Mastectomy for management of breast cancer in Ibadan, Nigeria

Abstract

Background: Modified radical mastectomy remains the standard therapeutic surgical operation for breast cancer in most parts of the world. This retrospective study reviews mastectomy for management of breast cancer in a surgical oncology division over a ten year period.

Methods: We reviewed the case records of consecutive breast cancer patients who underwent mastectomy at the Surgical Oncology Division, University College Hospital (UCH) Ibadan between November 1999 and October 2009.

Results: Of the 1226 newly diagnosed breast cancer patients over the study period, 431 (35.2%) patients underwent mastectomy making an average of 43 mastectomies per year. Most patients were young women, premenopausal, had invasive ductal carcinoma and underwent modified radical mastectomy as the definitive surgical treatment. Prior to mastectomy, locally advanced tumors were down staged in about half of the patients that received neo-adjuvant combination chemotherapy. Surgical complication rate was low. The most frequent operative complication was seroma collection in six percent of patients. The average hospital stay was ten days and most patients were followed up at the surgical outpatients department for about two years post-surgery.

Conclusions: There was low rate of mastectomy in this cohort which could partly be attributable to late presentation of many patients with inoperable local or metastatic tumors necessitating only palliative or terminal care. Tumor down-staging with neo-adjuvant chemotherapy enhanced surgical loco-regional tumor control in some patients. The overall morbidity and the rates of postoperative events were minimal. Long-term post-operative out-patients follow-up was not achieved as many patients were lost to follow up after two years of mastectomy.

Figure 1

Numbers of breast cancer patients seen and mastectomies done per year in Surgical Oncology Division, UCH Ibadan in 1999–2009.

Figure 2

Distribution of administration of chemotherapy in 354 patients who had mastectomy in Surgical Oncology Division, UCH Ibadan in 1999–2009.

Figure 3

Neo-adjuvant chemotherapy regimens in 174 pre-mastectomy patients in Surgical Oncology Division, UCH Ibadan in 1999–2009.

Figure 4

Tumour responses to neo-adjuvant chemotherapy in 174 pre-mastectomy patients in Surgical Oncology Division, UCH Ibadan in 1999–2009.

Figure 5

Complications of mastectomy in 51/354 breast cancer patients in Surgical Oncology Division, UCH Ibadan in 1999–2009.