Anesthesia for Mastectomy with Autologous Flap

2018 ◽  
pp. 125-130
Author(s):  
Eman Nada
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Chronic Pain ◽  
Latissimus Dorsi ◽  
Transversus Abdominis ◽  
Regional Analgesia ◽  
Risk Patients ◽  
Synthetic Grafts ◽  
Flap Perfusion

Mastectomy is performed for treatment of breast cancer or for prophylaxis of high-risk patients. The procedure is usually done under general anesthesia with or without regional analgesia. Reconstructive flap surgery is done to improve the quality of life. Autologous flaps provide better cosmetic and better longer term results than synthetic grafts. Common autologous flaps are transversus abdominis myocutaneous, deep inferior perforator epigastric perforator, and latissimus dorsi flap. Anesthesia plays an important role in the success of surgery. The procedure is long and needs meticulous attention to hemodynamics and maintenance of the flap perfusion which can be challenging. Chronic pain is common after mastectomy procedures; regional anesthesia together with other pharmacological analgesic therapy helps to reduce the development of chronic pain.

scholarly journals Myofascial Massage for Chronic Pain and Decreased Upper Extremity Mobility After Breast Cancer Surgery

2018 ◽  
Vol 11 (3) ◽  
pp. 4-9 ◽  
Author(s):  
Jeanne Massingill, LMT, MLD, CST, KT, NMT ◽  
Cara Jorgensen, LMT ◽  
Jacqueline Dolata, MBA ◽  
Ashwini R. Sehgal, MD
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Chronic Pain ◽  
Upper Extremity ◽  
Outcome Measures ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Mobility Limitations ◽  
And Control

Background: Chronic localized pain and decreased upper extremity mobility commonly occur following breast cancer surgery and may persist despite use of pain medication and physical therapy.Purpose: We sought to determine the value of myofascial massage to address these pain and mobility limitations.Setting: The study took place at a clinical massage spa in the U.S. Midwest. The research was overseen by MetroHealth Medical Center’s Institutional Review Board and Case Center for Reducing Health Disparities research staff.Participants: 21 women with persistent pain and mobility limitations 3–18 months following breast surgery.Research Design: We conducted a pilot randomized controlled trial where intervention patients received myofascial massages and control patients received relaxation massages.Intervention: Intervention participants received 16 myofascial massage sessions over eight weeks that focused on the affected breast, chest, and shoulder areas. Control participants received 16 relaxation massage sessions over eight weeks that avoided the affected breast, chest, and shoulder areas. Participants completed a validated questionnaire at the beginning and end of the study that asked about pain, mobility, and quality of life.Main Outcome Measures: Outcome measures include change in self-reported pain, self-reported mobility, and three quality-of-life questions.Results: At baseline, intervention and control participants were similar in demographic and medical characteristics, pain and mobility ratings, and quality of life. Compared to control participants, intervention participants had more favorable changes in pain (-10.7 vs. +0.4, p < .001), mobility (-14.5 vs. -0.8, p < .001), and general health (+29.5 vs. -2.5, p = .002) after eight weeks. All intervention and control participants reported that receiving massage treatments was a positive experience.Conclusions: Myofascial massage is a promising treatment to address chronic pain and mobility limitations following breast cancer surgery. Further work in several areas is needed to confirm and expand on our study findings.

scholarly journals Bridging The Age Gap: observational cohort study of effects of chemotherapy and trastuzumab on recurrence, survival and quality of life in older women with early breast cancer

2021 ◽  
Author(s):  
Alistair Ring ◽  
◽  
Nicolò Matteo Luca Battisti ◽  
Malcolm W. R. Reed ◽  
Esther Herbert ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
High Risk ◽  
Early Breast Cancer ◽  
Recurrence Risk ◽  
Older Individuals ◽  
Cancer Specific Survival ◽  
Metastatic Recurrence ◽  
Risk Patients

Abstract Background Chemotherapy improves outcomes for high risk early breast cancer (EBC) patients but is infrequently offered to older individuals. This study determined if there are fit older patients with high-risk disease who may benefit from chemotherapy. Methods A multicentre, prospective, observational study was performed to determine chemotherapy (±trastuzumab) usage and survival and quality-of-life outcomes in EBC patients aged ≥70 years. Propensity score-matching adjusted for variation in baseline age, fitness and tumour stage. Results Three thousands four hundred sixteen women were recruited from 56 UK centres between 2013 and 2018. Two thousands eight hundred eleven (82%) had surgery. 1520/2811 (54%) had high-risk EBC and 2059/2811 (73%) were fit. Chemotherapy was given to 306/1100 (27.8%) fit patients with high-risk EBC. Unmatched comparison of chemotherapy versus no chemotherapy demonstrated reduced metastatic recurrence risk in high-risk patients(hazard ratio [HR] 0.36 [95% CI 0.19–0.68]) and in 541 age, stage and fitness-matched patients(adjusted HR 0.43 [95% CI 0.20–0.92]) but no benefit to overall survival (OS) or breast cancer-specific survival (BCSS) in either group. Chemotherapy improved survival in women with oestrogen receptor (ER)-negative cancer (OS: HR 0.20 [95% CI 0.08–0.49];BCSS: HR 0.12 [95% CI 0.03–0.44]).Transient negative quality-of-life impacts were observed. Conclusions Chemotherapy was associated with reduced risk of metastatic recurrence, but survival benefits were only seen in patients with ER-negative cancer. Quality-of-life impacts were significant but transient. Trial Registration ISRCTN 46099296

scholarly journals Prevalence of Post-treatment Chronic Pain in Breast Cancer Patients and its Effect on their Quality of Life

2019 ◽  
Vol 10 (4) ◽  
pp. 355-361
Author(s):  
Meena Asokan ◽  
◽  
Harin Asokan ◽  
Amrita Mandal ◽  
Shanavas Cholakkal ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Chronic Pain ◽  
Cancer Patients ◽  
Post Treatment ◽  
Breast Cancer Patients
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