PURPOSE: The residual microscopic carcinoma after breast conserving surgery is the most important risk factor of local recurrence. As local recurrences usually develop around resected margins, it is ge nerally accepted that every effort should be made to achieve negative margins intraoperatively, and the presence of microscopically positive margins requires reexcision. Interestingly, sizable percentage of reexcisions results in a specimen free of residual tumor, and may not contribute to disease control, but do add morbidity, cost, and possibly compromise cosmetic result. The goal of our study was to identify which clinico-pathologic factors were associated with positive resection margin, and to identify the variables associated with no residual carcinoma on reexcision or total mastectomy specimens. METHODS: From Sepember 1994 to July 1999, 322 breast conserving surgery were performed on breast cancer patients at the Department of General Surgery, Samsung Medical Center. Among them, 13 patients had positive surgical margins and were treated with reexcision (reexcising the previous lumpectomy cavity with a margin of 1-2 cm of normal tissue) or total mastectomy. RESULTS: The factors associated with positive resection margins were large tumor size, the presence of extensive intraductal component (EIC), and suspicious mammographic microcalcifications without mass density. Six (46.3%) of these reoperation cases for positive margins were negative for residual tumor. The factors correlating with no residual carcinoma on reexcision or mastectomy specimens were small histologic primary tumor size and only one positive resection margin rather than 2 or more positive margins. CONCLUSION: The patients with above-mentioned factors associated with positive resection margins should be treated with more wide local excision or total mastectomy to avoid a second surgical procedure. If the patients with only one positive margin and small tumor size refuse second operation, they could be treated with irradiation only sparing an additional surgical procedure.
Breast Neoplasms ; Breast* ; Humans ; Mastectomy ; Mastectomy, Segmental* ; Mastectomy, Simple ; Neoplasm, Residual ; Recurrence ; Reoperation* ; Risk Factors

We present a case of erosive adenomatosis of the nipple in a 22-year-old woman. The clinical features of erosive adenomatosis of the nipple are similar to Paget's disease in that it has erythematous erosions with oozing and fissured crusts on one nipple. However, histologic findings are characteristic, consisting of dilated tubular structures that are lined by a peripheral layer of cuboidal cells and a luminal layer of columnar cells showing secretary properties into the lumen. The clinical course is benign, so simple mastectomy is enough for treatment.
Female ; Humans ; Mastectomy, Simple ; Nipples* ; Phenobarbital ; Young Adult

No abstract available.
Analgesia* ; Lymph Node Excision* ; Lymph Nodes* ; Mastectomy, Simple*

PURPOSE: The purpose of this study was to investigate the final outcomes of magnetic resonance imaging (MRI)-identified additional lesions (MRALs) in breast cancer patients and the role of second-look ultrasound (SLUS) and imaging-guided interventions. METHODS: We analyzed breast cancer patients with MRALs on preoperative MRI between January and June 2012. MRALs were defined as additional lesions suspected on MRI but not suspected on mammograms or ultrasound. The malignancy rate of MRALs, MRI-based Breast Imaging Reporting and Database System (BI-RADS) category, positional relationship with the index cancer, MRI-concordant lesion visibility on SLUS, performance of imaging-guided interventions, and total mastectomy (TM) rates were evaluated for the confirmed lesions. RESULTS: Among the 119 confirmed lesions, SLUS and imaging-guided interventions were performed in 94 (79.0%) and 82 cases (68.9%), respectively. The malignancy rate was 68.1% (81 of 119), and was significantly higher in BI-RADS 4C-5 lesions than in 4A-4B lesions (94.6% vs. 56.1%, P < 0.01) and in ipsilateral same-quadrant lesions than in contralateral lesions (84.2% vs. 33.3%, P < 0.01). The lesion visibility rate on SLUS was 90.4%. The malignancy rate was not significantly different according to lesion visibility on SLUS. The TM rate in the 98 cases with ipsilateral MRALs was 37.8%, while it was significantly lower in patients who underwent an imaging-guided intervention than in those who did not (27.9% vs. 54.1%, P=0.017). CONCLUSION: MRALs show a high probability of malignancy, especially if they are ipsilateral. SLUS and imaging-guided interventions can eliminate many unnecessary TMs.
Breast Neoplasms* ; Breast* ; Humans ; Magnetic Resonance Imaging* ; Mastectomy, Simple ; Ultrasonography*

Local excision and axillary dissection followed by radiation therapy to the breast has been shown to achieve equivalent local control and survival as mastectomy in an prospective randomized trials. We analyzed 28 cases of early breast cancer in order to evaluate the therapeutic effects of conservative f surgery and definitive radiotherapy in the management of early breast cancer as possible alternative of simple mastectomy, retrospectively. Obtained results were as follows 1. Treatment related acute side reactions are more prominant in the case of chemoradiotherapy group than radiotherapy alone group. 2. There were no cases of primary, regional or systemic failures on the last follow up examination. 3. Cosmetic results after treatment were satisfactory in 26 cases out of 28 cases on the last follow up examination. 4. There were no demonstrable differences of tumor control and cosmetic results between the treatment groups. Although, these results suggested that definitive radiotherapy after local excision would be a possible and desirable alternative instead of total mastectomy in the management of early breast cancers, analyzed cases were too small and follow up period was too short to evaluate the therapeutic effect of primary radiotherapy after local excision, exactly.
Breast ; Breast Neoplasms ; Chemoradiotherapy ; Follow-Up Studies ; Mastectomy ; Mastectomy, Simple ; Prospective Studies ; Radiotherapy* ; Retrospective Studies

The purpose of this study is to determine the need of education about BSE for the medical members, to survey about the performance and the knowledge of BSE in patients who operated on subtotal and total mastectomy and to compare the regularity of BSE with the severity of breast cancer. The subjects were 163 patients with operated on mastectomy who participated were interviewed in the S university Hospital. The collected data were analyzed by descriptive statistics and t-test, One-way ANOVA and Pearson Correlation with SPSSWIN program. Results were obtained as follows: 1. There was no statistical difference between in the regular group of the mammography and the regular BSE group(F=0.558, P=0.458). 2. There was statistical difference between the method of detection and the severity of the breast cancer(F=3.359, P=0.011). 3. There was statistical difference between regularity of the BSE and the severity of breast cancer(F=3.301. P=0.019). 4. There was showed higher severity of the breast cancer in the elderly patients (r=0.l72, P=0.019). 5. There was showed higher severity of the breast cancer in the lower educational level(r=-0,170, P=0.033). According to this study need to the development of the educational program about the BSE and the future research about the regular BSE of the high risk group in the breast cancer.
Aged ; Breast Neoplasms* ; Breast Self-Examination* ; Breast* ; Education ; Humans ; Mammography ; Mastectomy ; Mastectomy, Simple

BACKGROUND: Breast reconstruction has become more common as mastectomy has become more frequent. In Korea, the National Health Insurance Service (NHIS) began covering breast reconstruction in April 2015. This study aimed to investigate trends in mastectomy and breast reconstruction over the past 10 years and to evaluate the impact of NHIS coverage on breast reconstruction. METHODS: Nationwide data regarding mastectomy and breast reconstruction were collected from the Korean Breast Cancer Society registry database. Multiple variables were analyzed in the records of patients who underwent breast reconstruction from January 2005 to March 2017 at a single institution. RESULTS: At Seoul National University Hospital, the total number of reconstruction cases increased 13-fold from 2005 to 2016. The proportion of immediate breast reconstruction (IBR) cases out of all cases of total mastectomy increased from 4% in 2005 to 52.0% in 2016. The proportion of delayed breast reconstruction (DBR) cases out of all cases of breast reconstruction and the overall number of DBR cases increased from 8.8% (20 cases) in 2012 to 18.3% (76 cases) in 2016. After NHIS coverage was initiated, the proportions of IBR and DBR showed statistically significant increases (P < 0.05). Among the IBR cases, the percentage of prosthesis-based reconstructions increased significantly (P < 0.05), but this trend was not found with DBR. Total mastectomy became significantly more common after the expansion of NHIS coverage (P < 0.05). CONCLUSIONS: Over the last decade, there has been an increase in mastectomy and breast reconstruction, and the pace of increase accelerated after the expansion of NHIS coverage. It is expected that breast reconstruction will be a routine option for patients with breast cancer under the NHIS.
Breast Neoplasms ; Breast* ; Female ; Humans ; Insurance ; Korea ; Mammaplasty* ; Mastectomy ; Mastectomy, Simple ; National Health Programs* ; Seoul

PURPOSE: This study aimed to determine the clinical and pathological factors associated with a higher rate of positive or close margins after breast-conserving surgery (BCS) by comparing these patients to patients with a negative margin. The second aim was to evaluate intraoperative resection margin status and reoperation rates for margin control in patients who underwent BCS. METHODS: We reviewed the clinical and pathological data of all women diagnosed with invasive breast carcinoma (IBC) and ductal carcinoma in situ (DCIS) at our institution between January 2006 and December 2016. RESULTS: During the 10-year study period, 785 patients were diagnosed with either IBC or DCIS, and 402 of these patients had undergone a total mastectomy as the primary treatment. The remaining 383 patients who underwent BCS were included in the final analysis. Of these, 100 patients (26.1%) had intraoperative positive or close margins. The remaining 283 patients (73.9%) had a negative margin intraoperatively, but 32 of these patients had positive or close margins on permanent sections. In the multivariate analyses, microcalcifications on mammograms (vs. none; odds ratio [OR], 1.911; 95% confidence interval [CI], 1.156−3.160), in situ carcinomas larger than 2.0 cm (vs. ≤2.0 cm; OR, 3.106; 95% CI, 1.193−8.086), and lumpectomy (vs. quadrantectomy; OR, 2.863; 95% CI, 1.268−6.622) showed a significant association with a positive or close surgical margins. Patients with intraoperative positive or close margins underwent more reoperation than those with negative margins (5.0% vs. 2.8%). CONCLUSION: After BCS, microcalcifications on mammograms, large-sized in situ carcinomas, and lumpectomy were more likely to have positive or close margins.
Breast Neoplasms* ; Breast* ; Carcinoma, Intraductal, Noninfiltrating ; Female ; Humans ; Mastectomy ; Mastectomy, Segmental* ; Mastectomy, Simple ; Multivariate Analysis ; Odds Ratio ; Reoperation

PURPOSE: The combination of conservative surgery and radiotherapy is currently accepted as the preferred treatment for most patents with clinical stage I or II breast cancer. However, there is large amount of controversy concerning the optimal means of selecting patients and the details of the treatment technique. Breast cancer patients are being treated both in university hospitals and in community hospitals. Generally, the radiation therapy is not available in many community hospitals. Radiation therapy, which generally follows either a mastectomy or conservative surgery, is an important procedure. Therefore, the type of hospital facilities may influence which surgical procedures are selected. The authors conducted this study to analyse the current patterns of care for early invasive breast cancer in a hospital without a radiation therapy unit, even though the patient could receive such treatment from another affiliated hospital. METHODS: 131 cases of stage I and II breast cancer patients were reviewed between 1987 and 1997, and the types of treatments including surgery, radiation therapy and systemic therapy, were analysed retrospectively. RESULTS: The surgical procedures used were mainly a modified radical mastectomy (124/131, 94.7%), followed by breast conservation surgery (4/131, 3.1%), a total mastectomy (2/131, 1.5%) and a radical mastectomy (1/131, 0.8%). Radiation therapy was applied to 19 stage II patients (N=105), but not to any of the stage I patients (N=26). Systemic adjuvant therapy was done with chemotherapy (39/131, 29.8%), hormone therapy (17/131, 13.0%) and a combination of both modalities (67/131, 51.1%), with an exception of 8 cases. CONCLUSION: Breast conservation therapy for breast cancer patients was underutilized. The selection of the therapeutic method may be influenced by the facilities of the particular hospital. For proper treatment of early stage breast cancer, a surgeon must keep in close contact with bothe a radiologist and a radiotherapist, even in other affiliated hospitals.
Breast Neoplasms* ; Breast* ; Drug Therapy ; Hospitals, Community ; Hospitals, University ; Humans ; Mastectomy ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mastectomy, Simple ; Radiotherapy ; Retrospective Studies

PURPOSE: Breast cancer is increasing in Korea. and it has become the second most common cancer in females. This study reviewed the history of surgery and clinical analysis with follow up result on 2,677 cases of breast cancer operated at the Gospel Hospital during the 50-year period 1951 to 2000 was performed. METHODS: We reviewed breast cancer cases by operative record datas and previous reports of our hospital during the 50-year period. RESULTS: Minimal age was 14 years old and Maximal age was 90 years old in all cases. The total count of operation was 2,677 cases during the 50-year period (1951~2000). In 1951, the hospital was opened. In 1953, 52-year old female was operated by mammary amputation. In 1958, 47-year old female was operated by radical mastectomy. In 1976, 50-year old female was operated by modified radical mastectomy. Since 1996, radical mastectomy has not been operated any more. Radical mastectomy was performed in 234 cases (8.7%), modified radical mastectomy in 2,164 cases (81.0%), simple mastectomy in 79 cases (3.0%), partial mastectomy with axillary dissection in 90 cases (3.4%), wide excision in 110 cases (4.0%) Overall 5 year survival rate was 41.5% (1970~1982), 79.0% (1983~1993), 82.3% (1994~2000). CONCLUSION: This study shows the fact that the incidence of breast cancer is increasing and the minimal age is getting younger and the maximal age is getting older. The treatment for breast cancer is changing according to the period. also it will be developing.
Adolescent ; Aged, 80 and over ; Amputation ; Breast Neoplasms* ; Breast* ; Female ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mastectomy, Segmental ; Mastectomy, Simple ; Middle Aged ; Survival Rate