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>

Bakgrund: Bröstcancer är idag den vanligaste typen av cancer i världen hos kvinnor. Att drabbas av bröstcancer är en stor omställning i livet. Bra kontakt med omvårdnadspersonalen är viktigt för behandlingen och återhämtningen. Kvinnors upplevelser finns beskrivet i forskning och behöver sammanställas för att ge en överblick på kunskapsläget. Syfte: Syftet med denna litteraturstudie var att beskriva kvinnors upplevelse av att drabbas av bröstcancer, synen på omvårdnad och genomgå kirurgisk behandling.  Metod: Studien baserades på åtta studier som har genomförts med kvalitativ metod. Artiklarna kvalitetsgranskades med stöd av Olsson och Sörensens (2011) granskningstabell för att därefter analyseras med hjälp av Hsieh och Shannons (2005) analysmodell. Resultat: Resultatet kategoriserades i tre huvudteman: nyuppkomna känslor, kommunikation från omvårdnadspersonal och relationen med omvårdnadspersonalen med sammanlagt sex subteman. Kvinnorna som gjort kirurgisk behandling vid bröstcancer önskade stöd från omvårdnadspersonalen, förbättrad kommunikation och individanpassad information om operationen och vad som kommer hända sen. Konklusion: För att kunna ge kvinnorna bästa möjliga omvårdnad behöver omvårdnadspersonalen ha ett mer personcentrerat tankesätt med fokus på stöd och kommunikation samt ge individanpassad information. / Background: Breast cancer is the most common cancer among women all over the world. To be diagnosed with breast cancer is a big challenge. Good contact with healthcare professionals is important for treatment and recovery. The experience of women is described in research and need to be compiled to provide an overview of the state of knowledge  Aim: The purpose of this literature study was to examine women's experiences of suffering from breast cancer, their view of nursing care and undergoing surgical treatment. Methods: A qualitative method was used based on eight scientific articles reviewed with Olsson and Sörensen’s (2011) review table. The analysis process was inspired of Hsieh and Shannon’s (2005) analysis form. Results: The results were categorized into three main themes: new emotions, communication with nursing staff, and the relationship with nursing staff, altogether with six sub-themes. Women who have gone through surgical treatment due to breast cancer wanted support from the nursing staff, improved communication, personalized information about the surgery and what will happen post surgery. Conclusion: To be able to provide women with the best possible care, the nursing staff need to have a more person-centered mindset with a focus on support and communication and provide individualized information.

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.

Le cancer du sein est le cancer le plus fréquent chez les femmes. Il y a une multitude de solutions proposées concernant une éventuelle intervention médicale pour le cancer du sein ‐ une en particulier est la chirurgie mammaire conservatrice (tumoréctomie). Le but de la tumoréctomie est de parvenir à un contrôle local du cancer, ainsi que de préserver une forme du sein qui satisfait les besoins esthétiques de la femme. Bien que ces objectifs sont généralement atteint, il reste encore parfois des résultats inattendus,tels qu'une tumeur récurrence locale, ou des résultats cosmétiques insuffisants.L'objectif de cette thèse est de proposer une plateforme de calcul, qui contribue à la tumoréctomie. Cela comprend:1) Une étude de la dynamique de croissance des tumeurs du sein.2) Une étude sur la prédiction du contour du sein grâce a la chirurgie virtuelle.3) Un modèle de calcul de la forme finale du sein après cicatrisation. / Breast cancer is the most common cancer among women in the developed as well as the developing countries. There are a plethora of proposed solutions regarding possible medical interventions for breast cancer–one in particular is Breast Conserving Therapy (BCT). BCT comprises of complete surgical excision of the tumor (partialmastectomy), and post-operative radiotherapy for the remaining breast tissue. This is a feasible treatment for most women with breast cancer. The goal of BCT is toachieve local control of the cancer, as well as to preserve breast shape that appeases awoman’s cosmetic concerns. Although these goals are usually achieved, there are still occasional unexpected results, such as reexcision of the tumor due to a positive margin assessment, tumor local recurrence, unsatisfactory cosmetic results, and breastpain. Other than surgical experience and judgment, there are currently no toolswhich can predict the outcome of partial mastectomy on the contour and deformity of the treated breast. The objective of this dissertation is to propose computational framework, which contributes to BCT operations, this was achieve by exploring two areas.On the one hand we developed a multiscale model adapted for breast cancer tumor growth, ductal carcinoma in situ (DCIS). The model features included: nutrients growth limitation, wall degradation enzyme and HER2 chemical expression tumor phenotype. Our model successfully simulate some pattern of DCIS carcinoma.Among the interesting result we showed that the enzyme contributed to a greater tumor size and that when HER2 was over expressed, the growth limiting factor wasthe EGFR. On the other hand, we developed a virtual surgery box to simulate BCT surgery. The box will input MRI patient data and will output cosmetic and functional indicator to rate the impact of the surgery. It appears that stiffness of the tissue, resection radius as well as the lump quadrant location are the most sensitive parameters to the indicators. A healing model was also embedded to simulate the wound closure after resection, this model was stress dependent and illustrate anasymmetric wound closure progression.The tools developed in this research allows a new type of field convergence between the surgery and computation field. At the local level it will allow surgeons and patient to be able to communicate on the pertinence and necessity of performing alumpectomy surgery, enabling to anticipate the possible outcome of the operation.On the global aspect this type of tool gives birth to a new type of field: computational surgery, where computer scientist and surgeons work hand in hand to provide the best and the most reliable service to the patients.