Im Rahmen der vorliegenden Arbeit wurde eine retrospektive Analyse aller in der Frauenklinik des Klinikums Obergöltzsch in den Jahren zwischen 1993-2012 operierten Frauen mit der Erstdiagnose eines Mammakarzinoms vorgenommen. Dazu wurden 4462 Fälle hinsichtlich der operativen Versorgung ausgewertet. Zur besseren Vergleichbarkeit erfolgte die Einordnung in das Klassifikationssystem von Hoffmann und Wallwiener. Weiterhin erfolgte eine detaillierte Analyse einer 5 Jahres Kohorte ( 2003- 2007 ) hinsichtlich der Alters- und Stadienverteilung, der Rate an R 1- Resektionen, der Rate an Lokalrezidiven , der Wundheilungsstörungen und der ästhetischen Ergebnisse. Dabei wurde ein Überblick über das operative Spektrum der Frauenklinik des Klinikums Obergöltzsch aufgezeigt und die Qualität der Versorgung belegt.

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Im Rahmen der vorliegenden Arbeit wurde eine retrospektive Analyse aller in der Frauenklinik des Klinikums Obergöltzsch in den Jahren zwischen 1993-2012 operierten Frauen mit der Erstdiagnose eines Mammakarzinoms vorgenommen. Dazu wurden 4462 Fälle hinsichtlich der operativen Versorgung ausgewertet. Zur besseren Vergleichbarkeit erfolgte die Einordnung in das Klassifikationssystem von Hoffmann und Wallwiener. Weiterhin erfolgte eine detaillierte Analyse einer 5 Jahres Kohorte ( 2003- 2007 ) hinsichtlich der Alters- und Stadienverteilung, der Rate an R 1- Resektionen, der Rate an Lokalrezidiven , der Wundheilungsstörungen und der ästhetischen Ergebnisse. Dabei wurde ein Überblick über das operative Spektrum der Frauenklinik des Klinikums Obergöltzsch aufgezeigt und die Qualität der Versorgung belegt.

<p>Breast cancer is the most commonly diagnosed cancer type worldwide. Given high survivorship, increased focus has been placed on long-term treatment outcomes and patient quality of life. While breast-conserving surgery (BCS) is the preferred treatment strategy for early-stage breast cancer, anticipated healing and breast deformation (cosmetic) outcomes weigh heavily on surgeon and patient selection between BCS and more aggressive mastectomy procedures. Unfortunately, surgical outcomes following BCS are difficult to predict, owing to the complexity of the tissue repair process and significant patient-to-patient variability. To overcome this challenge, we developed a predictive computational mechanobiological model that simulates breast healing and deformation following BCS. The coupled biochemical-biomechanical model incorporates multi-scale cell and tissue mechanics, including collagen deposition and remodeling, collagen-dependent cell migration and contractility, and tissue plastic deformation. Available human clinical data evaluating cavity contraction and histopathological data from an experimental porcine lumpectomy study were used for model calibration. The computational model was successfully fit to data by optimizing biochemical and mechanobiological parameters through the Gaussian Process. The calibrated model was then applied to define key mechanobiological parameters and relationships influencing healing and breast deformation outcomes. Variability in patient characteristics including cavity-to-breast volume percentage and breast composition were further evaluated to determine effects on cavity contraction and breast cosmetic outcomes, with simulation outcomes aligning well with previously reported human studies. The proposed model has the potential to assist surgeons and their patients in developing and discussing individualized treatment plans that lead to more satisfying post-surgical outcomes and improved quality of life.</p>

Breast cancer is the most common cancer among women in the United States with over 60% of cases diagnosed as early stage disease. For those women without prohibiting clinical or cosmetic concerns, a choice between breast-conserving surgery and mastectomy can be made. Either choice confers equivalent survival. The decision-making process also involves consideration of recurrence risk as well as management of the unaffected, contralateral breast for both future surveillance and risk reduction. In recent years, increasing rates of mastectomy with contralateral prophylactic mastectomy have been reported among women with unilateral, early stage breast cancer. If eligible for a choice among surgical options, a woman’s decision becomes one of personal preference. The decision-making process is complex and involves consideration of potential benefits and harms with each option. The purpose of this dissertation was to: 1) analyze the psychometric properties of the Anxiety Subscale of the Depression Anxiety Stress Scale, 2) critically review Decisional Conflict Scales and 3) prospectively identify demographic, clinical, cognitive and affective factors influencing a woman’s decision to choose either breast conserving surgery or mastectomy with contralateral prophylactic mastectomy and to identify self-reported sources of information in the surgical decision-making process. Three manuscripts make up the dissertation. A secondary data analysis was conducted to test the psychometric properties of the Anxiety Subscale of the Depression Anxiety Stress Scale (DASS). The results of this analysis supported the reliability and validity of the DASS anxiety subscale. A critical review of decisional conflict measures for use with early stage breast cancer patients making surgical treatment decisions was conducted. The results of this review supported the use of Decisional Conflict Scales from a clinical and research perspective. Existing Decisional Conflict Scales show moderate to acceptable reliability. The first two manuscripts provided background and support for the use of scales included in the research study described in the third manuscript. This study was a prospective, exploratory, cross-sectional, mixed-methods study describing factors influencing preference for surgical choice among women with early stage breast cancer. A sample of 78 participants enrolled in the study, 47 who chose breast conserving surgery and 31 who chose mastectomy with contralateral prophylactic mastectomy. Differences were tested between the groups. Women who chose mastectomy with contralateral prophylactic mastectomy were younger, more likely to work full or part-time, had larger tumors and participated in preoperative genetic counselling. Women who chose breast conserving surgery were more likely to have participated in preoperative breast magnetic resonance imaging. Overall, women choosing either surgery were not experiencing severe levels of distress, depression, anxiety or stress although there were individual variations. Women choosing mastectomy with contralateral prophylactic mastectomy were more anxious and had more frequent intrusive thoughts about the diagnosis. They also had less decisional conflict as compared to women choosing breast conserving surgery. Information sources were similar but the most influential information source differed among the two groups. In both groups, intention for surgical choice was matched by the final decision. There are many factors influencing surgical choice among women with early stage breast cancer. Previous work has focused on clinical, demographic and diagnostic processes influencing the decision. With this study, evidence regarding the influence of cognitive and affective factors is described.