Necrotizing fasciitis of the breast is a rare but potentially fatal soft tissue infection. It may occur primarily in patients without any direct cause, and less commonly after undergoing elective surgical procedures such as cosmetic mammoplasties and oncologic resections.

This is a case of a 46-year-old female with stage IIIA invasive ductal carcinoma of the left breast treated with modified radical mastectomy presenting with a necrotizing infection involving the bilateral breast regions and left lateral abdomen six days after operation. She was managed with broad-spectrum antibiotics and radical debridement with right mastectomy, followed by wound coverage with split-thickness skin grafting. This is the eight case of breast necrotizing fasciitis occurring after mastectomy for breast cancer reported in the literature.

OBJECTIVE: To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative pain in patients undergoing modified radical mastectomy for breast cancer. METHODS: A total of 140 female patients scheduled for unilateral modified radical mastectomy for breast cancer undergoing general anesthesia were randomized into a TEAS group (70 cases) and a sham TEAS group (70 cases, 2 cases dropped out). Patients in both groups received TEAS or sham TEAS at bilateral Neiguan (PC6), Zusanli (ST36), and Danzhong (CV17), respectively, from 30 min before anesthesia induction until the end of surgery, and on 1st, 2nd, and 3rd days after surgery for 30 min a time, once a day. On 1st, 2nd, and 3rd days after surgery, the pain visual analogue scale (VAS) score was observed; on 3, 6, 12 months after surgery, the incidence rate of chronic pain was observed; before surgery, and on 1st, 3rd, and 7th days after surgery, the serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10 were detected; the number of analgesia pump press, rescue analgesia, and the occurrence of adverse reaction after surgery were recorded in the two groups. RESULTS: In the TEAS group, the VAS scores on 1st and 2nd days after surgery, and the incidence rates of chronic pain on 3 and 6 months after surgery were lower than those in the sham TEAS group (P<0.05). On 1st, 3rd, and 7th days after surgery, the serum levels of TNF-α, IL-6, and IL-10 were increased compared with those before surgery in both groups (P<0.05, P<0.01); the above indexes in the TEAS group were lower than those in the sham TEAS group (P<0.05). The number of analgesia pump press and the incidence rate of rescue analgesia after surgery in the TEAS group were lower than those in the sham TEAS group (P<0.05). There was no statistically significant difference in the incidence of adverse reactions after surgery between the two groups (P>0.05). CONCLUSION TEAS can effectively improve both the postoperative acute pain and chronic pain in patients undergoing modified radical mastectomy for breast cancer, the mechanism may relate to inhibiting the inflammatory reaction.
Humans ; Female ; Acupuncture Points ; Pain, Postoperative/blood* ; Middle Aged ; Breast Neoplasms/surgery* ; Adult ; Transcutaneous Electric Nerve Stimulation ; Mastectomy, Modified Radical/adverse effects* ; Interleukin-6/blood* ; Tumor Necrosis Factor-alpha/blood* ; Interleukin-10/blood* ; Aged

BACKGROUND

Studies reported survival benefits from early initiation of adjuvant chemotherapy from the time of mastectomy among breast cancer patients.

The researchers aimed to determine if early initiation of adjuvant chemotherapy among early-stage breast cancer patients undergoing modified radical mastectomy at Bataan General Hospital and Medical Center has increased the patient’s survival. We also want to asses if the Bataan General Hospital and Medical Center department of Oncology is rendering adjuvant chemotherapy as compared to the international standards. We also want to know the factors affecting the timing of initiation of adjuvant chemotherapy among the subjects.

A retrospective cohort study involving chart review covering the year May 2015 to January 2020 for stage 1 to 3 breast cancer patients, with a histopathologic confirmation, underwent definitive/curative breast surgery, and had started on adjuvant cytotoxic chemotherapy are included in the study.

In this retrospective study, we observed that time to initiation of adjuvant chemotherapy among breast cancer patients at Bataan General Hospital and Medical Center does not significantly improve overall survival of patients. The BGHMC Department of Oncology service is trailing the cut off 12 weeks or 84 days of initiation of adjuvant chemotherapy from the date of mastectomy. We also used the factors that affects the timing of initiation of adjuvant chemotherapy and found out that these variables cannot predict whether it will increase the patient’s survival since our sample size is too small.

Necrotizing fasciitis of the breast is a rare but potentially fatal soft tissue infection. It may occur primarily in patients without any direct cause, and less commonly after undergoing elective surgical procedures such as cosmetic mammoplasties and oncologic resections. This is a case of a 46-year-old female with stage IIIA invasive ductal carcinoma of the left breast treated with modified radical mastectomy presenting with a necrotizing infection involving the bilateral breast regions and left lateral abdomen six days after operation. She was managed with broad-spectrum antibiotics and radical debridement with right mastectomy, followed by wound coverage with split-thickness skin grafting. This is the eight case of breast necrotizing fasciitis occurring after mastectomy for breast cancer reported in the literature.
breast ; fasciitis, necrotizing ; mastectomy, modified radical

Breast Neoplasms/surgery* ; China ; Humans ; Mastectomy ; Mastectomy, Modified Radical

Male breast cancer (MBC), which constitutes only 1% of all breast cancer cases worldwide, is associated with mutations in the BRCA1 and BRCA2 genes, Klinefelter’s syndrome and a positive family history of breast or ovarian malignancy. Patients with MBC typically present with a palpable subareolar mass, with or without nipple involvement. MBC can be identified by mammography and/or ultrasonography. The definitive diagnosis is made through core needle biopsy and cytology. Breast cancer in men are typically low-grade, and usually estrogen- and progesterone-receptor positive. The surgical treatment of choice is usually a modified radical mastectomy. Hormone therapy, can be used as first-line treatment for hormone-receptor positive MBC, and as adjuvant or palliative therapy for advanced cases. The use of adjuvant cytotoxic chemotherapy has been shown to reduce cancer recurrence and improve overall survival. We present the case of a 51-year-old male who came in due to an enlarging right breast mass that had been removed twice in the past eight years. We were able to establish that the patient had MBC, for which he subsequently underwent a modified radical mastectomy
Klinefelter Syndrome ; Mastectomy, Modified Radical ; Tamoxifen x

PURPOSE: We compared the oncologic outcomes of breast-conserving surgery plus radiation therapy (BCS+RT) and modified radical mastectomy (MRM) under anthracycline plus taxane-based (AT) regimens and investigated the role of adjuvant radiation therapy (RT) in patients with pathologic N1 (pN1) breast cancer treated by mastectomy. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 2,011 patients with pN1 breast cancer who underwent BCS+RT or MRM alone at 12 institutions between January 2006 and December 2010. Two-to-one propensity score matching was performed for balances in variables between the groups. RESULTS: The median follow-up duration for the total cohort was 69 months (range, 1 to 114 months). After propensity score matching, 1,074 patients (676 in the BCS+RT group and 398 in the MRM-alone group) were analyzed finally. The overall survival, disease-free survival, locoregional failure-free survival, and regional failure-free survival (RFFS) curves of the BCS+RT group vs. MRM-alone group were not significantly different. The subgroup analysis revealed that in the group with both lymphovascular invasion (LVI) and histologic grade (HG) III, the BCS+RT showed significantly superior RFFS (p=0.008). Lymphedema (p=0.007) and radiation pneumonitis (p=0.031) occurred more frequently in the BCS+RT group than in the MRM-alone group, significantly. CONCLUSION: There are no differences in oncologic outcomes between BCS+RT and MRM-alone groups under the AT chemotherapy regimens for pN1 breast cancer. However, BCS+RT group showed superior RFFS to MRM-alone group in the patients with LVI and HG III. Adjuvant RT might be considerable for pN1 breast cancer patients with LVI and HG III.
Anthracyclines ; Breast Neoplasms ; Breast ; Cohort Studies ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Lymphedema ; Mastectomy ; Mastectomy, Modified Radical ; Mastectomy, Segmental ; Medical Records ; Propensity Score ; Radiation Pneumonitis ; Retrospective Studies

PURPOSE: To compare the dose distribution of three-dimensional conformal radiation therapy (3DCRT) with intensity-modulated radiation therapy (IMRT) for post-mastectomy radiotherapy (PMRT) to left chest wall. MATERIALS AND METHODS: One hundred and seven patients were randomised for PMRT in 3DCRT group (n = 64) and IMRT group (n = 43). All patients received 50 Gy in 25 fractions. Planning target volume (PTV) parameters—Dnear-max (D2), Dnear-min (D98), Dmean, V95, and V107—homogeneity index (HI), and conformity index (CI) were compared. The mean doses of lung and heart, percentage volume of ipsilateral lung receiving 5 Gy (V5), 20 Gy (V20), and 55 Gy (V55) and that of heart receiving 5 Gy (V5), 25 Gy (V25), and 45 Gy (V45) were extracted from dose-volume histograms and compared. RESULTS: PTV parameters were comparable between the two groups. CI was significantly improved with IMRT (1.127 vs. 1.254, p < 0.001) but HI was similar (0.094 vs. 0.096, p = 0.83) compared to 3DCRT. IMRT in comparison to 3DCRT significantly reduced the high-dose volumes of lung (V20, 22.09% vs. 30.16%; V55, 5.16% vs. 10.27%; p < 0.001) and heart (V25, 4.59% vs. 9.19%; V45, 1.85% vs. 7.09%; p < 0.001); mean dose of lung and heart (11.39 vs. 14.22 Gy and 4.57 vs. 8.96 Gy, respectively; p < 0.001) but not the low-dose volume (V5 lung, 61.48% vs. 51.05%; V5 heart, 31.02% vs. 23.27%; p < 0.001). CONCLUSIONS: For left sided breast cancer, IMRT significantly improves the conformity of plan and reduce the mean dose and high-dose volumes of ipsilateral lung and heart compared to 3DCRT, but 3DCRT is superior in terms of low-dose volume.
Breast Neoplasms ; Heart ; Humans ; Lung ; Mastectomy, Modified Radical ; Radiometry ; Radiotherapy ; Radiotherapy, Intensity-Modulated ; Thoracic Wall ; Thorax ; Unilateral Breast Neoplasms

We report a case of chronic myeloid leukemia (CML) that developed after postoperative chemotherapy with cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) for breast cancer. A 55-year-old woman was diagnosed with invasive ductal carcinoma which was treated with a modified radical mastectomy followed by six cycles of CAF chemotherapy. Nine years later, she developed CML and locoregional recurrence. Her breast recurrence showed strong estrogen receptor, weak progesterone receptor and strong human epidermal growth factor 2 (score 3+) expression. Her secondary CML in the chronic phase showed a complex variant translocation (CVT) involving chromosomes 9, 22, and 17. Considering that the HER2/neu gene is also located on chromosome 17, this secondary CML in chronic phase with CVT is indeed a rare occurrence. We discuss the associated genetic factors and the possible role of breast cancer chemo/radiotherapy in the development of such CML as well as its treatment and prognosis compared with de novo CML.
Breast Neoplasms* ; Breast* ; Carcinoma, Ductal ; Chromosomes, Human, Pair 17 ; Cyclophosphamide ; Doxorubicin ; Drug Therapy ; Epidermal Growth Factor ; Estrogens ; Female ; Fluorouracil ; Humans ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Mastectomy, Modified Radical ; Middle Aged ; Prognosis ; Receptors, Progesterone ; Recurrence

Medical leech therapy is a treatment for the venous congestion of tissue flaps, grafts, and replants. We report a case of methicillin-resistant Staphylococcus aureus (MRSA) following leech application at a congested flap after mastectomy. A 45-year-old woman had an invasive ductal carcinoma. Modified radical mastectomy was performed. The chest wall defect was reconstructed with a local rotation flap. On postoperative day (POD) 1, congestion and color change were observed, and 10 medical leeches were applied to the congested area. On POD 4, another 10 medical leeches were applied. On POD 12, wound necrosis progressed and a pus-like discharge appeared. A wound swab culture revealed MRSA. Debridement was carried out on POD 15. From POD 16, vancomycin and piperacillin/tazobactam were injected for 18 days. The wound culture on POD 18 also revealed MRSA. A split-thickness skin graft was performed on POD 28. MRSA has not been clearly identified in the literature as a leech enteric bacterium. Although MRSA may have come from another source, the present case raises the possibility of MRSA infections following leech application at congested flaps. When medical leeches are applied at the congestion site of a flap, an aseptic cradle will be helpful. Vancomycin irrigation may be needed if infection occurs.
Carcinoma, Ductal ; Debridement ; Estrogens, Conjugated (USP)* ; Female ; Humans ; Hyperemia ; Leeches ; Leeching ; Mastectomy* ; Mastectomy, Modified Radical ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Middle Aged ; Necrosis ; Skin ; Surgical Wound Infection ; Thoracic Wall ; Transplants ; Vancomycin ; Wounds and Injuries