Skin Sparing Mastectomy
Ahmed Abd Elhady Abd Elmoez;
Abstract
Breast cancer is a malignant epithelial tumor of the breast. Breast cancer is the commonest female cancer all over the world. In Egypt breast cancer represents 34% of female cancer and breast cancer causes 18% of deaths caused by cancer.
Treatment of early breast cancer up to stage II is mainly surgical radical mastectomy. Nowadays there are 2 alternatives for surgical treatment of early breast cancer:
Modified radical mastectomy with axillary lymph node dissection and preservation of pectoralis major muscle with or without breast reconstruction.
Conservative surgery which is recently the treatment of choice for malignant tumors at least up to stage II in which the surgeon removes the tumor with a part from the breast and axillary lymph node dissection which was most recently replaced by sentinel lymph node localization. Conservative surgery includes wide local excision, segmental excision or quadrantectomy, both wide local excision and segmentectomy would normally be followed by radiotherapy.
Randomized controlled clinical trials have shown that in tumors up to 4 cm. in size treatment by mastectomy or breast conservation results in no significant difference in overall survival, patients undergoing conservative surgery have greater freedom of dress and better body image than women who had mastectomy, local recurrence rates are similar with a non significant relative reduction in favor of mastectomy.
Radio-therapy given post-operatively after weeks to allow wound healing reduces the risk of isolated local recurrence by approximately
66%, thus radio-therapy is of potential benefit to all patients undergoing breast conservative surgery. Radio-therapy is given by 2 ways:
• External radiotherapy by electron beam therapy.
• Recently branchy therapy by either iodine or iridium which are put as interstitial implant, the implant is placed pre-operatively {conservative surgery} at time of excision or post operatively within 8 weeks of surgery.
Adjuvant systemic therapy includes endocrine therapy and cytotoxic chemotherapy.
A- Endocrine therapy:
Includes Tamoxifen which is an antiestrogen, blocking estrogen receptor alpha and is the most widely used adjuvant systemic therapy for postmenopausal women. Ovarian ablation is of benefit to premenopausal women.
B- Cytotoxic chemotherapy:
The standard regimen was a combined of cyclophosphamide, methotrexate and 5-fluorouracil, recently 5- fluorouracil adriamycin and cyclophosphamide are used. Anthracyclines which are anti-tumor anti-biotics, also taxanes which prevent mitotic division of cells at G and M phases are currently in use with the introduction of Vinorelbine as an active agent in metastatic breast cancer.
Neoadjuvant chemotherapy involves giving chemotherapy before surgery to patients with non metastatic primary breast cancer; it is in value in reducing size of tumor and investigating the response of patient to chemotherapy post-operatively.
Treatment of early breast cancer up to stage II is mainly surgical radical mastectomy. Nowadays there are 2 alternatives for surgical treatment of early breast cancer:
Modified radical mastectomy with axillary lymph node dissection and preservation of pectoralis major muscle with or without breast reconstruction.
Conservative surgery which is recently the treatment of choice for malignant tumors at least up to stage II in which the surgeon removes the tumor with a part from the breast and axillary lymph node dissection which was most recently replaced by sentinel lymph node localization. Conservative surgery includes wide local excision, segmental excision or quadrantectomy, both wide local excision and segmentectomy would normally be followed by radiotherapy.
Randomized controlled clinical trials have shown that in tumors up to 4 cm. in size treatment by mastectomy or breast conservation results in no significant difference in overall survival, patients undergoing conservative surgery have greater freedom of dress and better body image than women who had mastectomy, local recurrence rates are similar with a non significant relative reduction in favor of mastectomy.
Radio-therapy given post-operatively after weeks to allow wound healing reduces the risk of isolated local recurrence by approximately
66%, thus radio-therapy is of potential benefit to all patients undergoing breast conservative surgery. Radio-therapy is given by 2 ways:
• External radiotherapy by electron beam therapy.
• Recently branchy therapy by either iodine or iridium which are put as interstitial implant, the implant is placed pre-operatively {conservative surgery} at time of excision or post operatively within 8 weeks of surgery.
Adjuvant systemic therapy includes endocrine therapy and cytotoxic chemotherapy.
A- Endocrine therapy:
Includes Tamoxifen which is an antiestrogen, blocking estrogen receptor alpha and is the most widely used adjuvant systemic therapy for postmenopausal women. Ovarian ablation is of benefit to premenopausal women.
B- Cytotoxic chemotherapy:
The standard regimen was a combined of cyclophosphamide, methotrexate and 5-fluorouracil, recently 5- fluorouracil adriamycin and cyclophosphamide are used. Anthracyclines which are anti-tumor anti-biotics, also taxanes which prevent mitotic division of cells at G and M phases are currently in use with the introduction of Vinorelbine as an active agent in metastatic breast cancer.
Neoadjuvant chemotherapy involves giving chemotherapy before surgery to patients with non metastatic primary breast cancer; it is in value in reducing size of tumor and investigating the response of patient to chemotherapy post-operatively.
Other data
| Title | Skin Sparing Mastectomy | Other Titles | استئصال الثدى مع الحفاظ على الجلد | Authors | Ahmed Abd Elhady Abd Elmoez | Issue Date | 2014 |
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