatively by the more extensive surgical therapy.

The coracobrachialis muscle flap for coverage of exposed axillary vessels: a salvage procedure.

The coracobrachialis muscle has been suggested for possible use in coverage in infraclavicular defects, specifically in postmastectomy reconstructive patients. This case report demonstrates the successful clinical use of this flap for coverage of exposed axillary vessels in the infraclavicular area. Anatomy and techniques of dissection are reviewed as well as potential disadvantages.

Changing trends in postmastectomy breast reconstruction: a 13-year experience.

Over the past two decades, significant advances have been made in the treatment of breast cancer and reconstruction following mastectomy. This analysis represents a 13-year review (1979-1991) of 455 postmastectomy reconstructions involving 381 patients (age range 25 to 76 years, mean 51 years). Follow-up was 6 months to 13 years (mean 5 years). Timing of the reconstruction, reconstructive techniques used, incidence of complications, and final results were determined. Reconstructions were divided into three chronologic study groups: group I, 1979-1983; group II, 1984-1987; and group III, 1988-1991. A significant increase in the use of autogenous reconstruction was identified: 13 percent in group I to 37 percent in group III (p < 0.0002). Complication rates were not significantly different among the three groups (p > 0.02). Significant decreases in the use of implants alone and the latissimus dorsi flap with implant were identified, while tissue expansion and TRAM flap use increased significantly (p < 0.002). Also, a significant increase in immediate reconstruction from 6 percent in group I to 28 percent in group III occurred (p < 0.0002). There was no significant difference in complication rates between immediate and delayed reconstruction in any study group. Operative time averaged 2 hours less for nonautogenous techniques; however, autogenous reconstruction required significantly fewer operative revisions. The identified trends toward immediate reconstruction and use of autogenous tissue have been accomplished without an increase in complications. Despite a decrease in overall implant use, the textured silicone saline-filled expander/implant remains the most frequently used device for breast reconstruction, providing a safe and predictable method to accomplish both immediate and delayed postmastectomy reconstruction.

Rapid versus slow tissue expansion for breast reconstruction: a three-year follow-up.

Twenty-eight women scheduled for a breast reconstruction with tissue expansion were randomly divided into two groups. In the first group, the breast tissue was expanded rapidly, i.e., starting 1 week postoperatively on a daily basis; in the other group the breasts were expanded slowly, i.e., starting after 2 weeks, once each week. The expansion periods were 14 and 37 days, respectively. In both groups, the expansion volume was about 200 percent of the final breast prosthesis. The expanders were replaced by textured, gel-filled implants after 3 months. Follow-up examinations were performed after 1 year and 3 years to evaluate breast softness. An objective method, applantation tonometry, was used, and relative breast compressibility was calculated. The capsular contraction rate after 1 year was 45 percent in the rapid expansion patients and 23 percent in the slow expansion patients; after 3 years, it was 31 percent in the rapid expansion group and 33 percent in the slow expansion group. There was no statistically significant difference between the two groups at any time. Irradiated patients included in the study did not achieve poorer results. The results already obtained after 6 months remained stable up to 3 years after the implantation of the permanent prosthesis.

Why change a good thing? Revisiting the fleur-de-lis reconstruction of the breast.

Although the latissimus flap is known for its simplicity and reliability, use of the fleur-de-lis pattern was plagued by undesirable T-shaped donor sites and small breast volumes in thin patients. We report a modified technique for optimal shaping of the standard latissimus with the successful application of a modified fleur-de-lis pattern. Because a "wet" tumescent infiltration was utilized and large amounts of subcutaneous fat were harvested, these changes permitted application to a wide variety of patients, with generous breast volumes reducing the size of the implant placed and resulting in excellent donor-site scars. This is a retrospective cohort study of 53 delayed or immediate reconstructions performed consecutively by the principal author (M.E.A.) on 48 patients at a university-based, urban hospital. Each case was analyzed between April of 1995 and February of 1999, with a follow-up from 2.5 to 44 months. All patients underwent injection of tumescent solution into the subcutaneous plane and harvest of large amounts of subcutaneous fat with the neurologically intact latissimus muscle. The last 25 reconstructions utilized the modified fleur-de-lis skin pattern, an inferiorly based vertical limb and replacement of skin deficiency in both axes. Of 11 perioperatively irradiated patients, none required skin grafting, whereas 6 percent of all native mastectomy flaps were grafted. There was one instance of minor distal tip flap necrosis in a nonirradiated patient. No implants became infected or were extruded. Donor sites were without wound complications and unveiled a 16 percent overall seroma rate.Through selective addition of harvested tissue, this modified technique, particularly the fleur-de-lis pattern, permits improved volume and projection in the inferior pole. The T-shaped donor-site closure is not only acceptable, but is also desirable, with reduced wound tension and minimization of dog-ear formation. With a relative paucity of complications, this conceptually ideal modification is technically simple and aesthetically comparable to our transverse rectus abdominis muscle flap results.

Breast reconstruction with myocutaneous flaps in previously irradiated patients.

Breast reconstructions performed with latissimus dorsi and transverse rectus abdominis myocutaneous (TRAM) flaps in 82 patients with a history of previous chest-wall irradiation were compared with similar reconstructions in 202 nonirradiated patients to determine whether prior irradiation was associated with more frequent complications and to determine the success rate of breast reconstruction using distant flaps in irradiated patients. The mean dose of radiation administered was 5637 cGy. Complications in the reconstructed breast were more frequent in the irradiated patients (39 percent) than in the nonirradiated patients (25 percent; p = 0.03). In the irradiated group, breast complications were more common in reconstructions performed with the latissimus dorsi flap (63 percent) than in those performed with the TRAM flap (33 percent; p = 0.063). Aesthetic outcomes also were slightly poorer in the irradiated patients. Although complications were more common and aesthetic outcomes not as good in previously irradiated patients, we do not consider such irradiation to be a contraindication to breast reconstruction.

Acquired lymphedema: a chart review of nine women's responses to intervention.

The medical records of nine women who had acquired lymphedema as a sequela to a modified radical mastectomy for breast cancer were analyzed to ascertain what factors, phenomena, or experiences in their lymphedema treatment may have influenced outcomes. The women were identified as having either successful or poor outcomes. Their conservative lymphedema treatment consisted of compression pumps, compression garments, and, in some cases, manual lymph drainage. The qualitative analysis of records implicated the following factors in the outcome of conservative lymphedema treatment for these women: (a) the amount of delay before starting compression treatment, (b) the size of the lymphedematous arm when treatment started, (c) the availability of social and financial supports, and (d) the presence of complicating health problems. The findings of this study cannot be generalized; however, further scientific inquiry into the phenomena that lie behind treatment outcome variations could lead to more effective treatment approaches.

Work capacity of the upper limbs after mastectomy.

Cancer patients are now more often long-term survivors and their needs for returning to social and productive activities have become a primary focus of intervention. The purpose of the present study was to propose an objective evaluation test for predicting endurance capacity in breast cancer patients after surgery, in order to optimize return to work or previous daily activities, and for monitoring changes during rehabilitation. Twenty female patients (mean age: 44 +/- 5), who underwent radical breast surgery 2 months before being referred to our Unit, participated in the study. In addition to the measures of the circumferences in the arm-forearm and manual muscle strength test, we performed the following functional evaluations: 0-100 Constant scale for shoulder function; instrumental evaluation of daily/occupational upper limb activities (Lido WorkSET). We monitored the mechanical parameters, the perception of effort, pain or discomfort, and the range of movement while performing a 3-minute steady daily/occupational task chosen by the subject. Patients were asked to perform the 3-minute test at three different intensities ("moderate", "somewhat hard", "hard") until the perception of fatigue, pain or discomfort was rated > 3 on the 10 point Borg's scale. The 'power-duration' product (Watt x min) defined by the three tests (see Fig. 1) represented the individual tolerable work load, since subjective indicators of pain/discomfort remained within tolerable limits during the exertion. On this basis, patients were encouraged to return to levels of daily physical activities compatible with the individual tolerable work load. The second evaluation, although no statistical analysis was performed, confirmed that the "guided" daily activity in a 2-month period increased patients' capacities and "trust" in their physical capacity.

[Breast reconstruction following mastectomy]. / La reconstruction mammaire après ablation du sein.

In our country reconstructive breast surgery developed approximatively 20 years ago. In the early 70s breast reconstruction was only performed by simple implantation of a prosthesis. Other surgical techniques were quickly introduced, such as the transfer of the musculocutaneous flap of the latissimus dorsi and the autogenous reconstruction with the rectus abdominis musculocutaneous island flap, better known as TRAM. Since the beginning, breast reconstruction was recommended after a minimal delay of one year. More recently reconstruction was proposed to start earlier and immediate breast reconstruction became indicated in certain specific instances.

[The problems of the work rehabilitation of breast cancer patients after radical treatment]. / Voprosy trudovoi reabilitatsii bol'nykh rakom molochnoi zhelezy posle radikal'nogo lecheniia.

The paper discusses issues in occupational rehabilitation of breast cancer patients following radical treatment. A high level of labor orientation is emphasized which is to be considered in assessing working ability in an individual patient. As many as 71.2% of patients resumed working. Improvement in functional and psychoemotional status observed in the majority of patients as a result of rehabilitation treatment contributed to orientation to resume social activity.

[The rehabilitation of breast cancer patients]. / Reabilitatsiia bol'nykh rakom molochnoi zhelezy.

Immediate and long-term anatomic, functional, psychologic and social results of radical treatment of breast cancer were assessed in 2 groups of patients who had either undergone or not undergone rehabilitation. The study showed that purposeful rehabilitative treatment and organizational measures assured a decrease in invalidism rate in working age patients from 75 to 43.6% and better quality of life.

Reconstrução mamária em mulheres jovens e suas peculiaridades / Breast reconstruction in young women and their peculiarities

Introdução: O objetivo do trabalho foi avaliar as principais características e métodos utilizados na reconstrução mamária de mulheres jovens, considerando suas peculiaridades. Métodos: Foi realizada uma revisão retrospectiva dos prontuários das pacientes submetidas à mastectomia seguida de reconstrução mamária no período de janeiro de 2008 a dezembro de 2015, sendo selecionados aqueles cuja reconstrução foi realizada em mulheres de até 40 anos de idade. Resultados: 43 pacientes foram selecionadas. A média de idade foi de 33,86 anos. Grande parte possuía alguma comorbidade, sendo as mais comuns o sobrepeso e o transtorno ansioso/depressivo. Quatorze pacientes tinham história familiar da doença. A maioria obteve o diagnóstico de carcinoma ductal invasor. Tratamentos oncológicos complementares foram realizados em grande parte dos casos. Todas as pacientes foram submetidas à mastectomia total na mama portadora da neoplasia, sendo que em 16 houve a opção pela mastectomia redutora de risco contralateral. Do total de 43 reconstruções, 36 foram imediatas e 7 tardias; sendo 17 reconstruídos com implantes mamários, 13 com expansores teciduais, 4 com TRAM e 9 com GD. Houve 15 complicações, sendo as mais graves um caso de infecção com perda da reconstrução e um caso de necrose de aréola. Conclusões: Mulheres jovens submetidas à reconstrução mamária representam um subgrupo populacional com características próprias. Os padrões tumorais, pessoais e sociais diferem e, com base nesta imensa lista de variáveis, as possibilidades de tratamento são diversas. Em nossa casuística, o emprego de implantes mamários e expansores teciduais foi realizado com maior frequência neste subgrupo de pacientes.

Introduction: To evaluate the main features and methods used in breast reconstruction in young women considering their unique characteristics. Methods: A retrospective records review of patients who underwent mastectomy followed by breast reconstruction between January 2008 and December 2015 was conducted, selecting those reconstructions that were performed in women younger than 40 years. Results: Forty-three patients were selected. The average age was 33.86 years. Many had some comorbidities, the most common being overweight and anxiety/ depressive disorder. Fourteen patients had a family history of the disease. Most were diagnosed with invasive ductal carcinoma. Additional cancer treatments were administered in most cases. All patients underwent a full mastectomy in the breast with cancer, and in 16, there was the option of contralateral risk-reducing mastectomy. Of the 43 reconstructions, 36 were immediate and 7 were delayed, and 17 involved use of implants, 13 involved use of tissue expanders, 4 involved the TRAM, and 9 involved the GD. We observed 15 complications; the most severe were infection with reconstruction loss in one patient and areola necrosis in another. Conclusions: Young women undergoing breast reconstruction represent a population subgroup with its own characteristics. The tumors and personal and social patterns differ, and based on this long list of variables, treatment options are diverse. In our series, breast implants and tissue expanders were often most used.

Early rehabilitation reduces the onset of complications in the upper limb following breast cancer surgery.

BACKGROUND: Breast cancer (BC) is currently the most frequent tumor in women. Through the years, BC management has evolved towards conservative surgery. However, even minimally invasive surgery can cause neuromotor and/or articular impairments which can lead to permanent damage, if not adequately treated. AIM: To clinically evaluate upper ipsilateral limb function and the impact of certain post-surgical consequences arising after invasive or breast-conserving surgery for early BC, by intervening, or not intervening, with an early rehabilitation program. To investigate physical morbidity after sentinel (SLND) or axillary lymph node dissection (ALND) and after reconstructive surgery in the treatment of early BC. DESIGN: Observational prospective trial. SETTING: Inpatient and outpatient treatment. POPULATION: Eighty-three females participated in the study: 25 patients did not begin physiotherapy during hospitalization (Group A), 58 patients received early rehabilitation treatment (Group B). METHODS: The patients of Groups A and B were compared with respect to the following criteria: shoulder-arm mobility, upper limb function, and presence of lymphedema. All patients were assessed at 15-30, 60 and 180 days after surgery. RESULTS: Statistically significant differences, in favor of Group B, were encountered at the 180-day follow-up visit, especially with respect to articular and functional limitation of the upper limb. CONCLUSION AND CLINICAL REHABILITATION IMPACT: The results of the present study show that early assisted mobilization (beginning on the first postoperative day) and home rehabilitation, in conjunction with written information on precautionary hygienic measures to observe, play a crucial role in reducing the occurrence of postoperative side-effects of the upper limb.

Comfort, control, or conformity: women who choose breast reconstruction following mastectomy.

Following breast amputation women commonly are presented with two choices: to wear a prosthesis or undergo reconstruction. Breast restoration is assumed to allow a full emotional and physical recovery from a breast cancer crisis. Surgical reconstruction is offered to women as the final step in regaining a sense of complete womanhood, enabling a sense of optimism that both body and self will "get back to normal." This article examines 5 women's accounts of breast reconstruction and asks how breast reconstruction figures in the remaking of self following mastectomy. Issues pertaining to the reasoning behind seeking out the procedure, experiences of finding the right surgeon, and how women feel toward their reconstructed postsurgical body are examined. In conclusion it is argued that a number of contradictory expectations are held by women seeking reconstructions. While women suggest that reconstruction will restore lost femininity, sexuality, and normalcy in most cases it is not the procedure that enables this but the elimination of the hassles of prostheses. In contrast to the complete sense of self they expected to regain through reconstruction they articulate a restoration that is simply pragmatic. It is only once women have undertaken this last bastion of hope that they are forced to renegotiate their sense of themselves as women with or without breasts.