PURPOSE: Despite the advocation of a breast conserving approach to the treatment of breast cancer, many women continue to surgically require or choose mastectomy for the treatment of breast cancer. In many cases, breast reconstruction after mastectomy is being performed using tissue expander, implants or a myocutaneous flap. In recent years, immediate free transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction has become an cosmetically and economically attractive alternative, compared to other types of reconstruction, although the technique is not easy. The author's experience with 25 successful immediate free TRAM flap reconstructions is reviewed. METHODS: We analyzed 25 cases of immediate free TRAM reconstruction that were performed at the Department of Surgery, Hanyang University Hospital, from August 1995 to June 2000, for age, histologic type, stage and estimated degree of patient satisfaction. RESULTS: The patient age distribution ranged from 26 to 58 years old, the mean age was 38.3, and the majority of tumors were invasive ductal carcinoma (13 cases) and intraductal carcinoma (8 cases). All tumor sizes were less than 3 cm (Tis: 8 cases, T1: 8 cases, T2: 7 cases) with the exception of the phyllodes tumors (8 cm and 6 cm). The stage was from 0 to IIB (0: 7 cases, I: 7 cases, IIA: 8 cases, IIB: 1 case, phyllodes tumor: 2 cases). Immediate posto-perative complications included 3 cases of bleeding and 1 case of wound infection at the donor site. According to the patients' expressed opinions, almost all patients were pleased with the result. There was no local recurrence during the follow-up period except for one case of bone metastasis that developed. CONCLUSION:This technique undoubtedly can play a major role in the so called "onco-plastic" surgical management of breast cancer.
Age Distribution ; Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Mammaplasty ; Mastectomy* ; Middle Aged ; Myocutaneous Flap ; Neoplasm Metastasis ; Patient Satisfaction ; Phyllodes Tumor ; Rectus Abdominis ; Recurrence ; Tissue Donors ; Tissue Expansion Devices ; Wound Infection

PURPOSE: The sentinel lymph node (SLN) biopsy was recently introduced into the treatment of early breast cancer. However, there have been varying degrees of success in identifying the SLNs. Lymphatic mapping in breast cancer performed solely by intraparenchymal injection of blue dye remains an accepted method of identifying SLNs, largely because of its simplicity. This article describes the technical aspect and improved results of combined peritumoral and subareolar injection of isosulfan blue dye. METHODS: From Jan. 2000 to Jul. 2000, 55 patients with breast cancer (size<5 cm and clinically negative axillary nodes) were enrolled for SLN biopsy by peritumoral and subareolar injection of 1% isosulfan blue dye. And all patients underwent a complete axillary dissection. RESULTS: The identification rate of SLN was 96.4% (in 53 of 55 patients). Of these 53 patients, 11 patients (20.8%) had positive SLNs and 42 patients had negative SLNs. In 42 patients with negative SLNs, one patients was found to have disease on complete dissection, for a false-negative rate of 8.3% (1/12). Conclusion: Compared with other series of blue dye- directed lymphatic mapping, the present study of peritumoral plus subareolar plexus dye-only injection demonstrates a high SLNs localization rate and rapid learning curve. On the basis of these results, it is expected that subareolar lymphatic plexus is the central route to sentinel lymph nodes and the optimal way to perform dye-only lymphatic mapping of the breast.
Biopsy ; Breast ; Breast Neoplasms ; Humans ; Learning Curve ; Lymph Nodes* ; Sentinel Lymph Node Biopsy

PURPOSE: Rotter's nodes are removed in the course of a radical mastectomy, however they are not routinely removed in a modified radical mastectomy and breast conserving surgery, although they can be. Having been relatively ignored, the prognostic value and correlation of Rotter's nodes with axillary nodal status have rarely been reported or systematically studied. The aims of the present study were to assess the frequency and pattern of Rotter's node metastasis in breast cancer patients, and to compare the incidence of axillary lymph node metastasis and Rotter's node. We also investigated the rate of skip metastasis. METHODS: In order to investigate the predictability of axillary node positivity, we compared the status of axillary lymph nodes and the pathological prognostic markers. In 580 consecutive mastectomies performed for breast carcinomas between 1987 and 1999, axillary and Rotter's nodes were routinely dissected and separately sampled during mastectomy. RESULTS: The mean number of axillary lymph nodes and Rotter's nodes were 19.5 and 0.9. Axillary lymph nodes metastases were found in 47.2% of all patients. The frequency of axillary lymph node metastasis and the involvement of a higher level of axillary lymph node were significantly increased with increasing tumor size. However, metastasis at Rotter's nodes did not follow this pattern. Rotter's nodes were anatomically present in 39.8% of patients and an average of 2.3 lymph nodes was found in the interpectoral region. Rotter's metastases were found in 5% of all patients, and 10.6% of those with axillary lymph node metastases. The number of Rotter's nodes metastases was higher as the metastases were found at a higher level (p<0.05). CONCLUSION:The presence of axillary metastases was related to histologic grade, nuclear grade and lymphovascular invasion, but was not related to the mitotic index or perineural invasion. It is apparent that the potential risks from Rotter's and skip metastases were not great in all patients, although the routine excision of Rotter's nodes should be applied to patients with more locally advanced disease (T2-3, N1-N2).
Breast Neoplasms* ; Breast* ; Humans ; Incidence ; Lymph Nodes ; Mastectomy ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mastectomy, Segmental ; Mitotic Index ; Neoplasm Metastasis

PURPOSE: Generally, young age onset malignancies show worse prognosis. But is "young age onset" a single prognostic factor for breast cancer, has been controversial. The incidence of breast cancer according to age is different by region and races. This study purposed to know the incidence of breast cancer in younger or 35 year old (below Young age group) and its clinical characteristics, prognosis, and difference with older age onset breast cancer. METHODS: A retrospective study of consecutive 545 breast cancer patients who had been treated by our hospital from 1990 to 1999, was carried out. We investigated the ratio of 35 year old or younger breast cancer patients, age of menarche, TNM stage, histologic grades, hormone receptor status, survival rates. And compared it with counter age (>35) group's. The significances of differences were evaluated using Student's-t test or chi-square test by variable type. Analysis were performed using SPSS software. RESULTS: Younger age group patients were 62 (11.3%) among them, showed earlier menarche, worse histologic differentiation, and lower mammographic detection rate than counter group (p<0.05). There were no difference in TNM stage distribution, hormone receptor expression status according to age group (p>0.05). Young age group's 5 year overall and disease free survival rates were 83+/-5% and 58+/-8%, both were lower than counter group's 89+/-2% and 74+/-3% (p<0.05). Also age adjusted overall and disease free survival rates were worse than counter age group's. CONCLUSION:Younger age group shows worse survival rates, have poor prognostic factors and show early relapsing rate than older age group. So we can consider "young age onset" as a poor prognostic factor in breast cancer.
Adult ; Breast Neoplasms* ; Breast* ; Continental Population Groups ; Disease-Free Survival ; Female ; Humans ; Incidence ; Menarche ; Prognosis* ; Retrospective Studies ; Survival Rate

PURPOSE: It has long been controversial whether breast cancer of the younger women is more aggressive than that of older women and remains unclear whether the dismal outcome seen in the younger age group is a reflection of more advanced disease at the time of diagnosis or whether it is due to a difference in the underlying tumor biology. To investigate the outcome of primary breast cancers treated with breast conservation surgery according to the patient's age, we undertook this study. METHODS: One hundred and eighty-five patients with breast carcinoma, that underwent breast conservation surgery at the Severance Hospital, Yonsei University College of Medicine, during the period between July 1988 and December 1996, were divided into two groups on the basis of age 35 (patient group: age 35 or younger, and control group: over 35 years of age). Tumor stage by the American Joint of Committee on Cancer (AJCC) classification, histologic grade, adjuvant therapy, and the incidence of local or systemic recurrences were analyzed. Finally 10-year loco-regional recurrence free, distant relapse free (DRFS) and overall survival (OS) were estimates determined by Kaplan-Meier analysis. RESULTS: Among 185 patients, 42 women (22.7%) were included in the patient young group and the other 143 in the control group. There were no significant differences between the two groups in terms of the distribution of T stages, N stages, histologic subtypes, hormonal receptor expressions, and mean follow-up duration. The younger group had higher 10-year local recurrence (14.3%) and systemic recurrence (28.6%) rates than the control group (4.2% and 12.6%), respectively (p<0.05). The younger group also had a significantly worse 10-year overall survival rate of 78.6% (p<0.01). CONCLUSION:These results indicate that breast cancer patients younger than 35 years of age have higher local and systemic recurrences and poorer DRFS and OS than their older counterparts. These differences may reflect difference in tumor biology and imply that younger patients with breast cancer need both more aggressive and adequate systemic treatment after surgery.
Biology ; Breast Neoplasms ; Breast* ; Classification ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Incidence ; Joints ; Kaplan-Meier Estimate ; Recurrence ; Survival Rate

PURPOSE: The relationship of the age at diagnosis and the prognosis in breast carcinoma remains controversial. However, it is a widely held belief that breast cancer in young women especially women in the twenties is a disease more lethal than that found in older patients. We attempted to determine whether young age could be a poor prognostic factor for breast cancer. METHODS: A retrospective study was conducted of all women age 30 or younger who had undergone a definite operation from September 1994 to December 1999 in the Department of Surgery, Samsung Medical Center. Clinical features, histopathologic findings, and prognostic factors were evaluated and compared with those for the older group. RESULTS: There were 30 cases (75%) of infiltrating ductal carcinomas in the twenties, which was relatively less than that in the older group (84.8%)(p=0.001). Ductal carcinomas in situ and special types such as mucinous, secretory, and medullary carcinomas and phyllodes tumors were noted more and infiltrating lobular carcinomas less in the younger group than in the older group. Patients in the twenties had smaller tumors (p=0.001) and fewer axillary lymph node metastases (p=0.018) than those in the older group. There were no significant differences between the groups of age 30 or younger and older in terms of the extensive intraductal component (EIC), histologic and nuclear grades, hormonal receptors, p53 mutation rates, and TNM staging (p>0.05). The Nottingham Prognostic Index used to assess the prognosis in breast cancer patients failed to prove the young age as a poor prognostic factor (p=0.133). CONCLUSION:Breast cancer in our study population of women in the twenties did not have a poor prognostic factor. We conclude that age itself is not a poor prognostic factor in patients with breast cancer.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Carcinoma, Lobular ; Carcinoma, Medullary ; Diagnosis ; Female ; Humans ; Lymph Nodes ; Mucins ; Mutation Rate ; Neoplasm Metastasis ; Neoplasm Staging ; Phyllodes Tumor ; Prognosis* ; Retrospective Studies

PURPOSE: Paget's disease of the breast (PDB) occurs in approximately 1~3% of all primary breast carcinomas. This study aimed to determine the optimal surgical treatments for PDB in this study. METHODS: The medical records of 16 patients with PDB who had been treated between January 1986 and December 1998 were clinically reviewed retrospectively. Results: 13 patients had nipple changes consistent with clinical Paget' disease (CPD) including 8 who had an associated breast mass, and 5 who had no associated mass. Of the 13 patients with CPD, 12 were treated with a modified radical mastectomy while 1 was treated with a radical mastectomy. Breast cancer (BC) was found in all of 13 patients (100%) with CPD. The BC was centrally located in 46% of patients including 38% in CPD associated with the mass and 60% in CPD not associated with the mass. Out of 8 CPD patients associated with the mass, 7 (88%) had invasive cancer, 1 (12%) had a ductal carcinoma in situ (DCIS), and 2 (25%) had pathologic axillary nodes (PAN). The 5 year survival rate was 87.5%. Of the 5 CPD patients not associated with the mass, 4 (80%) had an invasive cancer, 1 (20%) had a DCIS and none had PAN. Their 5 year survival rate is 100%. CONCLUSION:All the patients with CPD had an associated BC. BC is more frequently centrally located in the CPD not associated with the mass (60%) than those associated with the mass (38%). Contrarily, the BC in CPD that was not associated with the mass was located more peripherally (40%). Therefore, the treatment of patients with CPD must be individualized in order to avoid under or overtreatment.
Breast ; Breast Neoplasms ; Carcinoma, Intraductal, Noninfiltrating ; Humans ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Medical Records ; Nipples ; Paget's Disease, Mammary* ; Retrospective Studies ; Survival Rate

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 adju-vant 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 c0onservation 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: In Korea, the incidence of breast cancer is continuously growing year after year, and it has become the second most common cancer in females following stomach cancer. This study analyzed the clinical results of 2,101 breast cancer surgeries performed in Korea. METHODS: 2,101 breast cancer surgeries were performed between Mar. 1989 and Dec. 1999 at the Breast Clinic in Asan Medical Center. RESULTS: Of 2,101 patients, 2,085 cases were female (99.2%), and 16 cases were male (0.8%). The mean age of the patients was 46 and 65% of them were under the age of 50. A radical mastectomy was performed in 1.0% of cases, a modified radical mastectomy in 75.4%, a simple mastectomy in 4.1%, breast-conserving surgery in 15.5%, and other procedures in 3.9%. Immediate breast reconstruction was performed in 136 cases (tissue expander in 61 cases, direct implant in 10 cases, transverse rectus abdominis muscle (TRAM) flap in 62 cases, and latissimus dorsi myocutaneous flap in 3 cases). The majority of reconstruction was changed to skin-sparing mastectomy (SSM) with TRAM flap. According to TNM classification, there were 156 cases (7.4%) of stage 0, 538 cases (25.6%) of stage I, 1,062 cases (50.6%) of stage II, 241 cases (11.5%) of stage III, 65 cases (3.1%) of stage IV, and 39 cases (1.9%) of an unknown stage. The axillary lymph node metastasis was present in 43.2%. The 5-year overall and disease-free survival rates were 83.1% and 76.7%, respectively. CONCLUSION:This study shows several features suggesting that the peak age of breast cancer in Korea is younger than that seen in western countries and that the types of Korean breast cancer tend to be similar to western patterns.
Breast Neoplasms* ; Breast* ; Chungcheongnam-do ; Classification ; Disease-Free Survival ; Female ; Humans ; Incidence ; Korea* ; Lymph Nodes ; Male ; Mammaplasty ; Mastectomy ; Mastectomy, Modified Radical ; Mastectomy, Radical ; Mastectomy, Segmental ; Mastectomy, Simple ; Myocutaneous Flap ; Neoplasm Metastasis ; Rectus Abdominis ; Stomach Neoplasms ; Superficial Back Muscles

PURPOSE: The "triple test" (TT) which consists of a physical examination (PE), mammography (MMG), and fine needle aspiration (FNA) has been used for diagnosing a palpable breast mass. However, the TT is not always accurate when it is applied to young women. This is because a dense breast hampers the sensitivity of a mammograph. Here, we introduce breast ultrasonography (USG) in place of a MMG (Modified TT; MTT) to determine whether this method can facilitate a correct diagnosis of a breast mass. METHODS: A MTT was performed in 142 palpable solid breast masses from 126 female patients between August 1998 and July 2000 at the out-patient breast clinic, Chungbuk National University Hospital. The breast masses were listed as benign or suspicious/malignant. All patients underwent a subsequent needle biopsy or surgical biopsy for a definitive diagnosis. RESULTS: 78 out of 142 palpable breast masses (54.5%) were benign, while 64 (45.5%) were diagnosed as having breast cancer. In all 105 cases (73.9%) where the MTT was concordant (elements had either all malignant or benign results), a needle or surgical biopsy was confirmatory (predictive values, sensitivity, and specificity 100%). In 37 cases of the non-concordant results, 16 (44.7%) were proven as malignant. The positive predictive value for PE, USG, and FNA was 80.6%, 87.1%, and 100% respectively. The negative predictive value for PE, USG, and FNA was 91.4%, 95.8%, and 91.8% respectively. The sensitivity for PE, USG, and FNA was 90.6%, 95.3%, and 89.1% respectively. The specificity for PE, USG, and FNA was 82.1%, 88.5%, and 100% respectively. CONCLUSION:The modified triple test was 100% accurate for diagnosing a palpable breast mass when all three elements were concordant. A palpable breast mass with a concordant benign modified triple test could be safely followed up without a surgical biopsy, and a final treatment could be applied to patients who have had a concordant malignant modified triple test.
Biopsy ; Biopsy, Fine-Needle ; Biopsy, Needle ; Breast Neoplasms ; Breast* ; Chungcheongbuk-do ; Diagnosis ; Female ; Humans ; Mammography ; Needles ; Outpatients ; Physical Examination ; Sensitivity and Specificity ; Ultrasonography ; Ultrasonography, Mammary