• Archives of Plastic Surgery
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• 제51권1호
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• pp.62-66
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• 2024

Gestational gigantomastia is characterized by the rapid growth of breasts during pregnancy. The treatment method of gestational gigantomastia is unclear; if the medical treatment is ineffective, surgery is considered. However, sufficient research on which method is best to perform breast reconstruction for the gestational gigantomastia patient has not yet been conducted. Our patient was young and had aesthetic needs; thus, we did not recommend modified radical mastectomy. However, it was difficult for the patient to consider active reconstruction using an implant or autologous tissue because of the expected complications and economic problems. The patient had a thin body shape and very large breasts compared with the trunk. Therefore, breast volume was not significantly required after reconstruction. Additionally, we expected that a considerable portion of skin would remain after mastectomy as a tubular-shaped breast. It was expected that the Goldilocks technique would be sufficient to meet the patient's volume needs. Therefore, we proceeded with total mastectomy and reconstruction using the Goldilocks procedure. No complications were recorded after the operation; most of the patient's discomfort was resolved, and the shape and size of the breasts were satisfactory.

• Journal of Chest Surgery
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• 제43권4호
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• pp.421-423
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• 2010

완전 방실 차단으로 우측 쇄골하 정맥을 통해 영구심박동기를 삽입한 52세 여자환자가 영구심박동기 발생장치(generator) 삽입 부위의 반복적인 감염을 주소로 내원하였다. 환자는 24년 전 유방암으로 좌측 변형근치유방절제술(Modified radical mastectomy, MRM)과 방사선 치료로 주변 조직의 심한 변화가 있었다. 이로 인해 정중 흉골 절개는 불가능할 것으로 판단하여 우측 개흉 술을 계획하였고, 개흉 후 체외순환 없이 우심방을 절개한 후 심박동기 와이어를 제거하고 새로운 심외막 와이어로 영구심박동기를 삽입하였다.

• 한국의학물리학회지:의학물리
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• 제27권4호
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• pp.196-202
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• 2016

We aim to develop the breast bolus by using a 3D printer to minimize the air-gap, and compare it to commercial bolus used for patients undergoing reconstruction in breast cancer. The bolus-shaped region of interests (ROIs) were contoured at the surface of the intensity-modulated radiation therapy (IMRT) thorax phantom with 5 mm thickness, after which the digital imaging and communications in mdicine (DICOM)-RT structure file was acquired. The intensity-modulated radiation therapy (Tomo-IMRT) and direct mode (Tomo-Direct) using the Tomotherapy were established. The 13 point doses were measured by optically stimulated luminescence (OSLD) dosimetry. The measurement data was analyzed to quantitatively evaluate the applicability of 3D bolus. The percentage change of mean measured dose between the commercial bolus and 3D-bolus was 2.3% and 0.7% for the Tomo-direct and Tomo-IMRT, respectively. For air-gap, range of the commercial bolus was from 0.8 cm to 1.5 cm at the periphery of the right breast. In contrast, the 3D-bolus have occurred the air-gap (i.e., 0 cm). The 3D-bolus for radiation therapy reduces the air-gap on irregular body surface that believed to help in accurate and precise radiation therapy due to better property of adhesion.

• Asian Pacific Journal of Cancer Prevention
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• 제16권11호
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• pp.4577-4581
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• 2015

Background: To explore the hospitalizations of breast cancer patients undergoing mastectomy, and to provide a basis for management, clinical prevention and treatment. Materials and Methods: We conducted an investigation by means of the retrospective survey and the medical records retrieval system, and made out the data of patients suffered from breast cancer in a hospital in Guangzhou from 2004 to 2013, including age, medical payment methods, pathological type, treatment, treatment results, complications, hospitalization days, cost and so on. Results: The average age of the inpatients was 50.14 years old. The main histologic types were infiltrating duct carcinoma (88.06%). The main surgery was modified radical mastectomy (80.41%). The cure rate was 90.80% during the 10 years. The main medical payment method was self-paying (57.28%). The average hospital stay was 13.51 days, and average hospitalization cost was RMB 23,083.66 yuan, proportion of drug fees up to 39.70%. Postoperative complication rate was 0.79%. The self-paying group was with the highest proportion of drug fees (P<0.05), while the free medical service group was with the longest hospitalization days (P<0.05). Conclusions: The payment methods significantly affected the proportion of drug fees and hospitalization days. The therapeutic effect was satisfactory with less complications and reasonable proportion of drug fees in our hospital.

• Asian Pacific Journal of Cancer Prevention
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• 제15권4호
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• pp.1621-1626
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• 2014

Background: Breast cancer is the most common malignant tumor in females worldwide. Many differences exist in clinico-pathological characteristics of breast cancer patients between China and Western countries. This study aimed to analyze clinico-pathological characteristics of breast cancer from central China. Methods: Clinico-pathological information on breast cancer from three hospitals in central China was collected and analyzed. Results: From 1994 to 2012, 2,525 patients with a median age 50 years were included in this study. The 45-49-year age group and invasive ductal carcinoma not otherwise specified accounted for the highest proportions (19.1%, 480/2,525 and 81.0%, 1,982/2,446). Stages 0-I, II and III accounted for 28.0% (682/2,441), 48.4% (1,180/2,441), and 23.7% (578/2,441), respectively. Distribution of N stage showed that N0 accounted for 53.2% (1,344/2,525), and proportion of N0 rose from 51.1% (157/307) in 30-39-year age group to 64.3% (110/171) in ${\geq}$ 70-year age group, with an average increase of 2.1% in each age group. Modified radical mastectomy, radical mastectomy, breast-conserving surgery and simple mastectomy were performed for 71.8% (1,812/2,525), 18.0% (454/2,525), 5.2% (131/2,525) and 2.6% (66/2,525), respectively. Proportions of breast-conserving surgery in age ${\leq}$ 44-year group (68/132, 51.5%) and simple mastectomy in age ${\geq}$ 60-year group (57/89, 64.0%) were higher than in the other age groups. Breast cancers positive for estrogen receptor accounted for 53.0% (1,107/ 2,112). The comparisons among this study and other reports showed higher proportion of younger patients, lower proportion of breast-conserving surgery and positive estrogen receptor patients in China than western countries. Conclusions: Clinico-pathological characteristics in this study demonstrated clear differences between the center of China than Western countries. Additional classification systems should be developed to guide grading of early breast cancer more accurately, especially for N0 patients. Invasive ductal carcinoma is a focus for intensive research.

• Archives of Plastic Surgery
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• 제38권5호
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• pp.627-635
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• 2011

Purpose: Advanced breast cancer traditionally has been perceived as a contraindication to immediate breast reconstruction, because of concerns regarding adjuvant treatment delays and the cosmetic effects of radiotherapy to breast reconstruction, so delayed reconstruction is usually preferred in advanced breast cancer patients undergoing mastectomy. However, with the improved outcome using multimodality therapy, consisting of perioperative chemotherapy and radiotherapy, immediate breast reconstruction is now being performed as surgical option for selected advanced breast cancer patients. Additionally, advanced breast cancer patients may be needed soft tissue coverage of an extensive skin and soft tussue defect after mastectomy. Current authors have experienced several types of immediate breast and chest wall reconstruction for advanced breast cancer. Methods: From December of 2007 to June of 2009, 14 women performed for immediate breast and chest wall reconstruction for advanced breast cancer. They had been treated with neoadjuvant chemotherapy or chemoradiotherapy followed by modified radical mastectomy or radical mastectomy. Four different techniques were used immediate breast and chest wall reconstruction, which are pedicled TRAM flap (4 cases), extended LD flap with STSG (3 cases), thoracoabdominal flap (4 cases) and thoracoepigastric flap (3 cases). Results: The mean age was 53 years and mean follow up period was 9 months. Patients' oncologic status ranged stage IIIa to stage IV. Two patients had major complications: partial flap necrosis of TRAM flap and one distal necrosis of thoracoabdominal flap. Three patients with stage IV disease died from metastases. Conclusion: The result of this study suggests that immediate breast and chest wall reconstruction can be considered as surgical option for advanced breast cancer. But we need long term follow up and large prospective studies for recurrence and survival.

• Asian Pacific Journal of Cancer Prevention
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• 제16권4호
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• pp.1559-1563
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• 2015

Background: Male breast cancer accounts for less than 1% of all cancers found in men. It usually presents at a later age and stage as compared to female breast cancer. Treatment strategies are extrapolated from the management of female breast cancer. Our study here looked at 18 patients diagnosed with and treated for male breast cancer at The Aga Khan University Hospital in Pakistan. We compared our findings with the existing data from Asian and Western countries. Materials and Methods: A retrospective study was conducted looking at patients with male breast cancer between January 1986 and December 2009. Patient and disease characteristics were analyzed and 5 year overall survival was calculated using Microsoft Excel and SPSS. Results: The average age at diagnosis was 52 years (38-67 years). Twelve (66.7%) patients had axillary lymphadenopathy. Stage II disease was the most common stage at presentation (9 patients, 50%). Infiltrating ductal carcinoma was seen in 16 patients (88.8%). Seven lesions were positive for both estrogen and progesterone receptors. Sixteen patients had surgery in the form of either modified radical mastectomy or radical mastectomy. Radiation was used in 7 patients in an adjuvant setting. The five year overall survival for stage I, II, III and IV disease was 100% vs 78% vs 50% vs 0%( p<0.05). Five year overall survival was 61%. None of the other prognostic factors were statistically significant. Median follow up was 15 months (3-202 months). Conclusions: Male breast cancer may be on a slow rise but is still an uncommon disease. Tumor stage and lymph node status are important prognostic markers. Public awareness and screening may help in detecting the disease at an earlier stage. Prospective trials are needed to improve the management of this disease.

• 대한방사선치료학회지
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• 제18권2호
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• pp.113-117
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• 2006

목 적: 유방암으로 진단 받고 변형 근치적 유방절제술(Modified Radical Mastectomy)후 흉벽에 방사선치료를 시행 받고 있는 환자를 대상으로 볼루스(Bolus) 적용에 따른 흉벽(흉터, 수술봉합부위)의 피부선량 변화를 분석 하여 적절한 볼루스 적용횟수를 얻고자 한다. 대상 및 방법: 유방암으로 진단받고 변형 근치적 유방절제술 후 방사선치료를 받고 있는 4명의 여성 환자(우측 2명 좌측 2명)를 대상으로 하였다. 흉벽 방사선조사는 4 MV광자선으로 매일 2 Gy씩 주 5회, 접선조사로 치료하였고, 총 조사선량은 50 Gy였는데 동측 내유방림프절은 포함하지 않았다. 치료 계획을 위한 전산화단층촬영에서 흉터 부위의 위치 확인을 위해 방사선비투과성물질인 Angio-catheter를 흉터 위에 위치시켰다. 획득한 영상을 이용하여 치료계획을 세웠고, 전산화치료계획장치에서 흉터부위 좌우 2 cm 영역을 포함하는 두께 0.5 cm, 넓이 6 cm의 볼루스를 적용시켰다. 계획한 내용을 바탕으로 볼루스를 적용하지 않은 경우와 볼루스를 적용한 경우에 대하여 선량분포 변화와 피부선량을 비교 분석하였고 열형광선량계 (Thermoluminescent dosimetry: TLD, Harshaw, USA)를 이용하여 관심 부위(흉터 부위 3 지점, 흉터 좌측 1 cm 3지점, 흉터 우측 1 cm 3지점) 9개 지점의 선량을 실측하였다. 결 과: 전산화치료계획장치에서 얻어진 선량분포를 통해 분석한 결과, 볼루스를 적용하지 않은 경우와 볼루스를 적용한 경우 모두에서 흉벽 부위에 $95{\sim}100%$ 선량이 감싸고 있었으나, 흉터 주위 피부선량에 있어서는 볼루스를 적용하지 않은 경우($50{\sim}75%$)와 볼루스를 적용한 경우($100{\sim}105%$)가 큰 차이를 보였다. 선량분포를 통한 관심지점의 피부선량은 볼루스를 적용하지 않은 경우에 비해 볼루스를 적용한 경우에서 환자 1번 23.3%, 환자 2번 35.6%, 환자 3번 34.9%, 환자 4번 41.7%의 선량 증가를 보였다. 볼루스를 적용하지 않은 경우와 볼루스를 적용한 경우의 TLD 평균 측정치는 환자 1번 161.1 cGy 209.3 cGy 환자 2번 150.2 cGy, 200 cGy, 환자 3번 150.5 cGy, 211.4 cGy, 환자 4번 155.5 cGy 198.6 cGy의 결과를 얻었다. 결 론: 본 원에서 변형 근치적 유방절제술 후 흉벽 방사선치료의 가장 적절한 볼루스 적용 횟수는 전 치료횟수의 $50{\sim}60%$ 적용이다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권9호
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• pp.4347-4351
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• 2012

Background: Breast cancer is the most common cancer of women and the principal cause of death in middle aged women. The objective of this study was to describe the trend of breast cancer and its management in Aden and adjacent south-eastern governorates of Yemen during the last 20 years. Patients and Methods: This is a retrospective analysis of previous studies on patients with breast cancer in Aden and adjacent south-eastern governorates, Yemen (January 1989 through December 2007). The studied variables were: sex, age, time and type of presentation, disease stage, pathological types and the performed surgical treatment. The sources of information were the treatment registry of Aden health office, archives of Al-Gamhouria teaching hospital; major referral and other public and private hospitals in Aden and Aden Cancer Registry. Results: The total number of patients was 476, 99% being females. The age range was 19-88 years. The most affected age was 30-50 years (60.5%), 95% presenting after one month of having breast symptoms. Forty-five percent presented with signs of advanced local disease, while 59.2% had palpable axillary lymph nodes on presentation. Early breast cancer (stages I-II) occurred in 47%, and late breast cancer (stages III-IV) in 51.5%. Invasive ductal carcinoma was the commonest pathology (89.3%). The main surgical treatment was mastectomy (modified radical mastectomy (50%). Conclusion: Breast cancer is predominantly a disease of young with late presentation and advanced disease. Improving health awareness and earlier diagnosis of the disease by health education, encouraging breast self-examination, and providing the mammography equipment and mammary clinics in hospitals are recommended. Establishment of oncology and radiotherapy centers in Aden is a necessity.

• Asian Pacific Journal of Cancer Prevention
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• 제15권7호
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• pp.3163-3167
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• 2014

Background: Breast-conserving surgery (BCS) plus radiotherapy is equivalent to modified radical mastectomy (MRM) in terms of outcome. However there is wide variation in mastectomy rates dependent both on tumour and patient characteristics. Objective: This study aimed to assess the determinants of surgery choice in Asian patients with early breast cancer in a middle-income country. Materials and Methods: 184 patients with early breast cancer treated between Jan 2008 and Dec 2010 were recruited to complete a questionnaire. Chi-square test was used to analyze the association between surgery choice and demographic and tumour factors, surgeon recommendation, family member and partner opinions, fear of recurrence, avoidance of second surgery, fear of disfigurement, interference with sex life, fear of radiation and loss of femininity. Results: 85 (46%) had BCS while 99 (54%) had mastectomy. Age >60, Chinese ethnicity, lower education level, and larger tumour size were significantly associated with mastectomy. Surgeon recommendation was important in surgery choice. Although both groups did not place much importance on interference with sex life, 14.1% of the BCS group felt it was very important compared to 5.1% in the mastectomy group and this was statistically significant. There was no statistical difference between the two groups in terms of the other factors. When analyzed by ethnicity, significantly more Malay and Indian women considered partner and family member opinions very important and were more concerned about loss of femininity compared to Chinese women. There were no statistical differences between the three ethnic groups in terms of the other factors. Conclusions: When counseling on surgical options, the surgeon has to take into account the ethnicity, social background and education level, age and reliance on partner and family members. Decision-making is usually a collective effort rather than just between the patient and surgeon, and involving the whole family into the process early is important.