M. Wickman - Academia.edu (original) (raw)
Papers by M. Wickman
Journal of Clinical Oncology, 2008
Purpose To prospectively evaluate body image, sexuality, emotional reactions (anxiety, depression... more Purpose To prospectively evaluate body image, sexuality, emotional reactions (anxiety, depression), and quality of life in a sample of women having increased risk for breast cancer before and 6 months and 1 year after bilateral prophylactic mastectomy (BPM), and to compare preoperative expectations of the operation with postoperative reactions concerning the impact on six areas of the women's lives. Patients and Methods A total of 90 of 98 consecutive women who underwent BPM during October 1997 to December 2005 were included. Data were collected by self-administered questionnaires (eg, Hospital Anxiety and Depression scale, Swedish Short Term-36 Health Survey, Body Image Scale, Sexual Activity Questionnaire) before the operation (n = 81), and 6 (n = 71) and 12 months (n = 65) after BPM. Results Anxiety decreased over time (P = .0004). No corresponding difference was found for depression. No differences in health-related quality of life over time were found, with one exception. A...
European Journal of Surgical Oncology (EJSO), 1996
Immediate breast reconstruction was introduced in 1990 at the Karolinska Hospital. A semistructur... more Immediate breast reconstruction was introduced in 1990 at the Karolinska Hospital. A semistructured interview with 20 patients operated on between 1991 and 1994 was undertaken to evaluate patients' degrees of satisfaction regarding pre-operative information, the need for psychological support and the opinion about the cosmetic outcome. During the pre-operative period, 18 patients felt that they were engaged in the decision-making whereas two patients felt that the surgeon alone was responsible for the decision. Regarding pre-operative information given, 7/20 were satisfied, 5/20 were mostly satisfied, 5/20 were unsatisfied and 3/20 had no opinion. During the early post-operative period (<3 months), five patients felt anxiety or depression and 10 patients felt a need of additional psychological support. Within 6 weeks 19/20 patients returned to their occupational level. During the late post-operative period (>3 months), 19/20 patients were generally satisfied with the reconstructive procedure. Eight patients thought the final result exceeded their initial expectations and 11/17 accepted the new breast as an integrated part of their body. The results confirm that immediate breast reconstruction plays an important role in the surgical management of breast cancer. The need for pre-operative information and continuous psychological support in terms of an empathetic behaviour cannot be underestimated.
Anesthesia & Analgesia, 1995
The aims of this study were to investigate the influence of adenosine infusion, firstly, on posto... more The aims of this study were to investigate the influence of adenosine infusion, firstly, on postoperative analgesic requirements, and secondly, on peroperative isoflurane requirements. Seventy-five women, aged 18-70 yrs, ASA grades I and II, scheduled for breast surgery, were randomly assigned to peroperatively receive a double-blind intravenous infusion of either adenosine, 80 pgkg-'*rnin-', or placebo, during surgery under isoflurane/N,O/O, anesthesia. The peroperative isoflurane requirements were significantly reduced at 30 and 90 min of surgery during adenosine treatment.
Acta Anaesthesiologica Scandinavica, 2005
Breast cancer treatment with mastectomy and immediate breast reconstruction (IBR) is associated w... more Breast cancer treatment with mastectomy and immediate breast reconstruction (IBR) is associated with intense pain in the primary post-operative period. The present prospective, placebo-controlled and double-blind study aimed to evaluate the analgesic efficacy of diclofenac, a non-steroid anti-inflammatory drug (NSAID), in combination with paracetamol and opioids. This was done by 64-h assessment of post-operative pain intensity, opioid consumption, blood loss, nausea and tiredness. Fifty women selected for mastectomy and IBR with submuscular implants with or without axillary lymph node dissection (ALND) were randomized to receive diclofenac 50 mg x 3 or placebo rectally in addition to oral paracetamol and intravenous opioids delivered using a patient-controlled analgesia (PCA) technique. During the first 20 h post-surgery, patients who received diclofenac experienced significantly less pain when resting than those who received placebo. When moving, a non-significant estimated difference in pain in favour of diclofenac was also noted. Opioid consumption during the first 6 h post-operatively was 34% less with diclofenac than with placebo. Means (SD) were 16.9 (10.3) mg and 25.6 (10.2) mg, respectively (P = 0.007). After 64 h, the difference was no longer statistically significant. Post-operative bleeding was significantly higher with diclofenac than with placebo (P < 0.01). Nausea and tiredness did not differ between the groups. The addition of NSAID to paracetamol and opioid-PCA reduced opioid consumption and improved pain relief during the first 20 h at rest but was not convincingly effective during mobilization. Post-operative blood loss was higher with diclofenac.
Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, 1995
Immediate breast reconstructions are being done more often nowadays to avoid the stress that the ... more Immediate breast reconstructions are being done more often nowadays to avoid the stress that the patient experiences while living without a breast. In this paper, the procedure and short term outcome of 75 patients who underwent immediate breast reconstructions at the Karolinska Hospital are reported. The median age of the patients was 48 years, and most of the tumours were stage O to 2 at the time of the operation, though reconstructions were also done for patients with more advanced cancer, for psychological reasons. The approach was multidisciplinary with oncologists, general surgeons, and plastic surgeons involved. Different reconstructive methods were used, and the operations were tailor-made for each patient. Twenty one permanent prostheses, 11 expanders, 33 expander prostheses, and eight pedicled and two free transverse rectus abdominis musculocutaneous (TRAM) flaps were used for reconstruction. The opposite breast was adjusted in 43 (57%) of the patients. There were 11 postoperative complications (15%), and in only one patient (1%), could the reconstruction not be completed. There was a tendency towards more complicated reconstructive procedures over time. The demand for immediate breast reconstruction is steadily increasing from both patients and doctors.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2007
Breast reconstruction has been shown to improve quality of life in women following mastectomy for... more Breast reconstruction has been shown to improve quality of life in women following mastectomy for breast cancer. To date, there have been no published prospective reports looking at the effect nationality has on patient quality of life following breast reconstruction. Women from the USA, Sweden and Canada were recruited prior to reconstruction and followed prospectively for 1 year postoperatively. Thirteen centres with 24 plastic surgeons were involved. Preoperatively and 1 year postoperatively, women completed the Short Form-36 questionnaire. Data were analysed using t-tests and analysis of variance. A total of 313 women were followed up. American women who had immediate expander/implant surgery were compared with Swedish patients, whilst Americans who had undergone transverse rectus abdominis myocutaneous (TRAM) flap reconstructions were compared with Canadians. Women benefited from having breast reconstruction, but this improvement was not dependent upon country of origin. Swedish women reported less improvement in one subscale, that of general health, compared with American women (P=0.01). There were no cultural differences detected between Americans and Canadians.
European Journal of Surgical Oncology (EJSO), 2000
Background: Women from families with breast and/or ovarian cancers seek advice and counselling fo... more Background: Women from families with breast and/or ovarian cancers seek advice and counselling for risk assessment, but they also want information about preventive measures that might reduce their risk of developing these neoplasms. Patients and methods: This study was undertaken in order to assess 15 women's experience with the decisionmaking process prior to undergoing prophylactic bilateral mastectomy (PM) and immediate breast reconstruction (IBR). It was also designed to determine the degree of the women's satisfaction with the information delivered by the different caregivers, and whether the women felt that their need for psychosocial support was appropriately met. An additional goal was to learn about the patients' satisfaction with the operations. Results: The women found it difficult to translate the genetic information transmitted to them, although they were satisfied by the way it was given. At some stage during the pre-operative and post-operative period nearly all women stated that they lacked psychological support from the different caregivers. No woman regretted her choice to undergo PM and IBR. By far, the most important issue was the actual risk reduction. However, the result exceeded all patients' initial expectations. When performing PM and IBR, a multidisciplinary team approach, including a psychologist, seems mandatory. It will facilitate the overall management of this group of women.
Breast (Edinburgh, Scotland), 2004
Immediate breast reconstruction (IBR) was implemented in 1990. Patients operated on for invasive ... more Immediate breast reconstruction (IBR) was implemented in 1990. Patients operated on for invasive breast cancer were assessed for oncological outcome after a minimum of 5-year follow-up. The study had a form of a retrospective analysis of 203 consecutive patients. The indications for IBR were always discussed in multidisciplinary case conferences. The pectoralis major fascia was left in place. The implant technique dominated. The break down by tumor stage was T1 tumors in 122 cases, T2 in 72, and T3 tumors in nine. Preoperative chemotherapy was given to 21 patients for tumors > 4 cm. Thirteen patients, or 6.5%, developed a local recurrence and seven are still alive with their reconstructed breast after excisions, chemo- and radiation therapy. Most (11) of the 13 recurrences occurred within 24 months after IBR. The recurrence rate remained low with this surgery plus reconstruction approach and IBR is therefore considered a safe procedure when implemented by a multidisciplinary team...
Immediate breast reconstruction (IBR) was implemented in 1990. Patients operated on for invasive ... more Immediate breast reconstruction (IBR) was implemented in 1990. Patients operated on for invasive breast cancer were assessed for oncological outcome after a minimum of 5-year follow-up. The study had a form of a retrospective analysis of 203 consecutive patients. The indications for IBR were always discussed in multidisciplinary case conferences. The pectoralis major fascia was left in place. The implant technique dominated. The break down by tumor stage was T1 tumors in 122 cases, T2 in 72, and T3 tumors in nine. Preoperative chemotherapy was given to 21 patients for tumors > 4 cm. Thirteen patients, or 6.5%, developed a local recurrence and seven are still alive with their reconstructed breast after excisions, chemo- and radiation therapy. Most (11) of the 13 recurrences occurred within 24 months after IBR. The recurrence rate remained low with this surgery plus reconstruction approach and IBR is therefore considered a safe procedure when implemented by a multidisciplinary team. Most recurrences appear within 2 years after reconstruction.
Plastic and Reconstructive Surgery, 2001
Breast reconstructions after breast cancer surgery are primarily performed to improve patients&am... more Breast reconstructions after breast cancer surgery are primarily performed to improve patients' quality of life. This study was performed to investigate patients' satisfaction with breast reconstruction and quality of life after pedicled or free transverse rectus abdominis musculocutaneous (TRAM) flap surgery and to evaluate the aesthetic result of the breast reconstruction both objectively and subjectively.Sixty-three patients (36 with pedicled flaps and 27 with free TRAM flaps) answered two questionnaires; of this group, 53 (27 with pedicled flaps and 26 with free TRAM flaps) participated in an aesthetic evaluation. The questionnaires consisted of two parts: one study-specific part concerning satisfaction with the result of the breast reconstruction, the other a standardized health-related quality of life part, the Short Form-36 questionnaire. The aesthetic examination consisted of an objective part in which various distances on the reconstructed and contralateral breast were measured. The volumes of the breasts were measured using a thermoplastic cast system. The softness of the breasts was assessed using applanation tonometry. A panel consisting of three plastic surgeons looked at four standardized photographs of each patient and evaluated the aesthetic outcome subjectively. The panel evaluated the breast reconstruction on 10 subscales. No statistically significant difference between the surgical groups was seen regarding the patients' satisfaction with the reconstruction. In the patients' self-assessment of the cosmetic outcome, the degree of symmetry was assessed higher in the free TRAM flap group. The health-related quality of life Short Form-36 questionnaire revealed no difference between the pedicled and free flap groups. Compared with a reference population, the breast-reconstructed group felt more tired and "worn out," less peaceful, more unhappy, and more restless. The free flap group reached a higher degree of symmetry in the objective evaluation and received generally higher scores from the three-member panel, compared with the pedicled TRAM flap group. A strong correlation between the patients' and the panel's evaluations of the cosmetic outcome was seen; generally, the panel's evaluation of the cosmetic result of the breast correlated with the satisfaction of the patients.
Plastic and Reconstructive Surgery, 1993
In 20 patients subjected to breast reconstruction by means of tissue expansion, a skin biopsy was... more In 20 patients subjected to breast reconstruction by means of tissue expansion, a skin biopsy was obtained at the vertex of the breast before and the day after expansion. Samples were incubated in [3H]thymidine, and the number of labeled cells were counted. A statistically significant rise in the number of labeled basal and suprabasal keratinocytes was seen after expansion. The findings suggest a net gain of tissue not only by stretching but also by formation of new tissue generated by tissue expansion.
European Journal of Cancer, 2011
Background: The proportion of women living diagnosed with breast cancer in the developed countrie... more Background: The proportion of women living diagnosed with breast cancer in the developed countries is increasing. Since breast cancer-specific deaths decrease with time since diagnosis, it is important to assess the burden of other causes of death as well. Materials and Methods: Different causes of death within 10 years from diagnosis were assessed in 12,850 women <75 years with stage 1−3 breast cancer diagnosed 1990-2006. Flexible parametric survival models were used to estimate hazard ratios over time-since-diagnosis by tumour characteristics and age at diagnosis. Results: The proportion of deaths attributed to breast cancer ranged from 95.0% among women <45 years at diagnosis to 44.5% among women 65−74 years. The proportion of circulatory system-specific deaths and of other causes of death increased with older age at diagnosis. Patients with 1−3 positive lymph nodes were more likely to die from breast cancer during the first 10 years of follow-up compared to women without positive lymph nodes. Women with ER-positive tumours had the same risk of dying from breast cancer after 5 years from diagnosis compared to women with ERnegative tumours. Conclusions: Lymph node negativity is an important long-term predictor of more favorable prognosis. The nature of the relationship between ER-status and risk of dying from breast cancer after five years of follow-up needs further investigation. Death due to circulatory system diseases becomes an important cause of death especially in women diagnosed with breast cancer at older age.
European Journal of Cancer, 1996
European Journal of Cancer, 2004
A consecutive sample of 56 women with a familial risk for breast cancer who were considering a pr... more A consecutive sample of 56 women with a familial risk for breast cancer who were considering a prophylactic mastectomy (PM) completed questionnaires preoperatively concerning risk perception, expectations with regard to surgery, anxiety and depressive symptoms (the Hospital Anxiety and Depression Scale (HAD) scale) and quality of life (The Swedish SF-36 Health Survey). 16 had had a previous breast cancer (Group BC) and 40 had not (Group R). They were compared with normative data from an agematched random sample of the Swedish population and with a reference sample of women with breast cancer. Most women estimated their breast cancer risk accurately. No statistically significant differences were found between Group BC and the normative sample on the HAD scale and SF-36, but Group R reported better physical functioning, emotional role functioning and mental health than the reference sample with breast cancer. Group BC scored closer to them than to the normative sample. Levels of emotional problems and quality of life were comparable to normative values among women considering PM. All women in the present study had previous genetic counselling and our results suggest that their interest in PM was not due to an overestimation of their personal risk.
Breast Cancer Research and Treatment, 2011
Background: Physicians are still concerned about the oncological safety regarding immediate breas... more Background: Physicians are still concerned about the oncological safety regarding immediate breast reconstruction (IBR) in breast cancer patients. This study aimed to evaluate possible differences between local, regional and distant recurrences between women having implant-based reconstruction versus women operated with mastectomy alone. Secondary aims were to evaluate time to oncological treatment as well as diseasefree and breast cancer specific survival. Patients and methods: In a retrospective cohort designed study, 300 reconstructed patients with invasive breast cancer were matched with 300 patients from the population-based Regional Breast Cancer Register of the Stockholm-Gotland health-care region operated with mastectomy alone. They were matched for age, tumor size, nodal stage and year of operation. Also included were patients treated with neoadjuvant chemotherapy and postoperative radiotherapy. The median follow-up for both groups was 11, 5 years (range 2-19). Results: There were no significant differences in the local recurrence rate, 8.2 % in the IBR group and 9.0 % in the control group or in the regional recurrence rate, 8.2 % versus 9.7 %. Distant metastases occurred more frequently in the control group (27.1 %) compared to the IBR group (20.3%). There were no significant differences in time to treatment or in complications rate. Breast cancer mortality was 17 % for the IBR group and 23 % in the control group during follow up. Conclusion: This long-term follow-up survey with a well matched control group demonstrates that IBR with implants is safe to offer patients with invasive breast cancer without any negative effect on the oncological safety.
European Journal of …, 2004
A consecutive sample of 56 women with a familial risk for breast cancer who were considering a pr... more A consecutive sample of 56 women with a familial risk for breast cancer who were considering a prophylactic mastectomy (PM) completed questionnaires preoperatively concerning risk perception, expectations with regard to surgery, anxiety and depressive symptoms (the ...
Plastic and …, 2001
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > April 15, ...
European Journal of Cancer Care, 2010
High satisfaction rate ten years after bilateral prophylactic mastectomy-a longitudinal study Wom... more High satisfaction rate ten years after bilateral prophylactic mastectomy-a longitudinal study Women from families with an increased risk for breast/ovarian cancer have undergone bilateral prophylactic mastectomy (BPM) since the early 1990s at the Karolinska University Hospital in Sweden. Perceptions of BPM as reported by the first women who underwent the procedure have previously been evaluated on a short-term basis (1-3 years). The present study aims to evaluate the long-term (10 years) physical and psychological consequences of BPM in the same cohort of women. Some of the very first women to undergo BPM participated in the present interview study (n = 13). The semi-structured interviews focused on the women's long-term experiences related to BPM and immediate breast reconstruction. Overall, the women were satisfied with their decision to undergo BPM and perceived a negligible remaining risk of getting breast cancer. For most women, the operation had not resulted in changes in family life or lifestyle (n = 8), although some described that the relationship with their spouse was affected (8/13), either in a negative (n = 5) or positive (n = 3) way. The cosmetic results were mainly positive (n = 10). Recurrent counselling and support during the whole process of decision, treatment and follow up is recommended.
Journal of Clinical Oncology, 2008
To prospectively evaluate body image, sexuality, emotional reactions (anxiety, depression), and q... more To prospectively evaluate body image, sexuality, emotional reactions (anxiety, depression), and quality of life in a sample of women having increased risk for breast cancer before and 6 months and 1 year after bilateral prophylactic mastectomy (BPM), and to compare preoperative expectations of the operation with postoperative reactions concerning the impact on six areas of the women's lives.
Journal of Clinical Oncology, 2008
Purpose To prospectively evaluate body image, sexuality, emotional reactions (anxiety, depression... more Purpose To prospectively evaluate body image, sexuality, emotional reactions (anxiety, depression), and quality of life in a sample of women having increased risk for breast cancer before and 6 months and 1 year after bilateral prophylactic mastectomy (BPM), and to compare preoperative expectations of the operation with postoperative reactions concerning the impact on six areas of the women's lives. Patients and Methods A total of 90 of 98 consecutive women who underwent BPM during October 1997 to December 2005 were included. Data were collected by self-administered questionnaires (eg, Hospital Anxiety and Depression scale, Swedish Short Term-36 Health Survey, Body Image Scale, Sexual Activity Questionnaire) before the operation (n = 81), and 6 (n = 71) and 12 months (n = 65) after BPM. Results Anxiety decreased over time (P = .0004). No corresponding difference was found for depression. No differences in health-related quality of life over time were found, with one exception. A...
European Journal of Surgical Oncology (EJSO), 1996
Immediate breast reconstruction was introduced in 1990 at the Karolinska Hospital. A semistructur... more Immediate breast reconstruction was introduced in 1990 at the Karolinska Hospital. A semistructured interview with 20 patients operated on between 1991 and 1994 was undertaken to evaluate patients' degrees of satisfaction regarding pre-operative information, the need for psychological support and the opinion about the cosmetic outcome. During the pre-operative period, 18 patients felt that they were engaged in the decision-making whereas two patients felt that the surgeon alone was responsible for the decision. Regarding pre-operative information given, 7/20 were satisfied, 5/20 were mostly satisfied, 5/20 were unsatisfied and 3/20 had no opinion. During the early post-operative period (<3 months), five patients felt anxiety or depression and 10 patients felt a need of additional psychological support. Within 6 weeks 19/20 patients returned to their occupational level. During the late post-operative period (>3 months), 19/20 patients were generally satisfied with the reconstructive procedure. Eight patients thought the final result exceeded their initial expectations and 11/17 accepted the new breast as an integrated part of their body. The results confirm that immediate breast reconstruction plays an important role in the surgical management of breast cancer. The need for pre-operative information and continuous psychological support in terms of an empathetic behaviour cannot be underestimated.
Anesthesia & Analgesia, 1995
The aims of this study were to investigate the influence of adenosine infusion, firstly, on posto... more The aims of this study were to investigate the influence of adenosine infusion, firstly, on postoperative analgesic requirements, and secondly, on peroperative isoflurane requirements. Seventy-five women, aged 18-70 yrs, ASA grades I and II, scheduled for breast surgery, were randomly assigned to peroperatively receive a double-blind intravenous infusion of either adenosine, 80 pgkg-'*rnin-', or placebo, during surgery under isoflurane/N,O/O, anesthesia. The peroperative isoflurane requirements were significantly reduced at 30 and 90 min of surgery during adenosine treatment.
Acta Anaesthesiologica Scandinavica, 2005
Breast cancer treatment with mastectomy and immediate breast reconstruction (IBR) is associated w... more Breast cancer treatment with mastectomy and immediate breast reconstruction (IBR) is associated with intense pain in the primary post-operative period. The present prospective, placebo-controlled and double-blind study aimed to evaluate the analgesic efficacy of diclofenac, a non-steroid anti-inflammatory drug (NSAID), in combination with paracetamol and opioids. This was done by 64-h assessment of post-operative pain intensity, opioid consumption, blood loss, nausea and tiredness. Fifty women selected for mastectomy and IBR with submuscular implants with or without axillary lymph node dissection (ALND) were randomized to receive diclofenac 50 mg x 3 or placebo rectally in addition to oral paracetamol and intravenous opioids delivered using a patient-controlled analgesia (PCA) technique. During the first 20 h post-surgery, patients who received diclofenac experienced significantly less pain when resting than those who received placebo. When moving, a non-significant estimated difference in pain in favour of diclofenac was also noted. Opioid consumption during the first 6 h post-operatively was 34% less with diclofenac than with placebo. Means (SD) were 16.9 (10.3) mg and 25.6 (10.2) mg, respectively (P = 0.007). After 64 h, the difference was no longer statistically significant. Post-operative bleeding was significantly higher with diclofenac than with placebo (P < 0.01). Nausea and tiredness did not differ between the groups. The addition of NSAID to paracetamol and opioid-PCA reduced opioid consumption and improved pain relief during the first 20 h at rest but was not convincingly effective during mobilization. Post-operative blood loss was higher with diclofenac.
Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery, 1995
Immediate breast reconstructions are being done more often nowadays to avoid the stress that the ... more Immediate breast reconstructions are being done more often nowadays to avoid the stress that the patient experiences while living without a breast. In this paper, the procedure and short term outcome of 75 patients who underwent immediate breast reconstructions at the Karolinska Hospital are reported. The median age of the patients was 48 years, and most of the tumours were stage O to 2 at the time of the operation, though reconstructions were also done for patients with more advanced cancer, for psychological reasons. The approach was multidisciplinary with oncologists, general surgeons, and plastic surgeons involved. Different reconstructive methods were used, and the operations were tailor-made for each patient. Twenty one permanent prostheses, 11 expanders, 33 expander prostheses, and eight pedicled and two free transverse rectus abdominis musculocutaneous (TRAM) flaps were used for reconstruction. The opposite breast was adjusted in 43 (57%) of the patients. There were 11 postoperative complications (15%), and in only one patient (1%), could the reconstruction not be completed. There was a tendency towards more complicated reconstructive procedures over time. The demand for immediate breast reconstruction is steadily increasing from both patients and doctors.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2007
Breast reconstruction has been shown to improve quality of life in women following mastectomy for... more Breast reconstruction has been shown to improve quality of life in women following mastectomy for breast cancer. To date, there have been no published prospective reports looking at the effect nationality has on patient quality of life following breast reconstruction. Women from the USA, Sweden and Canada were recruited prior to reconstruction and followed prospectively for 1 year postoperatively. Thirteen centres with 24 plastic surgeons were involved. Preoperatively and 1 year postoperatively, women completed the Short Form-36 questionnaire. Data were analysed using t-tests and analysis of variance. A total of 313 women were followed up. American women who had immediate expander/implant surgery were compared with Swedish patients, whilst Americans who had undergone transverse rectus abdominis myocutaneous (TRAM) flap reconstructions were compared with Canadians. Women benefited from having breast reconstruction, but this improvement was not dependent upon country of origin. Swedish women reported less improvement in one subscale, that of general health, compared with American women (P=0.01). There were no cultural differences detected between Americans and Canadians.
European Journal of Surgical Oncology (EJSO), 2000
Background: Women from families with breast and/or ovarian cancers seek advice and counselling fo... more Background: Women from families with breast and/or ovarian cancers seek advice and counselling for risk assessment, but they also want information about preventive measures that might reduce their risk of developing these neoplasms. Patients and methods: This study was undertaken in order to assess 15 women's experience with the decisionmaking process prior to undergoing prophylactic bilateral mastectomy (PM) and immediate breast reconstruction (IBR). It was also designed to determine the degree of the women's satisfaction with the information delivered by the different caregivers, and whether the women felt that their need for psychosocial support was appropriately met. An additional goal was to learn about the patients' satisfaction with the operations. Results: The women found it difficult to translate the genetic information transmitted to them, although they were satisfied by the way it was given. At some stage during the pre-operative and post-operative period nearly all women stated that they lacked psychological support from the different caregivers. No woman regretted her choice to undergo PM and IBR. By far, the most important issue was the actual risk reduction. However, the result exceeded all patients' initial expectations. When performing PM and IBR, a multidisciplinary team approach, including a psychologist, seems mandatory. It will facilitate the overall management of this group of women.
Breast (Edinburgh, Scotland), 2004
Immediate breast reconstruction (IBR) was implemented in 1990. Patients operated on for invasive ... more Immediate breast reconstruction (IBR) was implemented in 1990. Patients operated on for invasive breast cancer were assessed for oncological outcome after a minimum of 5-year follow-up. The study had a form of a retrospective analysis of 203 consecutive patients. The indications for IBR were always discussed in multidisciplinary case conferences. The pectoralis major fascia was left in place. The implant technique dominated. The break down by tumor stage was T1 tumors in 122 cases, T2 in 72, and T3 tumors in nine. Preoperative chemotherapy was given to 21 patients for tumors > 4 cm. Thirteen patients, or 6.5%, developed a local recurrence and seven are still alive with their reconstructed breast after excisions, chemo- and radiation therapy. Most (11) of the 13 recurrences occurred within 24 months after IBR. The recurrence rate remained low with this surgery plus reconstruction approach and IBR is therefore considered a safe procedure when implemented by a multidisciplinary team...
Immediate breast reconstruction (IBR) was implemented in 1990. Patients operated on for invasive ... more Immediate breast reconstruction (IBR) was implemented in 1990. Patients operated on for invasive breast cancer were assessed for oncological outcome after a minimum of 5-year follow-up. The study had a form of a retrospective analysis of 203 consecutive patients. The indications for IBR were always discussed in multidisciplinary case conferences. The pectoralis major fascia was left in place. The implant technique dominated. The break down by tumor stage was T1 tumors in 122 cases, T2 in 72, and T3 tumors in nine. Preoperative chemotherapy was given to 21 patients for tumors > 4 cm. Thirteen patients, or 6.5%, developed a local recurrence and seven are still alive with their reconstructed breast after excisions, chemo- and radiation therapy. Most (11) of the 13 recurrences occurred within 24 months after IBR. The recurrence rate remained low with this surgery plus reconstruction approach and IBR is therefore considered a safe procedure when implemented by a multidisciplinary team. Most recurrences appear within 2 years after reconstruction.
Plastic and Reconstructive Surgery, 2001
Breast reconstructions after breast cancer surgery are primarily performed to improve patients&am... more Breast reconstructions after breast cancer surgery are primarily performed to improve patients' quality of life. This study was performed to investigate patients' satisfaction with breast reconstruction and quality of life after pedicled or free transverse rectus abdominis musculocutaneous (TRAM) flap surgery and to evaluate the aesthetic result of the breast reconstruction both objectively and subjectively.Sixty-three patients (36 with pedicled flaps and 27 with free TRAM flaps) answered two questionnaires; of this group, 53 (27 with pedicled flaps and 26 with free TRAM flaps) participated in an aesthetic evaluation. The questionnaires consisted of two parts: one study-specific part concerning satisfaction with the result of the breast reconstruction, the other a standardized health-related quality of life part, the Short Form-36 questionnaire. The aesthetic examination consisted of an objective part in which various distances on the reconstructed and contralateral breast were measured. The volumes of the breasts were measured using a thermoplastic cast system. The softness of the breasts was assessed using applanation tonometry. A panel consisting of three plastic surgeons looked at four standardized photographs of each patient and evaluated the aesthetic outcome subjectively. The panel evaluated the breast reconstruction on 10 subscales. No statistically significant difference between the surgical groups was seen regarding the patients' satisfaction with the reconstruction. In the patients' self-assessment of the cosmetic outcome, the degree of symmetry was assessed higher in the free TRAM flap group. The health-related quality of life Short Form-36 questionnaire revealed no difference between the pedicled and free flap groups. Compared with a reference population, the breast-reconstructed group felt more tired and "worn out," less peaceful, more unhappy, and more restless. The free flap group reached a higher degree of symmetry in the objective evaluation and received generally higher scores from the three-member panel, compared with the pedicled TRAM flap group. A strong correlation between the patients' and the panel's evaluations of the cosmetic outcome was seen; generally, the panel's evaluation of the cosmetic result of the breast correlated with the satisfaction of the patients.
Plastic and Reconstructive Surgery, 1993
In 20 patients subjected to breast reconstruction by means of tissue expansion, a skin biopsy was... more In 20 patients subjected to breast reconstruction by means of tissue expansion, a skin biopsy was obtained at the vertex of the breast before and the day after expansion. Samples were incubated in [3H]thymidine, and the number of labeled cells were counted. A statistically significant rise in the number of labeled basal and suprabasal keratinocytes was seen after expansion. The findings suggest a net gain of tissue not only by stretching but also by formation of new tissue generated by tissue expansion.
European Journal of Cancer, 2011
Background: The proportion of women living diagnosed with breast cancer in the developed countrie... more Background: The proportion of women living diagnosed with breast cancer in the developed countries is increasing. Since breast cancer-specific deaths decrease with time since diagnosis, it is important to assess the burden of other causes of death as well. Materials and Methods: Different causes of death within 10 years from diagnosis were assessed in 12,850 women <75 years with stage 1−3 breast cancer diagnosed 1990-2006. Flexible parametric survival models were used to estimate hazard ratios over time-since-diagnosis by tumour characteristics and age at diagnosis. Results: The proportion of deaths attributed to breast cancer ranged from 95.0% among women <45 years at diagnosis to 44.5% among women 65−74 years. The proportion of circulatory system-specific deaths and of other causes of death increased with older age at diagnosis. Patients with 1−3 positive lymph nodes were more likely to die from breast cancer during the first 10 years of follow-up compared to women without positive lymph nodes. Women with ER-positive tumours had the same risk of dying from breast cancer after 5 years from diagnosis compared to women with ERnegative tumours. Conclusions: Lymph node negativity is an important long-term predictor of more favorable prognosis. The nature of the relationship between ER-status and risk of dying from breast cancer after five years of follow-up needs further investigation. Death due to circulatory system diseases becomes an important cause of death especially in women diagnosed with breast cancer at older age.
European Journal of Cancer, 1996
European Journal of Cancer, 2004
A consecutive sample of 56 women with a familial risk for breast cancer who were considering a pr... more A consecutive sample of 56 women with a familial risk for breast cancer who were considering a prophylactic mastectomy (PM) completed questionnaires preoperatively concerning risk perception, expectations with regard to surgery, anxiety and depressive symptoms (the Hospital Anxiety and Depression Scale (HAD) scale) and quality of life (The Swedish SF-36 Health Survey). 16 had had a previous breast cancer (Group BC) and 40 had not (Group R). They were compared with normative data from an agematched random sample of the Swedish population and with a reference sample of women with breast cancer. Most women estimated their breast cancer risk accurately. No statistically significant differences were found between Group BC and the normative sample on the HAD scale and SF-36, but Group R reported better physical functioning, emotional role functioning and mental health than the reference sample with breast cancer. Group BC scored closer to them than to the normative sample. Levels of emotional problems and quality of life were comparable to normative values among women considering PM. All women in the present study had previous genetic counselling and our results suggest that their interest in PM was not due to an overestimation of their personal risk.
Breast Cancer Research and Treatment, 2011
Background: Physicians are still concerned about the oncological safety regarding immediate breas... more Background: Physicians are still concerned about the oncological safety regarding immediate breast reconstruction (IBR) in breast cancer patients. This study aimed to evaluate possible differences between local, regional and distant recurrences between women having implant-based reconstruction versus women operated with mastectomy alone. Secondary aims were to evaluate time to oncological treatment as well as diseasefree and breast cancer specific survival. Patients and methods: In a retrospective cohort designed study, 300 reconstructed patients with invasive breast cancer were matched with 300 patients from the population-based Regional Breast Cancer Register of the Stockholm-Gotland health-care region operated with mastectomy alone. They were matched for age, tumor size, nodal stage and year of operation. Also included were patients treated with neoadjuvant chemotherapy and postoperative radiotherapy. The median follow-up for both groups was 11, 5 years (range 2-19). Results: There were no significant differences in the local recurrence rate, 8.2 % in the IBR group and 9.0 % in the control group or in the regional recurrence rate, 8.2 % versus 9.7 %. Distant metastases occurred more frequently in the control group (27.1 %) compared to the IBR group (20.3%). There were no significant differences in time to treatment or in complications rate. Breast cancer mortality was 17 % for the IBR group and 23 % in the control group during follow up. Conclusion: This long-term follow-up survey with a well matched control group demonstrates that IBR with implants is safe to offer patients with invasive breast cancer without any negative effect on the oncological safety.
European Journal of …, 2004
A consecutive sample of 56 women with a familial risk for breast cancer who were considering a pr... more A consecutive sample of 56 women with a familial risk for breast cancer who were considering a prophylactic mastectomy (PM) completed questionnaires preoperatively concerning risk perception, expectations with regard to surgery, anxiety and depressive symptoms (the ...
Plastic and …, 2001
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > April 15, ...
European Journal of Cancer Care, 2010
High satisfaction rate ten years after bilateral prophylactic mastectomy-a longitudinal study Wom... more High satisfaction rate ten years after bilateral prophylactic mastectomy-a longitudinal study Women from families with an increased risk for breast/ovarian cancer have undergone bilateral prophylactic mastectomy (BPM) since the early 1990s at the Karolinska University Hospital in Sweden. Perceptions of BPM as reported by the first women who underwent the procedure have previously been evaluated on a short-term basis (1-3 years). The present study aims to evaluate the long-term (10 years) physical and psychological consequences of BPM in the same cohort of women. Some of the very first women to undergo BPM participated in the present interview study (n = 13). The semi-structured interviews focused on the women's long-term experiences related to BPM and immediate breast reconstruction. Overall, the women were satisfied with their decision to undergo BPM and perceived a negligible remaining risk of getting breast cancer. For most women, the operation had not resulted in changes in family life or lifestyle (n = 8), although some described that the relationship with their spouse was affected (8/13), either in a negative (n = 5) or positive (n = 3) way. The cosmetic results were mainly positive (n = 10). Recurrent counselling and support during the whole process of decision, treatment and follow up is recommended.
Journal of Clinical Oncology, 2008
To prospectively evaluate body image, sexuality, emotional reactions (anxiety, depression), and q... more To prospectively evaluate body image, sexuality, emotional reactions (anxiety, depression), and quality of life in a sample of women having increased risk for breast cancer before and 6 months and 1 year after bilateral prophylactic mastectomy (BPM), and to compare preoperative expectations of the operation with postoperative reactions concerning the impact on six areas of the women's lives.