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Introducción: El cáncer de mama es el más frecuente y la principal causa de muerte por cáncer en la mujer. Es de peor pronóstico en las mujeres jóvenes por presentar una histología más agresiva y mayor índice de recidivas. Objetivo: Evaluar los resultados del tratamiento quirúrgico del cáncer de mama en mujeres hasta 40 años de edad en el Hospital Clínico Quirúrgico Hermanos Ameijeiras. Método: Se realizó un estudio descriptivo, longitudinal, retrospectivo y prospectivo en el período de mayo de 2005 a mayo de 2015. Se estudiaron 79 mujeres hasta 40 años que fueron operadas por diagnóstico de cáncer de mama. Resultados: Se encontró que 83,5 por ciento tenían entre 35 y 40 años, con solo 4 casos por debajo de los 30 años (5,1 por ciento). El 38,4 por ciento negaron historia familiar de cáncer. Las manifestaciones clínicas más frecuentes fueron la presencia de nódulos no dolorosos en 93,7 por ciento y nódulo de consistencia dura en 44,3 por ciento. Predominaron los tumores en estadio I con 48,1 por ciento, seguido del estadio II con 32,9 por ciento. La técnica quirúrgica más empleada fue la Mastectomía Radical Modificada en 58 casos (73,4 por ciento). En 37 pacientes (46,8 por ciento) hubo recaída de la enfermedad. Durante el seguimiento hubo 11 fallecidas (13,9 por ciento). El tiempo medio de supervivencia global fue de aproximadamente 9 años con una variación entre 7 y 10 años. El tiempo medio de supervivencia libre de enfermedad fue de 5,5 años con una variación entre 5 y 6 años para un intervalo de confianza del 95 por ciento. Conclusiones: En las mujeres menores de 40 años el cáncer de mama es de peor pronóstico por presentar una histología más agresiva y mayor índice de recidivas(AU)

Introduction: Breast cancer is the most frequent cancer and the main cause of death for cancer in women. It has a worse prognosis in young women due to more aggressive histology and higher recurrence rate. Objective: To assess the results of the surgical treatment of breast cancer in women up to 40 years of age in Hermanos Ameijeiras Clinical-Surgical Hospital. Method: A descriptive, longitudinal, retrospective and prospective study was carried out in the period from May 2005 to May 2015. Results: 79 women aged up to 40 years with a diagnosis of breast cancer who underwent surgery were studied. It was found that 83.5 percent were between 35 and 40 years old, with only 4 cases below 30 years (5.1 percent). 38.4 percent referred no family history of cancer. The most frequent clinical manifestations were the presence of non-painful nodules in 93.7 percent and nodule of hard consistency in 44.3 percent. The tumors in stage I predominated, with 48.1 percent, followed by other in stage II, with 32.9 percent. The most widely used surgical technique was modified radical mastectomy, in 58 cases (73.4 percent). In 37 patients (46.8 percent), there was relapse of the disease. During the follow-up, 11 patients (13.9 percent) deceased. The average time of overall survival was approximately 9 years, with a variation between 7 and 10 years. The mean time of disease-free survival was 5.5 years, with a variation between 5 and 6 years, which represents a 95 percent confidence interval. Conclusions: In women under 40 years of age, breast cancer has a worse prognosis due to a more aggressive histology and higher recurrence rate(AU)

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Surgery is the first-line treatment for early, localized, or operable breast cancer. Regional anesthesia during mastectomy may offer the prevention of postoperative pain. One potential protocol is the combination of serratus anterior plane block (SAM block) with pectoral nerve block I (PECS I), but the results and potential benefits are limited. Our study compared general anesthesia with or without SAM block + PECS I during radical mastectomy with axillary node dissection and breast reconstruction using evaluations of pain, opioid consumption, side effects and serum levels of interleukin (IL)-1beta, IL-6 and IL-10. This is a prospective, randomized controlled trial. Fifty patients were randomized to general anesthesia only or general anesthesia associated with SAM block + PECS I (25 per group). The association of SAM block + PECS I with general anesthesia reduced intraoperative fentanyl consumption, morphine use and visual analog pain scale scores in the post-anesthetic care unit (PACU) and at 24 h after surgery. In addition, the anesthetic protocol decreased side effects and sedation 24 h after surgery compared to patients who underwent general anesthesia only. IL-6 levels increased after the surgery compared to baseline levels in both groups, and no differences in IL-10 and IL-1 beta levels were observed. Our protocol improved the outcomes of mastectomy, which highlight the importance of improving mastectomy protocols and focusing on the benefits of regional anesthesia.

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BACKGROUND: The most common complication following modified radical mastectomy is seroma formation. Numerous approaches have been attempted to prevent this complication, ranging from the use of chemical substances to mechanical means, and none of these have proven to be consistently reliable. AIM: The aim of this study was to evaluate the safety and efficacy of talc in preventing postoperative seromas compared with iodine and standard care. METHODS: Patients with breast cancer undergoing modified radical mastectomy were randomly assigned to one of three study groups: control, subcutaneous talc, or iodine application. The primary endpoint was frequency of seroma formation. Secondary outcomes included wound complications (surgical site infection, flap necrosis, and wound dehiscence), analgesic use, postoperative pain, total drain outputs, and drainage duration. RESULTS: Of the 86 patients randomized in the study, 80 were analyzed. After interim analysis, the iodine intervention was discontinued because of increased adverse outcomes (drainage duration and total amount of fluid drained). Talc failed to demonstrate that its application in subcutaneous breast tissue prevents seroma formation (19.4% for talc group vs. 23.3% for control group; p = 0.70). However, patients who developed seroma in the talc group had fewer aspirations per patient seroma and less volume drained when compared with the control group (88.2 ± 73 vs. 158.3 ± 90.5; p = 0.17). CONCLUSIONS: Subcutaneous talc application was safe in the short term, but there was not sufficient evidence to support its use for seroma prevention following modified radical mastectomy in patients with breast cancer.

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BACKGROUND: The aim of this study was to compare the rates of local postoperative complications among women undergoing modified radical mastectomy with an electric scalpel (ES) or a harmonic scalpel (HS). It is thought that HS use has less postoperative complications, mainly seroma formation. METHODS: This study was a prospective non-randomised clinical trial (NCT01391988) among consecutive patients, performed in parallel. Patients underwent modified radical mastectomy using an HS or ES. We analysed the following operative variables: time, blood loss and seroma volume drainage. Postoperative complications, including seroma, flap necrosis, haematoma and infection were evaluated on the 7th and 14th days. RESULTS: Forty-six patients underwent a MRM with ES and 49 with HS; no differences were observed between the groups. The rate of local complications was 29% in the HS group and 52% in the ES group (p = 0.024). The rates of seroma (16.3% versus 28.3%; p = 0.161), necrosis (4.1% vs. 21.7%; p = 0.013; OR = 0.15), haematoma (2.0% vs. 8.7%; p = 0.195) and infection (2.0% vs. 6.5%; p = 0.351) were lower in the HS group. Adding the findings of all comparative studies using HSs in MRM to the seroma rates in the current study, the seroma rate, expressed as a categorical variable, did not decrease with HS. Seroma was present in 60/219 cases using an HS and in 69/239 cases utilising an ES (p = 0.72). Based on a multivariate analysis, HS decreased the risk of skin necrosis (p = 0.015). CONCLUSIONS: HSs do not decrease the seroma rate. However, this method may be useful in skin sparing mastectomy because it decreases skin flap necrosis.

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Though removing of the pectorals fascia has always been routinely performed in modified radical mastectomy for invasive breast cancer, there is no evidence that this routine is justified. The authors present some of the scarce data found in literature, and discuss the advantages of living the pectorals fascia in situ to facilitate implant based reconstruction.

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INTRODUCCIÓN. El cáncer de mama es la primera causa de muerte por cáncer en la mujer y se ha convertido en una pandemia que amenaza continuar si no se halla la forma de prevenirlo. El objetivo de este trabajo fue evaluar la supervivencia global y el intervalo libre de enfermedad en pacientes que recibieron como tratamiento inicial cirugía conservadora más radioterapia y mastectomía radical modificada; y determinar otras variables pronósticas, como la edad, clínicas histológicas, recaídas y tiempo entre la cirugía y la radioterapia. MÉTODOS. Entre enero del 2000 y diciembre del 2005 se realizó en el Hospital «Julio Trigo López¼ un estudio retrospectivo y descriptivo de un grupo de pacientes con cáncer primario de mama, en etapas I y II. Los datos se extrajeron de las historias clínicas y de encuestas. Se creó una base de datos y se realizó un análisis descriptivo de los datos, frecuencia y porcentajes para el caso de las variables cualitativas y medias, y desviaciones estándares para las cuantitativas. Se estimó la supervivencia y el intervalo libre de enfermedad utilizando el método de Kaplan Meir y se compararon en curvas según las variables de interés de Sug Rank. El análisis de las variables pronósticas de supervivencia e intervalo libre de enfermedad se realizó mediante análisis de regresión de Cox. RESULTADOS. El intervalo libre de enfermedad fue mayor en la cirugía conservadora que en la mastectomía radical modificada, y de igual manera se comporto la supervivencia global. Las pacientes con Rh positivo presentaron mayor intervalo libre de enfermedad (88 por ciento). El carcinoma infiltrante fue la variedad más frecuente y de mayor número de recaídas, en las cuales influyó el tiempo entre la cirugía y la radioterapia. La frecuencia más alta de cáncer de mama se observó en las mujeres mayores de 50 años. En la cirugía conservadora predominó la conducta terapéutica de cirugía más radioterapia y quimioterapia y en la mastectomía radical modificada, la quimioterapia. En la cirugía conservadora fueron más frecuentes las recaídas locorregionales, mientras que en la mastectomía radical, las recaídas más frecuentes se registraron a distancia. CONCLUSIONES. El tipo de cirugía no influyó significativamente en el intervalo libre de enfermedad, pero sí hubo diferencias entre las técnicas conservadoras. Los factores pronósticos tamaño del tumor, estado ganglionar y receptores hormonales influyeron en la supervivencia y en el intervalo libre de enfermedad en todas las pacientes(AU)

INTRODUCTION. Breast cancer is the first cause of death from cancer in females and it has become a pandemic threatening to continue if the way to prevent it is not found. The objective of this paper was to evaluate global survival and the disease free interval in patients that underwent conservative surgery plus radiotherapy and modified radical mastectomy as initial treatment, and to determine other prognostic variables, such as age, histological clinics, relapses and time elapsed between surgery and radiotherapy. METHODS. A retrospective and descriptive study was conducted in a group of patients with stage I and II primary breast cancer at «Julio Trigo López¼ Hospital from January 2000 to December 2005. Data were taken from the medical histories and surveys. A database was created and a descriptive analysis was made of the data, frequency and percentages for the case of qualitative and mean variables, and of the standard deviations for the quantitative variables. Survival and the disease free interval were estimated by Kaplan Meir's method and they were compared by curves according to the Sug Rank's variables of interest. The analysis of the prognostic variables of survival and disease free interval was carried out by Cox's regression analysis. RESULTS. The disease free interval was longer in conservative surgery than in the modified radical mastectomy. Global survival had a similar behaviour. Patients with positive Rh presented a longer disease free interval (88 percent). The infiltrating carcinoma was the most frequent variety and it had the greatest number of relapses, which were influenced by the time elapsed between surgery and radiotherapy. The highest frequency of breast cancer was observed in females over 50. The therapeutic conduct of surgery plus radiotherapy and chemotherapy prevailed in conservative surgery, whereas chemotherapy predominated in the modified radical mastectomy. The locoregional relapses were more common in conservative surgery; however, the most frequent relapses in radical mastectomy were registered at a distance. CONCLUSIONS. The type of surgery did not exert a significant influence on the disease free interval, but there were differences among the conservative techniques. The prognostic factors size of the tumor, ganglionic state and hormone recipients influenced on the survival and on the disease free interval of all patients(AU)

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CONTEXT AND OBJECTIVE: Modified radical mastectomy is widely utilized in breast cancer treatment. However, no prospective comparison has yet been made between the Madden technique (preservation of the pectoralis minor muscle) and the Patey technique (resection of this muscle). The aim of this work was to compare these two modified radical mastectomy techniques, by analyzing their degrees of difficulty and complications. DESIGN AND SETTING: Randomized trial at the Breast Unit of Hospital Araújo Jorge, Goiás; and Faculdade de Medicina da Universidade Federal de Goiás. METHODS: 430 patients with breast cancer with an indication for modified radical mastectomy were included in the program, of whom 426 patients were available for analysis (225 allocated to Patey and 201 to Madden). The chi-squared and Student t tests were used for analysis. RESULTS: The patients demographics were well balanced between the two groups. The mean duration of the surgical procedures was 105 (+/- 29.9) and 102 minutes (+/- 33), for the Patey and Madden groups, respectively (p = 0.6). Hospitalization duration was 2.3 days for both groups. The mean number of lymph nodes resected was 20.3 (+/- 7.6) for Patey and 19.8 (+/- 8.1) for Madden (p = 0.5). There were no differences in terms of vascular or nerve sections, hematomas or infections. The surgeons reported the same degree of difficulty for the two methods. CONCLUSION: The removal of the pectoralis minor muscle did not influence any of the variables studied. Therefore, either technique can be performed, at the surgeon's discretion.

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CONTEXT AND OBJECTIVE: Modified radical mastectomy is widely utilized in breast cancer treatment. However, no prospective comparison has yet been made between the Madden technique (preservation of the pectoralis minor muscle) and the Patey technique (resection of this muscle). The aim of this work was to compare these two modified radical mastectomy techniques, by analyzing their degrees of difficulty and complications. DESIGN AND SETTING: Randomized trial at the Breast Unit of Hospital Araújo Jorge, Goiás; and Faculdade de Medicina da Universidade Federal de Goiás. METHODS: 430 patients with breast cancer with an indication for modified radical mastectomy were included in the program, of whom 426 patients were available for analysis (225 allocated to Patey and 201 to Madden). The chi-squared and Student t tests were used for analysis. RESULTS: The patients' demographics were well balanced between the two groups. The mean duration of the surgical procedures was 105 (± 29.9) and 102 minutes (± 33), for the Patey and Madden groups, respectively (p = 0.6). Hospitalization duration was 2.3 days for both groups. The mean number of lymph nodes resected was 20.3 (± 7.6) for Patey and 19.8 (± 8.1) for Madden (p = 0.5). There were no differences in terms of vascular or nerve sections, hematomas or infections. The surgeons reported the same degree of difficulty for the two methods. CONCLUSION: The removal of the pectoralis minor muscle did not influence any of the variables studied. Therefore, either technique can be performed, at the surgeon's discretion.

CONTEXTO E OBJETIVO: A mastectomia radical modificada continua a ser amplamente usada para o tratamento de câncer de mama. Porém, até agora, a preservação do músculo peitoral secundário (técnica de Madden) não foi prospectivamente comparada à técnica de Patey. O objetivo deste trabalho foi comparar as duas técnicas de mastectomias radicais modificadas, analisando o grau de dificuldade e as complicações. TIPO DE ESTUDO E LOCAL: Estudo randomizado, realizado na Unidade de Mama do Hospital Araújo Jorge, Faculdade de Medicina da Universidade Federal de Goiás, Goiás, Brazil. MÉTODOS: 430 pacientes portadoras de câncer de mama com indicação de mastectomia radical modificada foram incluídas no programa. Foram disponíveis para análise 426 pacientes, das quais 225 alocadas no grupo Patey e 201 no grupo Madden. A análise foi feita por intenção de tratamento, usando-se o Qui-quadrado ou o teste t de Student, quando aplicáveis. RESULTADOS: A distribuição das características demográficas pacientes foi semelhante entre os grupos. A duração média da cirurgia foi de 105 minutos (DP ± 29.9) e 102 (DP ± 33) para o grupo Patey e Madden, respectivamente (p = 0,6). O tempo de internação foi de 2,3 dias para ambos os grupos. A média de linfonodos ressecados foi de 20,3 (DP ± 7,6) para Patey e 19,8 (DP ± 8,1) para Madden (p = 0,5). Não houve diferenças entre as complicações vasculares, nervosas, hematomas, infecções, bem quanto à dificuldade relatada pelo cirurgião. CONCLUSÃO: A retirada do músculo pequeno peitoral não influenciou nenhuma das variáveis estudadas. As técnicas de mastectomias radicais modificadas, Patey e Madden, foram semelhantes em todos os critérios observados, podendo ser executadas de acordo com a preferência do cirurgião.

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En 1945, Foote y Stewart plantearon que el antecedente más frecuente de cáncer en un seno es haber tenido una neoplasia en el seno contrario. Se realizó un estudio sobre los casos de cáncer de mama bilateral atendidos en nuestro servicio entre 1982 y 2003. Métodos: El universo de nuestro trabajo está compuesto por 25 pacientes que fueron atendidas en los últimos 20 años por cáncer de mama bilateral, la mayoría de ellos metacrónicos (21 casos). En cada caso se analizó edad, etapas clínicas al momento del diagnóstico, tratamiento utilizado, tipo histológico y evolución, entre otras variables. Resultados: Se observó la mayor incidencia de esta enfermedad en la 5ta. y 6ta. décadas de la vida, con predominio de los tumores en etapa II. El tipo de operación más realizado fue la mastectomía radical modificada de Patey y prevalecieron las técnicas más conservadores en la segunda operación. Siete de las pacientes fallecieron por la enfermedad. Conclusiones: El pronóstico de las mujeres con cáncer de mama bilateral suele ser favorable y depende de la etapa de desarrollo de éste al momento del diagnóstico. El tratamiento del segundo primario fue más conservador que el primero. El seguimiento estricto y el uso de la ingeniería genética son elementos fundamentales para el diagnóstico precoz(AU)

In 1945, Foote and Stewart said: the most frequent antecedent of cancer in a breast is having had a neoplasia in the other breast. A study of the cases of bilateral breast cancer seen in our service between 1982 and 2003 was conducted. Methods: The universe of our work was composed of 25 patients attended in the last 20 years due to bilateral breast cancer. Most of them were metachronic (21 cases). Age, clinical stages at the time of diagnosis, treatment used, histological type and evolution, among other variables, were analyzed. Results: the highest incidence of this disease was observed in the 5th and 6th decades of life, with predominance of stage II tumors. Patev's modified radical mastectomy was the most common operation. The most conservative techniques prevailed in the second operation. Seven of the patients died as a result of the disease. Conclusions: the prognosis of women with bilateral breast cancer is usually favorable and it depends on its development stage at the time of the diagnosis. The treatment of the second was more conservative than the first one. The strict follow-up and the use of genetic engineering are fundamental elements for the early diagnosis(AU)

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Foi realizado um estudo clínico-epidemiológico, do tipo caso-controle pareado, sobre carcinoma de mama onde foram selecionados 300 casos e 600 controles com idade de 25 a 75 anos. Constatou-se principalmente, que as pacientes procuravam tratamento para cancer de mama em estágios mais avançados, a maioria apresentava tumores maiores, T2 (40,0 por cento) e T3 (32,3 por cento). Os linfonodos axilares se encontravam acometidos em 48,9 por cento dos casos após estudo anátomo-patológico. O tratamento cirúrgico mais empregado foi a mastectomia à Patey (65,7 por cento); sendo que em 11,3 por cento dos casos foi realizado tratamento complementar com hormonioterapia, em 89,7 por cento a radioterapia e 56 por cento a quimioterapia. O tipo histológico mais comum foi o carcinoma ductal invasor e o lobular invasor. A análise bivariada condicional mostrou diferenças estatísticamente significativas para: ser dona de casa, ter menos que seis filhos ou ser nulípara, usar anticoncepcional oral e ter história de cancer de mama em familiar de primeiro grau. As seguintes características funcionaram como fator de proteção ("odds ratio" inferior a unidade): cor não branca, renda inferior a um salário mínimo, escolaridade inferior a primeiro grau, ciclos menstruais irregulares, história de aborto, ser hipertensa e ter filhos sem amamentá-los. A análise bivariada não condicional demonstrou que as pacientes que tiveram primeira gravidez ou primeiro parto antes de vinte anos tiveram menor risco para cancer de mama. O uso de estrogênio pós-menopausa não alterou o risco de desenvolvimento da doença. As seguintes variáveis foram estatísticamente independentes na análise multivariada: ser dona de casa, ter menos que seis filhos, estar em menopausa, ter história de cancer de mama em familiar de primeiro grau. Foram fatores de proteção para não ter cancer de mama: ter ciclos menstruais irregulares e não amamentar. A tábua de vida mostrou uma sobrevida média de 105,7 ñ 4,3 meses para um período de seguimento de 150 meses. As pacientes com estadiamento clínico mais avançado e com presença de metástases sobreviveram menos. O tempo livre de metástase foi de 103,3 ñ 4,1 meses. A causa de morte mais comum entre as pacientes foram as metástases óssea e pulmonar.

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