유두-유륜 보존 유방절제술 후 횡복직근 피판술을 이용한 즉시 유방재건술

서현석,이택종,엄진섭,안세현,손병호 대한성형외과학회 2006 Archives of Plastic Surgery Vol.33 No.5

Purpose: Skin-sparing mastectomy(SSM) with immediate breast reconstruction is becoming a proved option for early-stage breast cancer patients. Recently, skin-sparing mastectomy with preserving the nipple- areolar complex is becoming popular procedure.Methods: During a 13-month period, from April 2004 to January 2005, 101 cases of immediate breast reconstructions with pedicled TRAM flap were performed after 40 cases of nipple-areolar sparing mastectomies, 57 cases of skin-sparing mastectomies and 4 cases of modified radical mastectomies.Results: During the 11 months follow up period, necrosis of mastectomy skin flap occurred in 17.5% (n=10) after skin-sparing mastectomy and necrosis of mastectomy skin flap and nipple-areolar necrosis occurred in 30%(n=12) after nipple-areolar sparing mastectomy. These complications were healed after simple dressing without any surgical procedure.Conclusion: Nipple-areolar sparing mastectomy and immediate breast reconstruction with TRAM flap is good option for early breast cancer patients and some modifications are needed to reduce skin necrosis.

Breast Conservation Therapy Versus Mastectomy - Preliminary Results of Pattern of Failure and Survival Rate in Early Breast Cancer

김연실(Yeon-Sil Kim),윤세철(Sei-Chul Yoon),정수미(Su-Mi Chung),유미령(Mi-Ryeong Ryu),정상설(Sang-Sul Jung),최일봉(Ihl-Bohng Choi) 대한방사선종양학회 2004 Radiation Oncology Journal Vol.22 No.2

목 적: 조기 유방암에서 유방보존치료(유방보존수술+방사선치료) 혹은 유방전절제술로 치료했던 환자의 초 기 치료성적과 실패양상을 비교하고자 후향적으로 분석하였다. 대상 및 방법: 1989년 3월부터 1996년 8월까지 강남성모병원에서 AJCC병기 I, II로 치료를 받았던 유방암 환자를 대상으로 하였다. 88명은 유방전절제술을 시행하였고 85명은 유방보존술 후 방사선치료를 시행하였다. 방사선치료는 50 Gy 전 유방조사 후 원발부위에 10∼15 Gy 추가 조사하였다. 유방보존치료 환자의 34.1%, 유방전절제 환자의 45.5%에서 항암화학요법이 병용되었다. 양 치료군의 5년생존율과 5년무병생존율, 실패양상을 비교하였으며 치료실패와 연관된 위험인자를 Log-rank test를 이용하여 분석하였다. 중앙 추적기간은 63개월이었다. 결 과: 양 치료군 간에 5년생존율, 5년무병생존율의 유의한 차이(p>0.05)는 없었으며 국소재발 및 원격전이의 치료실패양상에도 차이가 없었다. 추적기간 중, 유방전절제군에서 11명(12.5%) 유방보존치료군에서 10명 (11.8%) 재발하였다. 초기 실패양상은 국소재발이 각각 6명, 5명이었고 원격전이가 각각 5명, 4명으로 차이가 없었다. 국소재발 단독의 경우 양 치료군에서 구제치료 후 대부분의 환자가 무병생존 (5/6 유방전절제술, 3/5 유방보존치료)하였다. 그러나 원격전이 환자의 경우 양 치료군 모두에서 방사선-항암화학요법의 구제치료에도 불구하고 대부분의 환자가 진행 혹은 사망하였으며 유방보존치료군의 1명의 환자만이 원격전이 후 구제치료에 성공하여 무병생존하였다. 양 치료군 간에 반대편유방암 발생률 및 다른 장기의 2차 원발암 발생률의 차이는 없었고 유방암으로 인한 사망률도 차이가 없었다. Log-rank 단변량분석에서 치료 실패와 관련된유의한 위험인자는 양 군 모두에서 N 병기, 액와 림프절 전이 숫자였으며 유방보존치료군에서는 수술절연침범유무가, 유방전절제군에서는 high nuclear grade가 치료실패와 관련된 위험인자였다(p<0.05). 결 론: 초기 분석결과 AJCC 병기 I, II 조기유방암에서 유방보존치료와 유방전절제술은 생존율뿐 아니라 치료 실패양상에도 차이가 없었으며 향후 이와 같은 결과를 확인하기 위한 장기간의 추적연구가 필요하다. Purpose: This retrospective study was conducted to compare early preliminary results of breast conservation therapy (BCT) with mastectomy in early breast cancer. Materials and Methods: We evaluated 171 women with AJCC stage I and II breast cancer who had been treated at Kangnam St. Mary’s Hospital from March 1989 to August 1996. Eighty-eight patients underwent mastectomy and 85 patients did conservative surgery with breast irradiation. In the BCT group, all patients received whole breast irradiation to a total dose of 45∼50 Gy/5∼6 wks, followed by a boost to the original tumor site at least 60 Gy. Chemotherapy was administered to 29 (34.1%) patients in BCT and 40 (45.5%) in mastectomy, with various sequencing of surgery and/or radiation. We compared survival rate, patterns of failure in each treatment group and the prognostic factors that had a significant effect on treatment failure. The median follow-up time was 63 months (19∼111 months). Log rank test was used to estimate the prognostic factors for treatment failure. Results: Overall survival, disease free survival, locoregional recurrence and distant metastasis rates were not significantly different between the two treatment groups. During the follow-up period, 11 patients (12.5%) in the mastectomy group and 10 patients (11.8%) in the BCT group were failed. Six local recurrences occurred after mastectomy and 5 after BCT. Five patients failed at distant site in mastectomy and 4 in BCT. Of the local recurrence cases, five of 6 mastectomy patients and 3 of 5 BCT patients were alive with no evidence of disease after salvage surgery and/or chemoirradiation. Our results indicated that the major influence on survival was distant metastasis. Unfortunately, control of distant metastasisis was not frequently achieved. Even with salvage systemic therapy or radiotherapy, most of distant metastasis patients died or had uncontrolled disease in both treatment groups: only one of 4 BCT patients and none of mastectomy patients were alive without disease. There was no apparent difference in the incidence rate of contralateral breast cancer and non-breast 2nd primary tumor between the two treatment groups. Univariate Log-rank test identified the N stage and the involved axillary LN number as distinct prognostic factors that were highly predictive of treatment failure in both treatment groups. Additionally, marginal status in BCT and histologic nuclear grade in the mastectomy group were risk factors for treatment failure (p<0.05). Conclusion: Although further careful follow-up is necessary to confirm the trends evident in this series, it would appear that patterns of failure and survival rate following conservative surgery and radiotherapy in early breast cancer are similar to those following mastectomy. The great majority of patients with local recurrence had an exellent salvage rate in both treatment groups. Therefore, these preliminary short term results support BCT as an equally effective management for early breast cancer as an alternative to mastectomy.

Perceptions of Prophylactic Mastectomy in Korea

윤한영,심정수,이종원 대한성형외과학회 2016 Archives of Plastic Surgery Vol.43 No.1

Background Increasingly, prophylactic mastectomy has been evaluated as a treatment of breast cancer. Hereditary breast cancer now accounts for approximately 5%–10% of all cases of breast cancer, meaning that the widespread implementation of prophylactic mastectomy may significantly reduce the occurrence of breast cancer. However, prophylactic mastectomy is rarely performed in Korea. Therefore, in this study, we assessed Koreans’ attitudes toward and awareness of preventive mastectomy. Methods This was a prospective study of a cohort of patients attending outpatient clinics and their relatives. Data were collected using self-administered questionnaires assessing sex, age, educational level, knowledge of breast cancer, understanding of prophylactic mastectomy, attitudes toward prophylactic mastectomy, and reasons for choosing prophylactic mastectomy. Results Sixty-five patients were included. Most patients (36.9%) were between 40 and 49 years of age and 58.4% were college graduates. Only six respondents (9%) understood prophylactic mastectomy, and 17 respondents (27%) stated that they would agree to undergo prophylactic mastectomy if necessary. Reasons given for refusing prophylactic mastectomy included aesthetic concerns (38%), the perception that it would not cure the disease (26%), possible surgical complications (24%), and financial cost (6%). Conclusions In this study, most of the respondents showed a poor knowledge of prophylactic mastectomy. Ultimately, it will be necessary to establish medical guidelines for patients with a high risk of breast cancer, with the objective of providing accurate information and proper treatment at hospitals.

Perceptions of Prophylactic Mastectomy in Korea

Yoon, Han Young,Shim, Jeong Su,Lee, Jong Won Korean Society of Plastic and Reconstructive Surge 2016 Archives of Plastic Surgery Vol.43 No.1

Background Increasingly, prophylactic mastectomy has been evaluated as a treatment of breast cancer. Hereditary breast cancer now accounts for approximately 5%-10% of all cases of breast cancer, meaning that the widespread implementation of prophylactic mastectomy may significantly reduce the occurrence of breast cancer. However, prophylactic mastectomy is rarely performed in Korea. Therefore, in this study, we assessed Koreans' attitudes toward and awareness of preventive mastectomy. Methods This was a prospective study of a cohort of patients attending outpatient clinics and their relatives. Data were collected using self-administered questionnaires assessing sex, age, educational level, knowledge of breast cancer, understanding of prophylactic mastectomy, attitudes toward prophylactic mastectomy, and reasons for choosing prophylactic mastectomy. Results Sixty-five patients were included. Most patients (36.9%) were between 40 and 49 years of age and 58.4% were college graduates. Only six respondents (9%) understood prophylactic mastectomy, and 17 respondents (27%) stated that they would agree to undergo prophylactic mastectomy if necessary. Reasons given for refusing prophylactic mastectomy included aesthetic concerns (38%), the perception that it would not cure the disease (26%), possible surgical complications (24%), and financial cost (6%). Conclusions In this study, most of the respondents showed a poor knowledge of prophylactic mastectomy. Ultimately, it will be necessary to establish medical guidelines for patients with a high risk of breast cancer, with the objective of providing accurate information and proper treatment at hospitals.

유방암 절제술이 성생활에 미치는 영향

구경애,소희영 충남대학교 의과대학 지역사회의학연구소 1996 충남의대잡지 Vol.23 No.1

This research was conducted to varify the factors related to sexual life in women who had a mastectomy. For that purpose, women who has a mastectomy and general cancer surgery, and who had not experienced mastectomy were, compared sexual related factors to extended the understanding of sexual life in women who had mastectomy. This study was a descriptive survey study. There were 219 subjects in the study, and they were selected by a convenient sampling method. The tool for this study was Derogatis Sexual Function Inventory modified by Chang and Rosenburg's Self-esteem Inventory. Data collection was done between Nov, 1995 and Feb. 1996 using a mail and interview by researcher. Data was analyzed by SAS program using frequency, ANOVA, ANCOVA, Pearson correlation coefficients, and Regression. The results of this study are summarized as follows: 1. There was a statistically significant difference in sexual attitude (F=3.57, P< .05) and sexual behavior (F=9.91, P< .001) among 3 groups. 2. In women who had mastectomy, there was a statistically significant difference in sexual satisfaction (F=4.04, P< .05) according to monthly income, in sexual behavior (F=3.42, P< .05) according to age in body image (F=4.10, P< .05) and sexual satisfaction (F=4.74, P< .05) according to spousal educational level, in sexual behavior (F=3.00, P< .05) and sexual satisfaction (F=5.52 P< .001) according to number of children, in spousal support (t=-5.61, P< .05) and body image (t=-3.01 P< .05) according to spousal stress, and in sexual satisfaction (F=6.01, P< .01) according to postoperative lapse. 3. Sexual satisfaction has statistically very highly significant positive correlation with spousal support (r=.4633, P< .0001), body image (r=.3634, P< .001), self-esteem (r= .3750 p< .001), sexual attitude (r=.4195, p< .0001), and sexual behavior (r=.4317 p<.0001). 4. The factors influencing sexual satisfaction of women who had a mastectomy were spousal support, sexual attitude and sexual behavior, and these 3 factors explained 41.6% of the total variance. In conclusion, for the care of women who had a mastectomy, nurses have to work with the husbands of clients to help them and understand the importance of their support. Nurses also need to make sure that the subjects have an adequate knowledge of sexual life after mastectomy. Nursing intervention should focus on the subjen for comprehensive approach to the management of psychosexual problemsvia psychological counseling by nurse specialist through perioperative period.

여성에서 남성 성전환자의 유방크기에 따른 유방절제방법

양진일,박수성,이근철,김석권 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.1

Purpose: Mastectomy is one of the operative procedures of female to male transsexuals. It is aimed to excise all of breast tissues and to reconstruct male chest wall, areola, and nipple. Breast sizes are varied by developmental status and their hormonal therapy. There are several approaches for mastectomy. This study is aimed to suggest appropriate mastectomy methods according to breast size in the female to male transgenders. Methods: We retrospectively analysed 46 patients of female to male transgenders. Breast size was categorized by their inner wear size. In A cup size, mastectomy was done with periareolar approach. In C cup size, inframammary fold approach subcutaneous mastectomy was performed. In B cup size, periareolar approach was used for grade A or B ptosis patient, and inframammary fold approach was choosen for the patient with grade C ptosis. Results: Subcutaneous mastectomy was done through semicircular periareolar approach for 26 patients. There were 2 cases of major complications that should be corrected by hematoma evacuation. Circumareolar approach was used for 5 patients, and a case of nipple - areolar complex necrosis was observed. Two cases of another complications which were irregularity of breast and wound disruption could be corrected. Inframammary fold approach was selected for 15 patients. There was a case of wound disruption, so revision surgery whould be done. Four cases of breast irregularity was corrected spontaneously, and 2 cases of partial necrosis of nipple - areolar complex were corrected with secondary healing. Patient satisfaction score for periareolar, cicumareolar, and inframmammary fold approach were 4.5, 4.2 and 4.1, respectively. Some major and minor complications were observed, but satisfactory results could be secured. Conclusion: Semicircular periareolar incision looked adequate for A cup size patient, circumareolar incision was suitable for B cup size with grade A or B ptosis. In B cup size with grade C ptosis patient and C cup patients, inframammary fold incision looked suitable for optimal results.

Necrotic Complications in Nipple-Sparing Mastectomy Followed by Immediate Breast Reconstruction: Systematic Review with Pooled Analysis

Lee, Kyeong-Tae,Mun, Goo-Hyun The Korean Society for Microsurgery 2014 Archives of reconstructive microsurgery Vol.23 No.2

This study provides a systematic review of the literature on nipple-sparing mastectomy and necrotic complications in order to estimate the prevalence of necrotic complications and to investigate their significant predictors. A literature search was conducted using the MEDLINE and Ovid databases. A pooled analysis was performed for calculation of the prevalence of nipple-areolar complex (NAC) necrosis, mastectomy flap necrosis, and overall necrotic complications and to evaluate the relationships between necrotic complications and potential risk factors. A total of 44 papers were analyzed. The prevalence of overall necrotic complications was 13.7%, including 7.5% for NAC necrosis and 7.8% for mastectomy flap necrosis. Types of incisions showed significant association with the rates of NAC necrosis and mastectomy flap necrosis. Incisions involving the NAC showed a significantly higher rate of NAC necrosis than those not involving it. The prevalence of NAC necrosis was higher in the autologous tissue reconstruction group than in the prosthesis group. Active smoking and diathermy dissection were significant predictors of both NAC necrosis and mastectomy flap necrosis. The findings of this review suggest that there are several predictors of necrotic complications in nipple-sparing mastectomy. Appropriate patient selection, careful operative planning, and surgical technique refinements may reduce the risk of necrotic complications.

Process of Coping with Mastectomy: a Qualitative Study in Iran

Fouladi, Nasrin,Pourfarzi, Farhad,Ali-Mohammadi, Hossein,Masumi, Atefeh,Agamohammadi, Masumeh,Mazaheri, Effat Asian Pacific Journal of Cancer Prevention 2013 Asian Pacific journal of cancer prevention Vol.14 No.3

Background: Breast cancer is the most prevalent cancer among Iranian women and mastectomy comprises 81% of surgeries for treatment of breast cancer. Mastectomy may create feelings such as deformation or impairment in patients, cause body-image disorder, and reduce sexuality and sexual activity which in turn may entail mental disorders. The study aimed to elaborate coping processes. Materials and Methods: A grounded theory method was used in conducting this study. Twenty Iranian participants undergoing mastectomy were recruited with purposive sampling. An open, semi-structured questionnaire were developed. Obtaining consent, conversations were recorded and immediately transcribed after each session. Data analysis was carried out with the constant comparative method using the Strauss Corbin approach. Results: Analyzing the collected data, the study came up with seven main categories which affected the coping process in patients with breast cancer, namely: reactions to mastectomy; loss and death contest; reconstruction of evaluation system; consent for undergoing mastectomy; reactions and troubles after loss; confrontation of loss and health; and reorganization and compatibility with changes. Conclusions: The results of the study indicated: when patients become informed of their breast cancer and the necessity of undergoing mastectomy as the treatment, they probably pass through seven categories to adapt after mastectomy. Having insight about them is likely to contribute medical personnel in leading patients to the highest degree of feeling healthy.

유방암 절제술 여성의 맥파요인 연구

김경철 ( Gyeong Cheol Kim ),박상욱 ( Sang Wook Park ),김이순 ( Yi Soon Kim ),김윤희 ( Yun Hee Kim ) 경락경혈학회 2011 Korean Journal of Acupuncture Vol.28 No.4

Objectives: This study was done to investigate the degree of the pulse wave parameter of post-mastectomy women and to identify the relationships between each of them. Methods: Data were obtained from public health center in Busan Metropolitan city. Participants were 82 post-mastectomy women aged 31-82. the data collection was from Oct, 1, 2010 to Oct, 31, 2010. the data were analyzed with descriptive statistics, one-way ANOVA, Duncan test. A p-value less than .05 was considered significant by 2-tailed test. All statistical analyses were performed with SPSS/Win(ver 12.0). Results: As for the difference in the pulse wave by the general characteristics. The pulse energy was showed highly in the order of Chon, Quan and Chuk of left and right pulse respectively. In the pulse energy of left Quan and right Chon, the case of both mastectomy was showed highly and in the pulse energy of left Chuk, the case of right mastectomy was showed highly. Left and right pulse energy of menopause female were significantly higher than normal range except left Chon and Chuk. In h1, h2, h4, h5, t1, t2, AP and Aw, the pulse energy of left Chon was showed the largest significantly. In As, the pulse energy of right Chon was showed the smallest and in Ad, right Chuk was showed the largest. In RAI, right and left Chuk was showed the highest respectively. Conclusions: From these result, we can see that there are relation between women`s age, area of operation breast and menopause after mastectomy in pulse wave. The result of this study will become basic data necessary for the Oriental Medicine treatment to reduce or prevent women`s functional difficulties, symptomatology after mastectomy.

절제(切除)된 정체성: 오드르 로드(Audre Lorde)의 『암일지』(The Cancer Journals)에 나타난 유방절제와 여성의 정체성

전세재 ( Seh Jae Chun ) 한국영미문화학회 2009 영미문화 Vol.9 No.2

This paper explores questions of changed identity and reconstruction of "I" that incorporates Audre Lorde`s experience and mastectomy by examining her collection of journal entries and essays in The Cancer Journals which reveal her process of coping with breast cancer and mastectomy. Although Lorde, a breast cancer patient, lost her right breast for cancer treatment, she redefines her position as one-breasted woman, one of the power rather than weakness and shame. For Lorde, the medical system relegates the breast cancer patients to the position of passive medical objects rather than enabling them to define their own illness experiences and to become the subjects of their own stories of illness. Rather than passively submitting to the dominant social view on women who have undergone mastectomy, she determined to break the verbal silence about women`s experiences of breast cancer through her writing and to address the visual silence by refusing to hide her body. After her mastectomy, Lorde`s healing process, centered on integrating her new physical shape and the emotions generated by this change into her everyday life, is in synchronization with her writing process in the form of autopathography. Lorde`s new sense of self is mirrored in the figure of the amazon warrior, which highlights the central concerns for Lorde in her process of reconstructing an identity. The Cancer Journals, as a political act, intends to effect change on both personal and social levels. On an individual level, Lorde uses her writing to help her integrate her changed body, thought and emotions into her everyday life, an act that is ideologically opposed to the message she receives from the medical and cancer establishments. On a social level, her writing and her refusal to wear a prosthesis make Lorde socially visible as a post-mastectomy woman, thereby challenging the dominant cultural construction of breast cancer and mastectomy as a disease and a condition that women should endure in silence and shame. The Cancer Journals provides women with a paradigm for facing breast cancer and coping with it openly rather than in isolation and silence and for synthesizing the physical, emotional, psychological and social components of illness into their lives.