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Breast surgeries for cancer and tumors were first described approximately 3,000 years ago, and since that time the standard of management has changed dramatically. From Egyptian papyri to Hippocratic theory, from Galen's dissections to Halsted's radical mastectomy, and from sentinel lymph node mapping to the development of nipple-sparing mastectomi...
Citations
... Surgical management of breast cancer has evolved since early described mastectomies [3]. Reconstruction is now integral to the surgical management of breast cancer as it has been shown to reduce psychosocial morbidity and increase greater patient satisfaction [4]. ...
Background
Breast cancer is the most common malignancy among women in the UK. Following mastectomy, reconstruction is now integral to the surgical management of breast cancer, of which implant-based reconstruction (IBBR) is the most common type. IBBR initially evolved from pre-pectoral to post-pectoral due to complications, but with developments in oncoplastic techniques and new implant technology, interest in pre-pectoral IBBR has increased.
Many surgeons use acellular dermal matrices (ADM); however, there is little evidence in literature as to whether this improves surgical outcomes in terms of complications, failure and patient satisfaction. This review aims to assess the available evidence as to whether there is a difference in surgical outcomes for breast reconstructions using ADM versus non-use of ADM.
Methods
A database search will be performed using Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Clinicaltrials.org. The search timeframe will be 10 years.
Studies will be screened using inclusion and exclusion criteria and data extracted into a standardised spreadsheet. Risk of bias will be assessed. Screening, extraction and risk-of-bias assessments will be performed independently by two reviewers and discrepancies discussed and rectified. Data analysis and meta-analysis will be performed using Microsoft Excel and R software. Forest plots will be used for two-arm studies to calculate heterogeneity and p-value for overall effect.
Discussion
With the renaissance of pre-pectoral IBBR, it is important that surgeons have adequate evidence available to assist operative decision-making. Assessing evidence in literature is important to help surgeons determine whether using ADM for IBBR is beneficial compared to non-use of ADM. This has potential impacts for patient complications, satisfaction and cost to healthcare trusts.
Systematic review registration
PROSPERO 2023 CRD42023389072.
... The surgery involves removal of a large amount of tissue including, entire breast is removed, including the skin, areola, nipple, and most axillary lymph nodes. 3 Leading to extensive tissue injury with a great chance of postoperative pain which sometimes becomes a matter of great concern after breast surgery. Nearly half of the patient suffers chronic pain, one quarter of them described their pain as moderate to high. 4 There are several risk factors for chronic postoperative pain, these includes younger age, invasive surgical interventions, and adjuvant radiation therapy following surgery. ...
Postoperative pain control in breast cancer surgery has become one of the most important goals for anesthesiologists. Several techniques have been trialed for providing postoperative analgesia after breast surgery. This randomized control study was designed to evaluate the postoperative analgesic effect of ultrasound-guided erector spinae plane (US-guided ESP) block for modified radical mastectomy surgery. To evaluate the postoperative analgesic effect of pectoral nerves block and erector spinae plane block for modified radical mastectomy surgery. This prospective, randomized, controlled trial was conducted at the A total 46 patients who were to undergo modified radical mastectomy, fulfilling selection criteria were included in the study following confirmation of the informed written consent and randomly divided into two groups-where each group include 23 Patients. Group A received ultrasound guided ESP and group B received ultrasound guided PECS block. All patients of both groups received GA after confirmation of block. All relevant information including demographic criteria, medical history, clinical evaluation during and after performance of block were collected. All patients were observed peri-operatively and data were recorded into the preformed questionnaires form. Finally, data was analyzed by SPSS version 22.0. Mean age of study population was 52.07±7.08 years with majority in age group 50-59 years. No significant difference was noted between patient's characteristics, duration of surgery and heart rate and mean arterial pressure of patient during and after operation between two groups (p>0.05). The mean VAS score was significantly low in ESP block as compared to the PECS block at all-time interval (p<0.05) except at 12 hours. Patients with ESP block had significantly late demand of 1st analgesic (12.13±2.45 hours vs 8.89±3.35 hours) (p<0.05) and significantly less total opioid consumption (5.17±0.57 mg vs 10.18±1.82 mg) (p<0.05) compared to patients with PECS block. Post-operative complication was noted significantly higher among patients with PECS block compared to ESP block. These findings from our study depict ESP block performed in patients scheduled for MRM (modified radical mastectomy) results in better pain control and less postoperative opioid consumption in the first 24 hours than PECS block. CBMJ 2022 July: vol. 11 no. 02 P: 86-95
... Research in oncology (genomics, transcriptomics, metabolomics, and proteomics), equipment development (diagnostic and therapeutic), and drug discovery play an important role in the treatment of BC [3,4]. Surgery remains the primary modality, and numerous innovations have evolved mastectomy techniques [4][5][6]. ...
INTRODUCTION: Immunotherapy has shown encouraging outcomes in breast cancer (BC) treatment in recent years. The programmed cell death ligand 1 (PD-L1) transmembrane protein is suggested to function as a co-inhibitory factor in the immune response, where it collaborates with programmed cell death protein 1 (PD-1) to stimulate apoptosis, suppress cytokine release from PD-1 positive cells, and limit the growth of PD-1 positive cells. Furthermore, in many malignancies, PD-L1 reduces the immune system’s response to neoplastic cells. These observations suggest that the PD-1/PD-L1 axis plays a vital role in cancer therapy and the regulation of cancer immune escape mechanisms. This review aimed to provide an overview of the functions of PD-1 and PD-L1 in BC cancer therapy.
METHODS: This research design is a literature review. The style is a traditional review on topics or variables relating to the PD-1/PD-L1 pathway. A literature search was carried out using five online databases.
RESULTS: The search using the keywords yielded a total of 248 studies. Each result was filtered again according to the inclusion and exclusion criteria, resulting in a final total of 4 studies to be included in the literature review.
CONCLUSIONS: The combination of PD-1/PD-L1 is essential for many malignancies. According to the evidence presented, this combination presents both an opportunity and a challenge in cancer treatment. Since many solid cancers, especially BC, express high levels of PD-1/PD-L1, cancer treatment mainly involves targeted therapies.
... MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions, or products referred to in the content. [3]. It was in 1757, when Henri François Le Dran's discovered that cancer could spread from the breast to the axillary lymph nodes under the arm. ...
Breast cancer is a global health concern, necessitating continuous advancements in diagnostic medical imaging technologies for early detection and improvement of treatment. This paper presents an overview of the past, present and future of breast cancer imaging using light and some results from the current studies. The paper specifically presents the role of Diffuse Optical Tomography (DOT) in breast cancer imaging. Conventional methods, such as X-ray mammography, face limitations. Diffuse Optical Tomography, a non-invasive light-based imaging modality can provide quantitative descriptive and architectural information about breast tissue. The paper discusses the key challenges and recent developments in breast cancer imaging using DOT to overcome some key challenges. This paper aims to contribute to the understanding of the evolving technological landscape in breast cancer imaging using light for improving early detection and patient outcomes.
... Mastectomy may be a treatment option at any stage of breast cancer, including in situ carcinoma depending on the doctor's recommendation and the patient's preferences [5,6,21]. This surgical method has existed for a long time and is still used in many settings [22]. ...
Background
Breast cancer represents the most prevalent cancer among Swedish women. Although considerable research has investigated the cost-effectiveness of emerging innovative medical treatments for breast cancer, studies addressing existing surgical procedures remain scant. Therefore, this study aimed to evaluate the cost-effectiveness of three surgical procedures for in situ breast cancer treatment in Sweden: mastectomy, lumpectomy without irradiation, and lumpectomy with irradiation.
Methods
A six-state Markov model with a 30-year time horizon was used to compare the cost-effectiveness of the three alternatives. Transition probabilities were based on a targeted literature review focusing on available evidence in Sweden and comparable contexts. Costs were estimated from both healthcare and societal perspectives, using patient data from the Swedish National Cancer Registry in 2020 (Cancerregistret). Health outcomes were quantified in terms of quality-adjusted life years (QALYs). Cost and health outcomes were then summarised into an incremental cost-effectiveness ratio (ICER) between competing strategies. A probabilistic sensitivity analysis (PSA) was conducted to address the uncertainties in the input parameters.
Results
The results showed that compared to lumpectomy without irradiation, lumpectomy with irradiation yielded a “moderate” ICER per QALY gained of 402,994 Swedish Krona (SEK) from a healthcare perspective and a “high” ICER of 575,833 SEK from a societal perspective. Mastectomy proved to be the costliest and least effective of the three alternatives over a 30-year period. The PSA results further substantiated these findings.
Conclusions
Our study demonstrated that lumpectomy with irradiation is “moderately” cost-effective compared with lumpectomy without irradiation. Nevertheless, extending this study by conducting a comprehensive budget impact analysis to account for the prevalence of in situ breast cancer in Sweden is prudent. These results imply that a costlier and less effective mastectomy should only be considered when lumpectomy options are infeasible. Further studies are needed to obtain more reliable parameters relevant to Sweden and to increase the consistency of the findings.
... In Tunisia, women's breast cancer is the most prevalent female cancer and is considered as a serious public health issue (Ben Gobrane H et al. 2011, Zemni et al. 2022. The most common therapeutic intervention is mastectomy (Freeman et al. 2018). While waiting for a planned mastectomy, women have physical, emotional, and informational requirements; CARING care interventions can help women with these needs (Cardoso et al. 2023). ...
Our poster presents the most important findings from this study have been assumed in patients and nurses who concur on the value of nursing care in the preoperative stage for women waiting for mastectomy surgery.
Although patients tended to prefer the humanistic and relational dimensions, nurses prioritize the "comfort" and "clinical" dimensions.Appropriate preoperative preparation, technical and also human care imbued with caring, prove that significant improvements are needed in to enhance the quality of nursing care provided.
... In fact, there has been an increasing mastectomy trends recently in the USA due to the progress in mastectomy techniques as well as postmastectomy reconstruction techniques [6,7]. What was once a radical operation; removing the entire breast, the skin/nipple-even the underlying muscles-is no longer the case [8]. Skin and nipple-sparing mastectomies nowadays preserve the natural breast mold and look, without jeopardizing tumor control and reconstruction allows the patient to select the desired size for her reconstructed breast [9][10][11][12][13]. ...
Purpose of Review
Integrating postmastectomy radiotherapy (PMRT) and breast reconstruction remains a multidisciplinary clinical challenge. While PMRT improves tumor outcomes in patients with locally advanced breast cancers, it increases breast reconstruction complications. Therefore, understanding the nuances of different surgical and PMRT techniques and their dynamic interaction is crucial to overcome such challenge.
Recent Findings
Introduction of new reconstruction techniques including single-stage implant reconstruction, different types of surgical mesh and pre-pectoral implants placement, allowed different approaches for the caregivers and patients. In parallel to this surgical progress, there were PMRT advances such as intensity-modulated radiotherapy (IMRT), protons, different types of skin bolus, and more knowledge about usage of chest wall boost.
Summary
In this review article, we discuss the different surgical and PMRT advances through a comprehensive literature review. We also discuss personalized approach to this problem using machine learning nomograms and risk score calculators.
... O câncer de mama (CM) é considerado um problema de saúde pública pelas altas taxas de incidência e mortalidade. As cirurgias para o tratamento do CM são conhecidas como mastectomias que são divididas em: radical modificada (retira tecido mamário, pele, mamilo, aréola, linfonodos axilares e preserva os músculos peitorais), simples (preserva os músculos peitorais e parte dos linfonodos) e poupadora de pele e mamilos; e conservadoras: quadrantectomia, tumorectomia ou mastectomia parcial, as quais preservam o tecido mamário com a retirada do tumor e de uma margem de segurança, mas podem se diferenciar na execução da técnica (Freeman et al., 2018;Meghan L. Czajka & Christopher Pfeife, 2022). ...
Objetivo: analisar a correlação entre a amplitude de movimento articular, força muscular e funcionalidade do membro superior ipsilateral a mama afetada no pós-cirúrgico de mulheres com diagnóstico de Câncer de mama. Metodologia: Estudo transversal dos dados obtidos no pós-cirúrgico de 22 mulheres em tratamento do câncer de mama no Hospital João de Barros Barreto em Belém-PA. Foi realizada avaliação dos dados sociodemográficos, características clínicas, prática de atividades físicas, força muscular, amplitude de movimento articular e funcionalidade dos membros superiores. Resultados: 60% da amostra apresentou faixa etária ≥ 40 anos de idade. A média da amplitude de movimento foi de 165.4º, 164.8º, 44º, 89.3º, 88.2º e a média da força muscular foi de 5.54 kg, 9.60 kg, 7.67 kg, 5.56 kg, 4.78 kg (para os movimentos de flexão, abdução, extensão, rotação interna e rotação externa, respectivamente). Os valores de R² ajustado e Teste F para funcionalidade foram de 0.594 e 16.4, respectivamente, em relação a força muscular de abdução e de amplitude de movimento para rotação externa. Conclusão: O estudo demonstrou que o melhor modelo de correlação para amplitude de movimento e força muscular de ombro em relação a funcionalidade correspondeu a diminuição da amplitude de movimento de rotação externa e de força muscular para abdução. Assim, o modelo pode prever um aumento de 59% da incapacidade dos membros superiores de pacientes com câncer de mama após o tratamento cirúrgico.
... Mastectomy may be a treatment option at any stage of breast cancer, including in situ carcinoma depending on the doctor's recommendation and patients' preferences (5,6,21). This surgical method has existed for a long-time period and is still being used in many settings (22). ...
Background:Breast cancer is the most prevalent cancer among Swedish women, and while treatments have progressed significantly over the years, there have been few health economics assessments of these treatments, particularly cost effectiveness analysis. This study was to evaluate the cost-effectiveness of three surgical procedures for in situ breast cancer treatment in Sweden: mastectomy, lumpectomy without irradiation, and lumpectomy with irradiation.
Methods:A 6-state Markov model with a 30-year time horizon was used to compare the cost-utility of these three alternatives. Transition probabilities were based on a targeted literature review focusing on available evidence in Sweden and similar contexts. Healthcare and societal perspectives were both considered in cost estimation using the Swedish National Cancer Registry patient data in 2020 (Cancerregistret), and a quality-adjusted life years (QALYs) was used to calculate utility. Probabilistic sensitivity analysis (PSA) was applied to handle uncertainties among the parameters.
Results:The results showed that lumpectomy with irradiation are cost-effective compared to lumpectomy without irradiation with an incremental cost effectiveness ratio (ICER) of 402,994 Swedish Krona (SEK) from a healthcare perspective and of 575,833 SEK from a societal perspective. Mastectomy alternative was dominated by the two lumpectomy alternatives, as it was the costliest option and yielded the lowest QALYs over the 30-year period. PSA results also supported the findings.
Conclusions:This study conducted a cost-utility analysis of three surgical procedures for in situ breast cancer treatment in Sweden, namely mastectomy, lumpectomy without and with irradiation. Further studies are needed to obtain more reliable parameters in Sweden and increase the consistency of the findings.
... Breast cancer is both an ancient disease, first described by the Egyptians [19], and a disease of civilization, since its incidence has increased in the last century. ...
Background
Breast cancer, although the most frequently diagnosed malignant tumor in humans, has a less clear etiology compared to other frequent cancer types. Mouse-mammary tumor virus (MMTV) is involved in breast cancer in mice and dogs and might play a role in the etiology of some breast cancers in humans, since an MMTV-like sequence was identified in 20–40% of breast cancer samples in Western Europe, USA, Australia and some other parts of the world. The purpose of our study was to identify MMTV-like DNA sequences in breast tissue samples from breast cancer patients who underwent curative surgery in our regional academic center in Romania, EU.
Methods
We selected 75 patients with non-metastatic breast cancer treated surgically with curative intent, who did not undergo any neoadjuvant treatment. Out of these patients, 50 underwent radical lumpectomy and 25 modified radical mastectomy. Based on previous reports in the literature we searched using PCR the MMTV-like DNA env sequence in the breast cancer tissue and normal breast tissue obtained from the same patients.
Results
None of the examined samples was positive for MMTV-like target sequences on PCR.
Conclusions
We could not prove that MMTV plays a role in the etiology of breast cancer in our patient group. This finding is similar to those from publications of other geographically related research groups.
