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Background: Breast cancer is the most commonly diagnosed type of cancer in the world and it is a major stressor in women's lives. Breast cancer cases are increasing in both rural and urban settings. Mastectomy is a procedure that removes the breast to prevent cancer cells from returning. Many complications can develop after a mastectomy but lymphedema and limited range of motion are the most prevalent. The present study aimed to assess the effectiveness of post mastectomy exercises in breast cancer patients on reduction of lymphedema and improving range of motion among patients undergone mastectomy. Objectives: To assess pre interventional level of lymphedema among patients undergone mastectomy. To assess pre interventional range of motion among patients undergone mastectomy. To evaluate the effectiveness of post mastectomy exercises in reducing lymphedema among patients undergone mastectomy To evaluate the effectiveness of post mastectomy exercises in improving range of motion among patients undergone mastectomy. To associate demographic variable with post mastectomy exercises. To associate correlation of post mastectomy exercise with lymphedema and range of motion. Methodology: A pre interventional one group pretest posttest design would be adopted to assess the effectiveness of post mastectomy exercises in breast cancer patients on reduction of lymphedema and improving range of motion among patients undergone mastectomy. In this study interventional analytical study will be used. Purposive sampling technique will be used to collect the data. The study will include 30 patients undergone mastectomy will be assessed by using American lymphology lymphedema scale and Elvaru STJ (Subtalar joint) range of motion and range of motion reliability tool with the help of inch tape and goniometer and then post mastectomy exercises will be teach by researcher as intervention. Expected Results: The goal of this study is to see how effective post-mastectomy exercises are at reducing lymphedema and improving range of motion in breast cancer patients who had undergone mastectomy. Teaching post-mastectomy exercises can help the respondents reduce lymphedema and improve their range of motion.

INTRODUCTION The aim of this study was to evaluate the use of post-mastectomy hypofractionationed radiation therapy (HFRT) for breast cancer in Victoria, Australia. METHODS This is a population-based cohort of women with breast cancer who received post-mastectomy RT to the chest wall with or without nodal irradiation between 2012 and 2017. HFRT was defined as

Background: Breast implant placement is a common operation performed by plastic surgeons, with more than 78,664 implant-based breast reconstructions carried out in the United States in 2016. Infect...

Breast reconstruction is associated with improved patient well-being after mastectomy; however, factors that contribute to post-surgical dissatisfaction remain poorly characterized. Adult women who underwent post-mastectomy implant-based or autologous breast reconstruction between 2015 and 2019 were recruited to participate in semi-structured interviews regarding their lived experiences with reconstructive care. Participants completed the BREAST-Q, and tabulated scores were used to dichotomize patient-reported outcomes as satisfied or dissatisfied (high or low) for each BREAST-Q domain. A convergent mixed-methods analysis was used to evaluate interviews for content related to satisfaction or dissatisfaction with breast reconstruction. Overall, we interviewed 21 women and identified 17 subcodes that corresponded with the five BREAST-Q domains. Sources of dissatisfaction were found to be related to the following domains: (a) low breast satisfaction due to asymmetry, cup size, and lack of sensation and physical feeling (n = 8, 38%); (b) poor sexual well-being due to shape, look and feel (n = 7, 78% [of 9 who discussed sexual well-being]); (c) reduced physical well-being of the chest due to persistent pain and weakness (n = 11, 52%); (d) reduced abdominal well-being due to changes in abdominal strength, numbness, and posture (n = 6, 38% [of 16 who underwent abdominally based reconstruction]); and (e) low psychosocial well-being impacted by an unexpected appearance that negatively influenced self-confidence and self-identity (n = 13, 62%). Patients may be unprepared for the physical, sexual, and psychosocial outcomes of breast reconstruction. Targeted strategies to improve preoperative education and shared decision making are needed to mitigate unexpectedness associated with breast reconstruction and related outcomes.

Aim: The purpose of this study is to evaluate the late toxicities in hypo fractionated radiation schedule in breast cancer patients with regional nodal irradiation (RNI), limited to axilla and supraclavicular regions. Late effects on arm and shoulder were noted as follows: skin edema (lymphedema), restricted shoulder movements (brachial plexus injury) and localised pain.Material and Methods: In this study we randomly enrolled 100 breast cancer post mastectomy cases in the year 2018. All cases were previously asymptomatic after surgery. They were prospectively treated with hypo fractionated local and regional nodal irradiation by 2.67 gray / fraction dose, total 15 fractions (total dose-40 gray). Evaluation was done at 12 months after completion of radiation therapy. Assessment was done by RTOG, LENT- SOMA scales. Results: Significant lymphedema was observed in 17 (17%) cases. Restricted arm mobility was seen in 14 (14%) of patients. Pain (moderate/severe) in arm and shoulder was most commonly seen, in 25 (25%) cases. Conclusions: As hypo fractionated regimes in breast cancer treatment have become new standard; its late term effects are significant and comparable to other conventional radiation therapy regimes. These studies need further and longer duration of evaluation.

Purpose Post-mastectomy radiation therapy significantly reduces locoregional recurrence rates, which can be achieved with external beam radiotherapy delivered to chest wall, followed by scar irradiation either by electron or high-dose-rate (HDR) mould brachytherapy. The present study evaluates dosimetric advantage of Acuros® BV, a TG-186 MBDCA, over TG-43 formalism using 192Ir source for HDR brachytherapy in chest wall scar boost using catheter flap. Material and methods A total of 25 patients, free of cardiac and pulmonary co-morbidities, who met the inclusion criteria were involved in the study. Catheter flap made of silicon with 20 channels was used to deliver a total dose of 7.5 Gy/3 fx by HDR surface mould brachytherapy to delineated scar volume. Plan was optimized with iterative method to obtain desired results with TG-43 formalism, followed by Acuros® BV (GBBS algorithm) without altering dwell positions or time. The two algorithm plans were analyzed qualitatively and quantitatively with dose-volume histograms. Results The mean D98% CTV-HDR_evl coverage decreased by 1.16% compared to TG-43, and near-maximum dose decreased by 8.18% (p = 0.000), mean Dmax dose to CTV-HDR_evl, and mean Dmean dose was lesser by 6.25% (p = 0.000) and 10.82% (p = 0.000), respectively, compared to TG-43. Heart D2% showed significant results, whereas Dmedian (cGy) revealed very significant difference. A 5 mm thick skin contour showed statistically significant results (p = 0.000) for V150% and V200%. Conclusions The presented data showed how Acuros® BV, algorithm-based calculation in scar boost irradiation of breast, accounting for a mass density of the medium and scatter condition, considered actual dose prediction in a medium.

Background: Axillary Web Syndrome (AWS) is characterized by axillary pain radiating down the ipsilateral arm, shoulder range-of-motion limitation, and an axillary web of tissue most obvious on physical examination when the patient tries to abduct her arm. The use of laser as a non-surgical medical treatment modality for assisting the normal processes of healing has increased over the last few years. However, the efficacy of laser in reducing pain or promoting tissue repair remains controversial. Objective: This study was undertaken to determine the effect of low-level laser therapy on axillary web syndrome post mastectomy. Patients and Methods: This study included forty female patients who underwent mastectomy and received their treatment in Tagamoo branch of National Cancer Institute. Their ages ranged 40 to 55 years and body mass index ranged 25 to 30 (kg/m2). The patients were selected from Medical Oncology Department, National Cancer Institute, between January 2019 to June 2019. Results: The results of this study revealed that Group A and Group B showed significant improvement in shoulder mobility (Flexion, Abduction and External rotation) and decrease of pain but by comparison between the two groups, group A showed greater improvement than Group B. Conclusion: It could be concluded that low level laser in addition to traditional therapy and medical therapy can improve shoulder mobility and decrease pain more than using only traditional and medical therapy.The result of this study supported the expectation that Low Level Laser had a position effect on axillary web syndrome.

Wei-Xiang Qi, Lu Cao, Cheng Xu, Shengguang Zhao, Jiayi Chen Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of ChinaCorrespondence: Jiayi Chen; Wei-xiang QiDepartment of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of ChinaEmail jiayichen2019@126.com; qiweixiang1113@163.comAim: To establish and validate a nomogram for predicting prognosis of breast cancer patients with pN0-1 who were treated with mastectomy and without adjuvant radiotherapy.Material and Methods: The LASSO regression was performed to identify predictors of breast cancer-specific survival (BCSS), local regional recurrence (LRR) and distant metastasis (DM). Model performance was evaluated by the concordance index (C-index) and calibration plot.Results: The 5-year BCSS, LRR and DM rates for the entire cohort were 98%, 2% and 4%, respectively. LASSO regression analysis found that pathological T stage, number of positive LN, grade and Ki-67 were significant predictors for both BCSS and DM-free survival, while number of resected LN and PR status were predictors for DM-free survival. In addition, number of positive LN was the only significant predictor for developing LRR. The C-indexes for the 5-year BCSS and DM nomograms were 0.81 and 0.78 in the training data set, 0.65 and 0.70 in the testing set and 0.72 and 0.69 in the external validation set, respectively.Conclusion: Our prognostic nomograms accurately predict 5-year BCSS and DM-free survival in post-mastectomy breast cancer without adjuvant radiotherapy, which provides a useful tool to identify high-risk patients who could benefit from additional adjuvant therapy.Keywords: breast cancer, pN0-1, mastectomy, LASSO analysis, nomogram, prognosis

Purpose of this study was to assess likelihood of undergoing breast reconstruction based on race, socioeconomic status, insurance, and distance from the hospital. Patients with public insurance were less likely to undergo reconstruction than patients with private insurance (OR = 2.99, p

Female BRCA1/BRCA2 mutation carriers may elect bilateral risk-reducing mastectomy. There is a paucity of data on yield of imaging surveillance after risk-reducing mastectomy. This retrospective study focused on female BRCA1/BRCA2 mutation carriers who underwent bilateral mastectomy either as primary preventative, or as secondary preventative, after breast cancer diagnosis. All participants underwent breast imaging at 6- to 12-month intervals after mastectomy. Data on subsequent breast cancer diagnosis and timing were collected and compared between the groups. Overall, 184 female mutation carriers (134 BRCA1, 45 BRCA2, 5 both BRCA genes) underwent bilateral mastectomy after initial breast cancer diagnosis, between April 1, 2009 and August 31, 2018. During a mean follow-up of 6.2 +/- 4.2 years, 13 (7.06%) were diagnosed with breast cancer; 12 ipsilateral (range: 0.4-28.8 years) and 1 contralateral breast cancer, 15.9 years after surgery. On the contrary, among asymptomatic BRCA1 (n = 40) and BRCA2 (n = 13) mutation carriers who underwent primary risk-reducing mastectomy (mean age at surgery 39.5 +/- 8.4 years); none has developed breast cancer after a mean follow-up of 5.4 +/- 3.4 years. BRCA1/BRCA2 mutation carriers with prior disease who underwent risk-reducing mastectomy after breast cancer diagnosis are still prone for developing ipsi or contralateral breast cancer, and therefore may benefit from continues clinical and imaging surveillance, unlike BRCA1/BRCA2 mutation carriers who undergo primary preventative bilateral mastectomy.

BackgroundBreast cancer is the leading cancer affecting women in Singapore. Its survivors commonly experience decline in physical function and quality of life post-mastectomy, due to their upper limb morbidity and wound issues. Rehabilitation can address the aforementioned issues. When rehabilitation is accessible and easy to adhere, it can optimize recovery.Home-based tele-rehabilitation guided by healthcare professionals and self-managed by patients can potentially optimize the patients’ adherence to rehabilitation and recovery. With that in mind, a team of breast cancer specialists (oncologists, nurses, and therapists) in Singapore has developed one of the first tele-rehabilitation systems for local women undergoing a unilateral mastectomy. To our knowledge, no such systems have been evaluated or proven effective as a treatment option among local breast cancer patients with acute disabilities.MethodsThis is a pilot quasi-experimental trial that aims to evaluate the feasibility of tele-rehabilitation and tele-drain care compared to usual care. Up to 40 patients (20 per group) will be recruited for this trial. They will be assigned to an intervention group that receives rehabilitation via a tele-rehabilitation system or a control group that receives rehabilitation in person at their clinic. The primary outcome of this trial is rehabilitation participation (i.e., the time spent on rehabilitation). The secondary outcomes are upper extremity functioning, perceived health, and quality of life.DiscussionAs part of this pilot trial, patients who opt in for the tele-rehabilitation will be asked to share their experience with and thoughts on the tele-rehabilitation system. With the evidence obtained from the tele-rehabilitation patients of this trial, we will be able to improve the current system for our future trial. Further, our additional data on rehabilitation participation, physical function, and quality of life will help us design a sufficiently powered future main trial.Trial registrationThe trial was approved by the National Healthcare Group’s Domain Specific Review Board (#2019/00283) and registered withwww.ClinicalTrials.gov(#NCT04269967) in February 2020.

Autologous flap reconstruction is widely used after skin sparing mastectomy to reconstruct the appearance of the breast. We present 2 cases of breast cancer recurrence in a deep inferior epigastric perforator reconstruction, including a 65-year-old female with history of papillary carcinoma and a 35-year-old female with history of a high grade invasive ductal carcinoma with extensive ductal carcinoma in situ. Differential imaging considerations of the post mastectomy patient are reviewed. Typical appearance of a deep inferior epigastric perforator flap reconstruction as well as location and timing of presentation may help differentiate a recurrence from the more commonly encountered postsurgical etiologies.

Ramifications of postoperative complications on long-term survival after mastectomy are uncertain.Overall complications (Clavien-Dindo Grades I-IIIB) and wound complications were analyzed using the Kaplan-Meier method for impact on 5-year overall (OS) and disease-free survival (DFS).A total of 378 patients underwent mastectomy alone (157, 41%) or mastectomy with reconstruction (221, 59%) for Stage I-III disease with a median follow-up of 5 years. Postoperative complications occurred in 186 patients (49%), requiring non-surgical (I/II = 83, 22%) or surgical (IIIa/IIIb = 103, 27%) management. Wound complications occurred in 140 patients (37%). Reconstruction was associated with a higher rate of complication (P 0.001). Postoperative complications after mastectomy (with or without reconstruction) did not significantly affect OS or DFS. Wound complications also showed no significant effect on OS or DFS following mastectomy alone, or mastectomy with reconstruction.Postoperative complications after mastectomy, with or without reconstruction, bear no significant impact on 5-year survival.

Background: Health is the major reference regarding quality of life ;when it comes to breast cancer in particular, the loss of abreast traumatically affects a women’s life, reflecting on her quality of life. Aim of this study is to identify factors associated with quality of life among women undergoing hormonal therapy post mastectomy at outpatient’s clinics in El-Beheira oncology center. Research design: a descriptive cross sectional research design. Settings: This study was carried out in hormonal therapy outpatient clinics in oncology center in EL-Beheira governorate. Subjects: this study was carried on a convenient sample of 200 women. Data collection tools: data were collected using two tools: women structured interview schedule and Quality of Life Assessment scale Sheet (WHOQOL-100).Results: the age of the studied women ranged from less than 30years to equal or less than 45 years with a Mean ± SD(36.64 ± 5.33) years. More than half of the studied women (57.5%) had fair quality of life while more than two fifths (42%) of them had poor quality of life. According to linear regression model for predictors of quality of life among women undergoing hormonal therapy post mastectomy : women's education, monthly income, using of family planning methods, stage (III) of breast cancer and the presence of sores in the breast skin are the most independent risk factors associated with poor quality of life . On the other hand, the most independent protective factors associated with good QoL are women's age(OR=0.837, P=0.015) in which old age are (80%) protective for good QoL than young age , occupation (OR=0.201, P=0.017) in which worker women are (20%) protective factors associated with good QoL than non-worker, number of children (OR=0.709, P=0.011) in which women who have higher number of children are (70.0%) protective for good QoL than women have lower number of children . Conclusion: the study concluded that, women's education, monthly income, using of family planning methods, stage (III) of breast cancer and the presence of sores in the breast skin are the most independent risk factors associated with poor quality of life. Therefore, results are useful to establish strategy to improve quality of life of post mastectomies women. Recommendations: this study recommends Providing financial support for underprivileged, post mastectomies survivors and patients with low socioeconomic status in order to help them in continuing treatment according to protocol and an experimental study should be carried out to find out the effectiveness of a liaison psychiatric nursing program in reducing the stress levels, improving quality of life and enhancing coping strategies among the patients with cancer especially those undergoing mastectomy. Keywords: Factors, Associated, Women, Outpatient Clinics, El-Beheira, Oncology Center, Quality of life, Hormonal therapy, Post mastectomy. Title: Factors Associated with Quality of Life among Women Undergoing Hormonal Therapy Post Mastectomy at Outpatients Clinics in El-Beheira Oncology Center Author: Nadia Mohammed Darder, Wesam kamal Ali Farag, Abeer Abdel Aziz Madian International Journal of Novel Research in Healthcare and Nursing ISSN 2394-7330 Vol. 9, Issue 2, May 2022 - August 2022 Page No: 1-16 Novelty Journals Website: www.noveltyjournals.com Published Date: 10-May-2022 DOI: https://doi.org/10.5281/zenodo.6535624 Paper Download Link: https://www.noveltyjournals.com/upload/paper/Factors%20Associated%20with-10052022-1.pdf, International Journal of Novel Research in Healthcare and Nursing, Novelty Journals, Website: www.noveltyjournals.com, {"references":["[1]\tTyagi N , Sharma G, Sahu N , Chaudhary N and Sharivistiva B. Cancer: An Overview. 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Introduction: The latissimus dorsi (LD) flap has been used for reconstructing mastectomy defects since the early 1900s. Although its popularity has declined over the last decades, it still retains an important role in breast reconstruction. We present our recent experience with the multistage LD flap and implant for extremely complex post-mastectomy defects. Patients and Methods: Between 2011 and 2020, 42 consecutive patients underwent post-mastectomy LD reconstruction with an expander (STAGE 1). Some of them received prior fat-grafting of the mammary region (STAGE 0). All patients were scheduled for an expander-definitive implant change (STAGE 2). Some of them completed the program with fat-grafting, nipple and areola reconstruction, and other refinements (STAGE 3 or 4). Results: Two patients underwent fat-grafting at STAGE 0. Mean age at STAGE 1 was 46.7 years, mean BMI was 23.6, 14.4% of the patients were smokers, and 21.4% had comorbidities. Immediate reconstructions were performed in 35.7% and delayed in 64.3%. Mean surgical time at STAGE 1 was 194.7 min for delayed reconstructions and 242.3 min for immediate ones. Mean hospital stay for STAGE 1 procedures was 3.8 days; all other STAGES were performed as ambulatory surgery. No flap necrosis was observed and only 1 patient required a surgical revision for bleeding. Dorsal seroma occurred in 45.2% of cases. Conclusions: The multistage LD flap with implant is a useful and safe tool within the reconstructive armamentarium for post-mastectomy defects. It combines multiple simple procedures and does not require specific skills and surgical training (level of evidence 4).

Background/aim This study aimed to investigate the bolus practice among Italian radiation oncologists. Patients and methods In 2018, a survey on bolus application was sent to all members of the Italian Association of Radiotherapy and Clinical Oncology. Results The survey was joined by 102 radiation oncologists. Not all respondents answered to every question. A 69.5% of 82 respondents used bolus in case of skin infiltration and 52 of 68 respondents (76.5%) applied it every day. Skin was included as part of chest wall Clinical Target Volume both in the absence or the presence of breast reconstruction. Five mm bolus was the most used. 3D Conformal radiotherapy was the most used technique, in 73.5% of cases. Acute RTOG G2-G3 skin toxicity was recorded by 93.9% physicians. Conclusion There was heterogeneity in the use of bolus, though an agreement was found in some topics. The achievement of a National Consensus may represent an interesting future goal.

Immediate breast reconstruction versus delayed breast reconstruction improves quality of life of breast cancer patients undergoing total mastectomy without impacting oncologic outcomes. Two types of immediate reconstruction are possible, implant-based reconstruction or autologous reconstruction. These reconstructions interpose a tissue in the operating bed, which modifies target volume definition compared to a wall without reconstruction Post mastectomy radiotherapy increases the rate of postoperative complications for both surgical procedures. Recent guidelines were published about target volume definition in the post mastectomy setting after implant-based reconstruction. Guidelines about target volume definition after autologous reconstruction are still awaited. The aim of our work is to present the different surgical procedures for immediate breast reconstruction, their complications, and the definition of the postmastectomy target volume.

To assess the proportion of breast cancer patients treated with total mastectomy who are interested in undergoing breast reconstruction, the factors associated with their desire to undergo this procedure, and the motives stated for their decision. Women with stage I–III breast cancer, public health insurance, and history of total mastectomy treated at a center in Monterrey, Mexico, were invited to answer a series of questionnaires regarding their clinical and demographic characteristics, information received about breast reconstruction, body image, and relationship satisfaction. A total of 100 patients were interviewed, of which 68% desired to undergo breast reconstruction. Only 35% recalled talking about this procedure with a physician and 85% claimed not to have enough information to make an informed decision. Those who desired breast reconstruction were younger (p < 0.001), more likely to be in a relationship (p = 0.025), and had a higher probability of having talked to a physician about the procedure (p = 0.019). Furthermore, they felt less sexually attractive (p < 0.001), more deformed (p = 0.006), and less feminine (p = 0.005) since the mastectomy. The main motives to undergo this procedure were to have breast symmetry and greater freedom on which clothes to wear, while the main deterrent was the high economical cost. Insufficient information about the procedure and high economical cost were identified as potential barriers to undergo breast reconstruction. The findings of this study emphasize the pressing need to optimize patient care by providing information in a standardized manner and improving access to breast reconstruction within the Mexican public healthcare system.

To design a new breast vacuum bag to reduce global and local setup errors in post-mastectomy radiation therapy (PMRT). A total of 24 PMRT patients were immobilized with an old vacuum bag and 26 PMRT patients were immobilized with a new vacuum bag. The registration results were analysed using four regions of interest (ROI): the global ROI [including the whole region of the planning target volume (PTV), GROI], the supraclavicular area (SROI), the ipsilateral chest wall region (CROI) and the ipsilateral arm region (AROI). The global and local setup errors of the two groups were compared. The global setup errors of the new vacuum group were significantly smaller than those in the old vacuum group with the exception of yaw axes (P

Purpose This study was designed to evaluate skin dose in both VMAT and tangent treatment deliveries for the purpose of identifying suitable bolus use protocols that should produce similar superficial doses. Methods Phantom measurements were used to investigate skin dose in chest wall radiotherapy with and without bolus for 3D and rotational treatment techniques. Optically stimulated luminescence dosimeters (OSLDs) with and without housing and EBT3 film were used. Superflab (3, 5, and 10 mm) and brass mesh were considered. Measured doses were compared with predictions by the Eclipse treatment planning system. Patient measurements were also performed and the bolusing effect of hospital gowns and blankets were highlighted. The effect of flash for VMAT plans was considered experimentally by using 2 mm couch shifts. Results For tangents, average skin doses without bolus were 0.64 (EBT3), 0.62 (bare OSLD), 0.77 (jacketed OSLD), and 0.68 (Eclipse) as a fraction of prescription. For VMAT, doses without bolus were 0.53 (EBT3), 0.53 (bare OSLD), 0.64 (jacketed OSLD), and 0.60 (Eclipse). For tangents, the average doses with different boluses as measured by EBT3 were 0.99 (brass mesh), 1.02 (3 mm), 1.03 (5 mm), and 1.07 (10 mm). For VMAT with bolus, average doses as measured by EBT3 were 0.83 (brass), 0.96 (3 mm), 1.03 (5 mm), and 1.04 (10 mm). Eclipse doses agreed with measurements to within 5% of measurements for all Superflab thicknesses and within 15% of measurements for no bolus. The presence of a hospital gown and blanket had a bolusing effect that increased the surface dose by approximately 10%. Conclusions Results of this work allow for consideration of different bolus thicknesses, materials, and usage schedules based on desired skin dose and choice of either tangents or an arc beam techniques.

BackgroundBreast reconstruction (BR) is performed to improve outcomes for patients undergoing mastectomy. A recently developed core outcome set for BR includes six patient-reported outcomes that should be measured and reported in all future studies. It is vital that any instrument used to measure these outcomes as part of a core measurement set be robustly developed and validated so data are reliable and accurate. The aim of this systematic review is to evaluate the development and measurement properties of existing BR patient-reported outcome measures (PROMs) to inform instrument selection for future studies.MethodsA PRISMA-compliant systematic review of development and validation studies of BR PROMs was conducted to assess their measurement properties. PROMs with adequate content validity were assessed using three steps: (1) the methodological quality of each identified study was assessed using the COSMIN Risk of Bias checklist; (2) criteria were applied for assessing good measurement properties; and (3) evidence was summarized and the quality of evidence assessed using a modified GRADE approach.ResultsFourteen articles reported the development and measurement properties of six PROMs. Of these, only three (BREAST-Q, BRECON-31, and EORTC QLQ-BRECON-23) were considered to have adequate content validity and proceeded to full evaluation. This showed that all three PROMs had been robustly developed and validated and demonstrated adequate quality.ConclusionsBREAST-Q, BRECON-31, and EORTC QLQ-BRECON-23 have been well-developed and demonstrate adequate measurement properties. Work with key stakeholders is now needed to generate consensus regarding which PROM should be recommended for inclusion in a core measurement set.

Highlights • Arms down positioning is achievable for proton post-mastectomy radiation therapy. • Arms down position is dosimetrically comparable to conventional arms up position. • Arms down position setup is as accurate as the conventional arms up position setup. • An arms-down contouring atlas has been provided for reproducibility., Background and purpose Breast cancer patients receiving radiation are traditionally positioned with both arms up, but this may not be feasible or comfortable for all patients. We evaluated the treatment planning and positioning reproducibility differences between the arms up and arms down positions for patients receiving post-mastectomy radiation therapy (PMRT) using proton pencil beam scanning (PBS). Materials and methods Ten PMRT patients who were scheduled to receive PBS underwent CT-based treatment planning in both an arms down and a standard arms up position. An arms down contouring atlas was developed for consistency in treatment planning. Treatment plans were performed on both scans. A Wilcoxon test was applied to compare arms up and arms down metrics across patients. Five patients received treatment in the arms-down position at our institution while others were treated with the arms up. Residual set-up errors were recorded for each patient’s treatment fractions and compared between positions. Results Target structure coverage remained consistent between the arms up and arms down positions. In regard to the OAR, the heart mean and maximum doses were statistically significantly lower in the arms up position versus the arms down position, however, the absolute differences were modest. Patients demonstrated similar setup errors, less than 0.5 mm differences, in all directions. Conclusions PBS for PMRT in the arms down position appeared stable and reproducible compared to the traditional arms up positioning. The degree of OAR sparing in the arms down group was minimally less robust but still far superior to conventional photon therapy.

Since April 2015, post-mastectomy breast reconstruction has been covered by the Korean National Health Insurance Service (NHIS). The frequency of these procedures has increased very rapidly. We analyzed data obtained from the Big Data Hub of the Health Insurance Review and Assessment Service (HIRA) and determined annual changes in the number of breast reconstruction procedures and related trends in Korea. We evaluated the numbers of mastectomy and breast reconstruction procedures performed between April 2015 and December 2018 using data from the HIRA Big Data Hub. We determined annual changes in the numbers of total, autologous, and implant breast reconstructions after NHIS coverage commenced. Data were analyzed using Microsoft Excel. The post-mastectomy breast reconstruction rate increased from 19.4% in 2015 to 53.4% in 2018. In 2015, implant reconstruction was performed in 1,366 cases and autologous reconstruction in 905 (60.1% and 39.8%, respectively); these figures increased to 3,703 and 1,570 (70.2% and 29.7%, respectively) in 2018. Free tissue transfer and deep inferior epigastric perforator flap creation were the most common autologous reconstruction procedures. For implant-based reconstructions, the rates of directto-implant and tissue-expander breast reconstructions (first stage) were similar in 2018. This study summarizes breast reconstruction trends in Korea after NHIS coverage was expanded in 2015. A significant increase over time in the post-mastectomy breast reconstruction rate was evident, with a trend toward implant-based reconstruction. Analysis of data from the HIRA Big Data Hub can be used to predict breast reconstruction trends and convey precise information to patients and physicians.

The purpose of the study was to quantify local setup errors and evaluate the planning target volume (PTV) margins for sub-regions in cone-beam computed tomography (CBCT)-guided post-mastectomy radiation therapy (PMRT). The local setup errors of 20 patients undergoing CBCT-guided PMRT were analysed retrospectively. Image registration between CBCT and planning CT was performed using four sub-regions of interest (ROIs): the supraclavicular area (SROI), ipsilateral chest wall region (CROI), ipsilateral chest wall plus supraclavicular region (SROI + CROI) and vertebral region (TROI). Bland–Altman analysis, correlation, local setup errors and PTV margins among these ROIs were evaluated. There was no significant consistency or correlation for registration results between the TROI and the CROI or SROI regions on any translational axis. When using the SROI + CROI as the ROI, the systematic error (Σ) and random error (σ) of the local setup errors for the CROI region were 1.81, 1.19 and 1.76 mm and 1.84, 2.64 and 3.00 mm along the medial–lateral (ML), superior–inferior (SI) and anterior–posterior (AP) directions, respectively. The PTV margins for the CROI region were 5.80, 4.82 and 6.50 mm. The Σ and σ of the local setup errors for the SROI region were 1.29, 1.15 and 0.77 mm and 1.96, 2.65 and 2.2 mm, respectively, and the PTV margins were 4.59, 4.73 and 3.47 mm. Large setup errors and local setup errors occur in PMRT. The vertebral body should not be a position surrogate for the supraclavicular region or chest wall. To compensate for the local setup errors, different PTV margins are required, even with CBCT guidance.

Introduction: Breast cancer cases, mastectomy and following reconstruction procedures are growing in numbers. Despite being lifesaving, mastectomies have a destructive psychological impact on the patients. On the other hand, breast reconstruction improves psychological damages within the same population. Various techniques for nipple reconstruction were described in literature. Trillium flap is an innovative technique to reconstruct neo-nipple with several advantages that make it superior to other popular flaps. Objectives: To come up with an innovative design for reconstructing a neo-nipple post mastectomy, that is superior to other popular flaps. Results: The Trillium flap design has less visible and easily camouflaged scars, is geometry-based, specific, well-detailed and flexible to produce a tailored nipple with any desired height and diameter and ensures the flaps good vascularity and the neo-nipple projection sustainability. Conclusion: Trillium flap is an innovative technique to reconstruct neo-nipple with several advantages that make it superior to other popular flaps. The results shown in the study are for experimental procedures done on human tissue samples of excised flaps from abdominoplasties and brachioplasties. Further application on actual cases is needed with monitoring of neo-nipple projection sustainability on the long term.

Aim To treat breast cancer patients in telecobalt unit with image based conformal radiotherapy planning using the multi-isocentric technique. Background Breast cancer is the leading cancer among all the female cancers. With improved screening techniques, many patients are being diagnosed at an early stage and the need for radiotherapy in such patients has increased. The telecobalt machine is still a preferred machine in many of the low income countries as it is cost-effective and can offer uninterrupted treatment to large number of patients. Materials and Methods Three hundred patients requiring radiotherapy had a computed tomography based planning. Patients were immobilized using a breast board with a thermoplastic mould. Three dimensional planning was done with the multi-isocentric technique. These patients were then simulated using a Nucletron Simulix digital simulator for field verification and were treated in a Theratron Phoenix telecobalt treatment unit. Results The doses to the heart, ipsilateral lung and the conformity index were within the recommended values. The homogeneity index was not comparable; however, a section by section qualitative analysis was done and a final plan approved. As per the RTOG toxicity grading system, acute skin reaction grade 3 was observed in 3.6% of treatments to intact breast including nodal regions and in 3.5% of post mastectomy radiation patients. Conclusion Single isocenter technique was not feasible as the telecobalt unit did not have multileaf collimators and asymmetric jaws. With improved image based planning, a multi-isocentric technique was planned. By evaluating the dose distribution, beam modifications can be made and treatments can be given with acceptable toxicity.

This is an invited review article, tracking the changes in the indications and use of post-mastectomy radiation over the last 25 years. While radiation after mastectomy has been in use for decades, several key prospective randomized trials published in recent years have changed and strengthened role of this modality. This manuscript will track the milestones over the last three decades.

Chylous leakage is a rare complication following mastectomy and axillary dissection. We report a case of a 46-year-old female who underwent modified radical mastectomy and developed chylous leakage. She was treated successfully with conservative management. Keywords: Chylous leakage, chyle, mastectomy, axillary dissection

BACKGROUND The association of radiotherapy with breast cancer survival in patients who underwent a mastectomy and had micrometastases in the sentinel lymph node is unclear. MATERIAL AND METHODS The survival benefit of radiotherapy was examined in patients with T0/1-T2N1mi breast cancer undergoing mastectomy plus sentinel lymph node biopsy (SLNB). Kaplan-Meier curves were employed for survival analysis and competing risk analysis, and a propensity score matching (PSM) cohort was enrolled to investigate whether such patients benefit from radiotherapy. RESULTS We identified 2864 patients in the SEER database from 2004 to 2015. All eligible patients were divided into the radiotherapy and the no-radiotherapy cohorts. With the median follow-up of 53 months, 5-year breast cancer-specific survival (BCSS) was 94.4% vs 95.2% (P=0.135), and 5-year overall survival (OS) was 91.2% vs 90.1% (P=0.466) in the radiotherapy cohorts and no-radiotherapy cohorts, respectively. The results of the competing risk analysis showed a comparable 5-year cumulative incidence of breast cancer-specific death (BCSD) in the radiotherapy and no-radiotherapy groups (5.5% vs 4.7%, P=0.107) but a higher 5-year cumulative incidence of other causes of death (OCD) in the no-radiotherapy cohort (3.3% vs 5.3%, P=0.011). No significant difference was observed for BCSS or OS in the PSM cohort. CONCLUSIONS Radiotherapy has no benefit for patients with T0/1-T2 breast cancer undergoing mastectomy with N1mi disease on SLNB. This analysis provides evidence that radiotherapy may safely be omitted in this group of patients.

Background: The objective of any mastectomy is to rid the chest wall of any breast tissue but since the breast being unencapsulated, there is every chance that some amount of breast tissue may be left behind in the skin aps after resection. As the remnant breast tissue is likely to be exposed to the same carcinogenic risk factors as the tissue removed. Hence, there is always a possibility that the residual tissue may become the seat of a recurrence. To get rid the chest wall so far the residual breast tissue will Objective: be minimal and the recurrence of breast carcinoma will be less. Patents Data source: of proven case of CA breast who underwent MRM at RG KAR MEDICAL COLLEGE AND HOSPITAL from July 2016 to June 2018 are included in the study group. This is a prospective study Study design: of total 45 patients are selected. Materials and methods: Prospective analysis of 45 post MRM women whose mean age is 49.5 years (mean ± SD age, 49.5 ± 2.4 years). Tissue specimens taken from central part of four quadrants of two skin aps for histo-pathological examination. Skin ap thickness measured for more than 8mm. All patients followed for any recurrence of breast carcinoma. Results: Of all histo-pathological specimens left sided breast cancer cases were more common than right side. 48-49 years age group had the most number of cases and more than 53 years the least. The lower medial quadrant the most 5(45.45%), upper and lower lateral quadrant 3(27.27%) each for positive and upper medial quadrant negative for breast tissue. Breast carcinoma negative in all specimens. Skin ap necrosis of 2(4.44%) cases. No recurrences noted during my study period. My study has demonstrated presence of residual breast tis Conclusion: sue in a signicant percentage of post mastectomy skin aps. No residual cancer tissue was found. During the duration of the study, no recurrence of breast carcinoma was detected in patients with residual breast tissue in skin aps.

Background: Although the axillary web syndrome (AWS) is a common post-mastectomy complication. A small number of studies have reported treatment strategies for the AWS that showed interventions for one month were an effective strategy. The current study in AWS patients investigated the clinical efficacy of short-term massage manipulation (STMM) combined with remote guided self-exercise (RGS).Method: The patients were randomized into either short-term massage manipulation combine with remote guided self-exercise group (STMM+RGS group) or treatment without massage manipulation and remote guided self-exercise group (T- STMM+RGS group). STMM+RGS group received massage manipulation for 20 min per day for 7 days as total hospitalized therapy and then received telephone-guided therapy for 9 weeks, rehabilitation gymnastics provided during hospitalization.T- STMM+RGS group received rehabilitation gymnastics only. The primary outcome was changes in upper limb range of movement (ROM), assessed at 3, 6, and 9 weeks after intervention. The secondary outcomes were scores of visual analog scales (VAS), disability of arm, shoulder and hand (DASH) index, and activities of daily living (ADL) index assessed at 3, 6, 9 weeks of follow-up.Results: 106 patients were enrolled in the trial, 86 were randomized to treatment groups, with 79 completing the trial (41 in STMM+RGS group, 38 in T-STMM+RGS group). At 6 and 9 weeks of follow-up ROM had improved in STMM+RGS group compared with that observed in T-STMM+RGS group(p<0.05). This improvement was more pronounced and significantly different at 9 weeks(p<0.01).. There was also a significant difference in VAS at 6 and 9 weeks between the two groups. The DASH score improved significantly in STMM+RGS group compared with that in T-STMM+RGS group at 3, 6, and 9 weeks of follow-up(p<0.01), while the ADL score was significantly different (p) in the two groups at 3 and 6 weeks , but showed no significant difference after 9 weeks of follow-up.Conclusion: The combination of STMM and RGS improves upper limb ROM, relieves upper limb pain, and reduces the occurrence of disabilities in post-mastectomy patients with the AWS.