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Scrutinizing the evidence for breast
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Surgery FAQ Articles

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trauma to your  
breast in order to
forestall possible
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    Articles supporting issues mentioned on Surgery FAQ page

    Timing Surgery with Post Ovulatory Phase:

    Int J Clin Pract. 2002 Apr;56(3):188-90
    Timing of surgery for breast cancer.
    Fentiman IS.
    Hedley Atkins Breast Unit, Guy's Hospital, London, UK.

    Several studies have now shown that premenopausal women with early breast cancer have a
    significantly better prognosis if their tumours are excised during the luteal phase of the cycle. The 10-
    year survival for node positive cases undergoing follicular phase surgery was 33% compared with
    78% in those having surgery at other times of the menstrual cycle. Further work has shown that
    there is an improved survival in those with plasma progesterone levels >4 ng/ml(-1), associated with
    the luteal phase. Luteal phase surgery is also associated with a decreased risk of vascular invasion,
    implying that the tumour is more cohesive at that time. Similarly, in the heaviest quartile of
    postmenopausal patients, with the highest endogenous oestrogen levels, there was vascular invasion
    around tumours in 45% compared with only 11% of the lightest quartile. Changing the hormonal
    milieu at the time of surgery for breast cancer may have the ability to improve the prognosis for some
    patients with early breast cancer.


    2:  Lemon HM, Rodriguez-Sierra JF.  
    Timing of breast cancer surgery during the luteal menstrual phase may improve prognosis.
    Nebr Med J. 1996 Mar;81(3):73-8. Corrected and republished in: Nebr Med J. 1996 Apr;81(4):110-5.
    PMID: 8907825
    3:  Lemon HM, Rodriguez-Sierra JF.
    Timing of breast cancer surgery during the luteal menstrual phase may improve prognosis.
    Nebr Med J. 1996 Apr;81(4):110-5. PMID: 8628449
    4:  Pujol P, Daures JP, Brouillet JP, Chang S, Rouanet P, Bringer J, Grenier J, Maudelonde T.
    A prospective prognostic study of the hormonal milieu at the time of surgery in premenopausal breast
    carcinoma. Cancer. 2001 May 15;91(10):1854-61.
    PMID: 11346866
    5:  Cooper LS, Gillett CE, Patel NK, Barnes DM, Fentiman IS.  
    Survival of premenopausal breast carcinoma patients in relation to menstrual cycle timing of surgery
    and estrogen receptor/progesterone receptor status of the primary tumor. Cancer. 1999 Nov 15;86
    (10):2053-8. PMID: 10570431
    6:  Saad Z, Bramwell V, Duff J, Girotti M, Jory T, Heathcote G, Turnbull I, Garcia B, Stitt L.
    Timing of surgery in relation to the menstrual cycle in premenopausal women with operable breast
    cancer. Br J Surg. 1994 Feb;81(2):217-20. PMID: 8156340
    7:  Badwe RA, Bettelheim R, Millis RR, Gregory W, Richards MA, Fentiman IS.  
    Cyclical tumour variations in premenopausal women with early breast cancer. Eur J Cancer. 1995
    Dec;31A(13-14):2181-4. PMID: 8652239
    8:  Badwe RA, Wang DY, Gregory WM, Fentiman IS, Chaudary MA, Smith P, Richards MA, Rubens
    RD. Serum progesterone at the time of surgery and survival in women with premenopausal operable
    breast cancer. Eur J Cancer. 1994;30A(4):445-8. PMID: 8018400


    Cancer Res. 2002 Aug 1;62(15):4491-8. Related Articles, Links  

    Morphine stimulates angiogenesis by activating proangiogenic and survival-promoting signaling and
    promotes breast tumor growth.

    Gupta K, Kshirsagar S, Chang L, Schwartz R, Law PY, Yee D, Hebbel RP.

    Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota 55455,

    Morphine is used to treat pain in several medical conditions including cancer. Here we show that
    morphine, in a concentration typical of that observed in patients' blood, stimulates human
    microvascular endothelial cell proliferation and angiogenesis in vitro and in vivo. It does so by
    activating mitogen-activated protein kinase/extracellular signal-regulated kinase phosphorylation via
    Gi/Go-coupled G protein receptors and nitric oxide in these microvascular endothelial cells. Other
    contributing effects of morphine include activation of the survival signal PKB/Akt, inhibition of
    apoptosis, and promotion of cell cycle progression by increasing cyclin D1. Consistent with these
    effects, morphine in clinically relevant doses promotes tumor neovascularization in a human breast
    tumor xenograft model in mice leading to increased tumor progression. These results indicate that
    clinical use of morphine could potentially be harmful in patients with angiogenesis-dependent


    The Breast Journal
    Volume 11 Issue 2 Page 100  - March 2005

    Total Mastectomy Under Local Anesthesia: The Tumescent Technique
    Grant W. Carlson, MD

    The management of breast cancer in elderly women is controversial. Breast cancer in this age group
    tends to be biologically less aggressive and is highly responsive to hormonal intervention. The risk of
    dying of other causes often exceeds the risk of cancer recurrence. For these reasons, older patients
    tend to be treated less aggressively. One large study of elderly women with breast cancer found that
    half of the patients were undertreated. Four patients (mean age 72 years, range 6195 years)
    underwent a unilateral total mastectomy for cancer under local anesthesia using the tumescent
    technique of infiltrating dilute lidocaine with epinephrine (25 ml of 1% lidocaine [250 mg] and 1 ml
    of 1:1000 epinephrine [1 mg] to 1 L of Ringers lactate) via an infusion pump. Three of the patients
    had estrogen receptor (ER)-negative tumors and one patient had tumor progression despite switching
    from tamoxifen to anastrozole. All four patients were class IV as defined by the American Society of
    Anesthesiology (ASA). There was no morbidity related to the surgery in the form of hematoma, wound
    infection, or skin flap necrosis. The patients were discharged 14 days after surgery. The anesthesia
    was adequate in all four cases and there was no deviation from the described technique. The mean
    operative time was 35 minutes (range 2446 minutes). The tumescent technique is a safe, effective
    method for performing a total mastectomy in patients who would not be considered candidates for
    general anesthesia.


    Plast Reconstr Surg. 2003 Aug;112(2):467-76.      

    Infectious complications following breast reconstruction with expanders and implants.

    Nahabedian MY, Tsangaris T, Momen B, Manson PN.

    Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.

    The incidence of infection following breast reconstruction with expanders and implants ranges from
    1 to 24 percent. Numerous factors associated with infection have been described; however, a one-
    variable at time setting and multifactorial analysis have not been performed. The purpose of this
    study was to analyze a set of factors that may predispose women to infection of the expander or
    implant. Between 1997 and 2000, a total of 168 implant reconstructions were performed in 130
    women at a single institution. The mean age for all women was 48.2 years (range, 25 to 77 years).
    The factors that were analyzed included axillary lymph node dissection, chemotherapy, radiation
    therapy, tumor stage, timing of implant insertion, number of sides (unilateral versus bilateral),
    tobacco use, and presence or absence of diabetes mellitus. Statistical analysis was performed with
    stepwise logistic regression. Mean time to follow-up for all patients was 29 months (range, 12 to 47
    months). Infectious complications occurred in 10 women (7.7 percent) and in 10 expanders or
    implants (5.9 percent). Infected implants were removed an average of 116 days following insertion
    (range, 14 to 333 days). Cultured bacteria included Staphylococcus aureus and Serratia marcescens.
    A significant association (p < 0.04) was detected between implant infection and radiation therapy.
    The chance for implant infection was 4.88 times greater for implants that were exposed to radiation
    therapy compared with those that were not. In addition, there was suggestive (p < 0.09) evidence that
    the chance of implant infection following lymph node dissection was 6.29 times higher than when no
    lymph nodes were removed. No significant association between implant infection and age, diabetes,
    tobacco use, tumor stage, timing of implant insertion, or chemotherapy was found.

    Breast implants following mastectomy in women with early-stage breast cancer: prevalence and
    impact on survival

    Gem M Le1 , Cynthia D O'Malley1 , Sally L Glaser1 , Charles F Lynch2 , Janet L Stanford3 , Theresa
    HM Keegan1  and Dee W West1
    1Northern California Cancer Center, Fremont, California, USA
    2Iowa Cancer Registry, University of Iowa, Iowa City, Iowa, USA
    3Fred Hutchison Cancer Research Center, Division of Public Health Sciences, Seattle, Washington,

    Breast Cancer Res 2005, 7:R184-R193   

    Few studies have examined the effect of breast implants after mastectomy on long-term survival in
    breast cancer patients, despite growing public health concern over potential long-term adverse
    health effects.
    We analyzed data from the Surveillance, Epidemiology and End Results Breast Implant Surveillance
    Study conducted in San Francisco–Oakland, in Seattle–Puget Sound, and in Iowa. This population-
    based, retrospective cohort included women younger than 65 years when diagnosed with early or
    unstaged first primary breast cancer between 1983 and 1989, treated with mastectomy. The women
    were followed for a median of 12.4 years (n = 4968). Breast implant usage was validated by medical
    record review. Cox proportional hazards models were used to estimate hazard rate ratios for survival
    time until death due to breast cancer or other causes for women with and without breast implants,
    adjusted for relevant patient and tumor characteristics.
    Twenty percent of cases received postmastectomy breast implants, with silicone gel-filled implants
    comprising the most common type. Patients with implants were younger and more likely to have in
    situ disease than patients not receiving implants. Risks of breast cancer mortality (hazard ratio, 0.54;
    95% confidence interval, 0.43–0.67) and nonbreast cancer mortality (hazard ratio, 0.59; 95%
    confidence interval, 0.41–0.85) were lower in patients with implants than in those patients without
    implants, following adjustment for age and year of diagnosis, race/ethnicity, stage, tumor grade,
    histology, and radiation therapy. Implant type did not appear to influence long-term survival.
    In a large, population-representative sample, breast implants following mastectomy do not appear to
    confer any survival disadvantage following early-stage breast cancer in women younger than 65 years

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    Web page updated January 18,  2010.
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