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da Costa Vieira RA, Andrade WP, Vieira SC, Romano M, Iglesias G, Oliveira AF. Surgical management of locally advanced breast cancer: Recommendations of the Brazilian Society of Surgical Oncology. J Surg Oncol 2022; 126:57-67. [DOI: 10.1002/jso.26890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/25/2022] [Accepted: 03/27/2022] [Indexed: 01/27/2023]
Affiliation(s)
- René A. da Costa Vieira
- Grupo de Estudos da Mama. Sociedade Brasileira de Cirurgia Oncológica Brazil
- Hospital de Câncer de Muriaé Muriaé Minas Gerais Brazil
| | - Wesley P. Andrade
- Grupo de Estudos da Mama. Sociedade Brasileira de Cirurgia Oncológica Brazil
- Instituto de Oncomastologia São Paulo Brazil
| | - Sabas C. Vieira
- Grupo de Estudos da Mama. Sociedade Brasileira de Cirurgia Oncológica Brazil
- Oncocenter Teresina Piaui Brazil
| | - Mauricio Romano
- Grupo de Estudos da Mama. Sociedade Brasileira de Cirurgia Oncológica Brazil
| | - Gustavo Iglesias
- Grupo de Estudos da Mama. Sociedade Brasileira de Cirurgia Oncológica Brazil
- Instituto Nacional do Câncer Rio de Janeiro Brazil
| | - Alexandre F. Oliveira
- Grupo de Estudos da Mama. Sociedade Brasileira de Cirurgia Oncológica Brazil
- Universidade Federal de Juiz de Fora Minas Gerais Brazil
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Fahradyan A, Liu A, Taylor L, Jones V, Li WY. Short Stay Management of Locally Advanced Breast Cancer Using Immediate Local Thoracoabdominal Advancement Flap and Enhanced Recovery After Surgery Protocol. Ann Plast Surg 2022; 88:S366-S373. [PMID: 37740470 DOI: 10.1097/sap.0000000000003140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
BACKGROUND Patients with locally advanced invasive breast cancer (LABC) are often considered inoperable, because of the anticipated chest wall defect and need for complex reconstruction. We present a series of patients who underwent mastectomy with extensive skin resection and immediate chest wall reconstruction using a local thoracoabdominal advancement flap (TAAF). All patients were managed after surgery with an ERAS (Enhanced Recovery After Surgery) protocol, to decrease length of stay in hospital. We also present 1 patient who subsequently had satisfactory bilateral delayed breast reconstruction with pedicled latissimus dorsi myocutaneous flaps with prepectoral silicone implants. METHODS This is a single-surgeon, single-institution retrospective chart review of patients with LABC who underwent mastectomy with skin resection and local TAAF from May 2017 to October 2019, with minimum 3-month follow-up. RESULTS Thirteen patients met inclusion criteria. Twelve of 13 patients presented with stage III or IV invasive breast cancer, with skin involvement. The mean chest wall defect measured 248.7 cm2 (140-336 cm2; SD, 63.2 cm2), and all were successfully reconstructed with immediate local TAAF. There were no intraoperative complications, but 1 patient developed a postop hematoma. The mean hospital stay was 1.3 nights, with 9 patients (69.2%) staying less than 23 hours and 4 patients (30.8%) staying 2 nights. Nine patients (69.2%) underwent adjuvant therapy, beginning on average 32 days (13-55 days; SD, 13.1 days) after surgery. The mean follow-up time was 13.8 months (4.5-31.6 months; SD, 9.2 months). One patient underwent successful delayed bilateral breast reconstruction with pedicled latissimus dorsi myocutaneous flaps and silicone implant placement. CONCLUSIONS Our study demonstrates that reconstruction with local TAAF is an outpatient procedure that reliably provides durable, immediate chest wall coverage, after mastectomy in patients with LABC. This technique has a short operative time, low blood loss, and low complication rate, allowing timely adjuvant therapy. Using an ERAS postop protocol we were able to reduce mean hospital stay to 1.3 days. Compared with other described techniques of reconstruction, the additional scars and donor site morbidity are minimal, allowing for delayed breast reconstruction. We also present survival outcomes data on these surgically managed patients.
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Affiliation(s)
| | - Alice Liu
- Keck School of Medicine, University of Southern California, Los Angeles
| | | | | | - Wai-Yee Li
- Plastic and Reconstructive Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA
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Quality of Life in Palliative Post-mastectomy Reconstruction: Keystone versus Rotational Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3457. [PMID: 33747689 PMCID: PMC7963501 DOI: 10.1097/gox.0000000000003457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/07/2021] [Indexed: 12/01/2022]
Abstract
Background: Late stage breast cancer presents with malignant wound causing skin infiltration, pain, bleeding, and malodour, which affect quality of life (QoL). Palliative mastectomy aims to eliminate wound symptoms and requires prolonged wound care to improve QoL. This study aimed to prospectively investigate QoL differences in 2 alternative reconstructive methods: keystone flap and rotational flap. Methods: Twenty-four late stage breast cancer patients with symptoms of cancer wounds were included in this study. They were divided into 2 groups: keystone flap and rotational flap. Each patient’s QoL was evaluated using EORTC QLQ-C30 and QLQ-BR23 before and 3 weeks after surgery. Results: Global health post-surgery was significantly improved compared with pre-surgery in all patients (P < 0.001), across both the keystone (P = 0.018) and rotational groups (P = 0.007). Breast symptoms post-surgery were also improved compared with pre-surgery in all patients (P = 0.035). However, when analyzed per group, breast symptoms were only improved significantly in the keystone group (P = 0.013) but not in the rotational group (P = 0.575). When compared between 2 groups, future perspective post-surgery in the keystone group [100 (0–100)] was better than the rotational group [66.7 (0–100)], (P = 0.020). Conclusions: Reconstructive surgery after mastectomy improves QoL in late stage breast cancer patients. The keystone flap is superior to the rotational flap in improving global health and breast symptoms.
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da Costa Vieira RA, de Oliveira-Junior I, Branquinho LI, Haikel RL, Ching AW. ASO Author Reflections: Modified External Oblique Myocutaneous Flap for Breast Cancer. Ann Surg Oncol 2020; 28:3365. [PMID: 33128121 DOI: 10.1245/s10434-020-09252-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/04/2020] [Indexed: 11/18/2022]
Affiliation(s)
- René Aloisio da Costa Vieira
- Programa de Pós-Graduação em Oncologia, Hospital de Cancer de Barretos, Barretos, Brazil. .,Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho - UNESP, São Paulo, Brazil.
| | - Idam de Oliveira-Junior
- Programa de Pós-Graduação em Tocoginecologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho - UNESP, São Paulo, Brazil.,Departamento de Mastologia e Reconstrução Mamária, Hospital de Câncer de Barretos, Barretos, Brazil
| | | | - Raphael Luiz Haikel
- Departamento de Mastologia e Reconstrução Mamária, Hospital de Câncer de Barretos, Barretos, Brazil
| | - An Wan Ching
- Departamento de Cirurgia Plástica, Universidade Federal de Sao Paulo, Escola Paulista de Medicina - UNIFESP, São Paulo, Brazil
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da Costa Vieira RA, de Oliveira-Junior I, Branquinho LI, Haikel RL, Ching AW. Modified External Oblique Myocutaneous Flap for Repair of Postmastectomy Defects in Locally Advanced Breast Tumors: A Cohort Series Associated with a Systematic Review of Literature. Ann Surg Oncol 2020; 28:3356-3364. [PMID: 33063264 DOI: 10.1245/s10434-020-09205-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/14/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Locally advanced breast tumors (LABT) are situations of difficult resolution in clinical practice. External oblique myocutaneous flap (EOMF) is an option, but there are few studies in the literature on its use. METHODS This was a retrospective, cohort institutional study of patients with LABT who were undergoing mastectomy combined with the use of modified-EOMF (M-EOMF). Preoperative indications and conditions, factors associated with surgery, time to radiotherapy, local recurrence, and survival were assessed. A systematic review of the literature also was performed to evaluate the use of EOMF. RESULTS Over the 10-year period, 17 patients underwent M-EOMF closure. The mean duration of surgery was 251 min, and extensive skin area was resected (mean 468 ± 260 cm2). Four patients developed local recurrence. The actuarial survival at 36 months was 48.3%. Using PRISMA statement, among 115 articles evaluated from 3 databases, 8 articles were selected, in which 146 patients underwent EOMF. EOMF are associated with low postoperative complications with 8.9% skin necrosis. The M-EOMF allowed the resection of larger areas than other flaps described in the literature but is associated with skin necrosis. CONCLUSIONS M-EOMF has the advantages of not requiring a change in the patient's position for the closure of large areas. It is thus an acceptable option for chest wall reconstruction in tumors at the limit of resectability.
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Affiliation(s)
- René Aloisio da Costa Vieira
- Postgraduate Program of Oncology, Barretos Cancer Hospital, Barretos, SP, Brazil. .,Postgraduate Program Tocoginecology, Botucatu Medical School, Sao Paulo State University - UNESP, São Paulo, Brazil.
| | - Idam de Oliveira-Junior
- Postgraduate Program Tocoginecology, Botucatu Medical School, Sao Paulo State University - UNESP, São Paulo, Brazil.,Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, São Paulo, Brazil
| | | | - Raphael Luiz Haikel
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, São Paulo, Brazil
| | - An Wan Ching
- Department of Plastic Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Min K, Choi EJ, Lee YH, Eom JS, Son BH, Ahn SH, Kim EK. Single vertical incision thoracoabdominal flap for chest wall reconstruction following mastectomy of locally advanced breast cancer. Ann Surg Treat Res 2019; 97:168-175. [PMID: 31620390 PMCID: PMC6779953 DOI: 10.4174/astr.2019.97.4.168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/11/2019] [Accepted: 07/30/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose Skin grafts have been widely used in managing extensive chest wall defects after mastectomy for advanced breast cancer. However, their durability and tolerability to radiotherapy is still controversial. A thoracoabdominal (TA) flap with a few technical refinements can safely transfer a larger flap while minimizing complications. Methods From January 2007 to February 2018, a retrospective review was performed to compare 2 groups after wide breast excision: skin graft group (group 1) and lateral-based, single vertical incision rotation-advancement TA flap (group 2). Patients' demographics, operative details, complications, hospital stay, postoperative outpatient visits, cost, and start of adjuvant therapy were analyzed between the 2 groups. Results During the study period, 34 patients received skin graft and 41 patients received TA flap. group 2 had a shorter hospital stay (6.41 ± 2.64 days vs. 12.62 ± 4.60 days, P < 0.001) and shorter time to complete wound healing (29.27 ± 18.68 days vs. 39.24 ± 27.70 days, P = 0.03) than group 1. There was also a difference in the period from surgery to initiation of adjuvant therapy (group 1, 45.04 days ± 17.79 days; group 2, 37.07 ± 15.38 days, P = 0.073). Although limitation in shoulder motion was more frequent in group 2, limitation of motion for >1 year was observed in 4 patients in only group 1 (43.90% vs. 38.24%, P = 0.613). Conclusion TA flap has a simple design that minimizes concerns involving the donor site. Moreover, it does not require complicated procedures and allows for re-elevation whenever necessary. Finally, it guarantees faster wound recovery than skin graft with fewer complications.
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Affiliation(s)
- Kyunghyun Min
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Jeong Choi
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon Hoon Lee
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Sup Eom
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Ho Son
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sei Hyun Ahn
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Key Kim
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Burattini ACB, Horacio GS, Beloti TR. Reply: ITADE flap after mastectomy for locally advanced breast cancer: A good choice for mid-sized defects of the chest wall, based on a systematic review of thoracoabdominal flaps. J Surg Oncol 2019; 119:1181. [PMID: 30887497 DOI: 10.1002/jso.25439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 01/24/2019] [Accepted: 02/16/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Ana C B Burattini
- Department of Plastic Surgery, Pérola Byington Hospital, São Paulo, Brazil.,Sociedade Brasileira de Cirurgia Plástica (SBCP), São Paulo, Brazil
| | | | - Tuanny R Beloti
- Sociedade Brasileira de Cirurgia Plástica (SBCP), São Paulo, Brazil
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Vieira RAC, Boni RADS, Silva VD. Reply: ITADE flap after mastectomy for locally advanced breast cancer: A good choice for mid‐sized defects of the chest wall based on a systematic review of thoracoabdominal flaps. J Surg Oncol 2019; 119:1182-1183. [DOI: 10.1002/jso.25436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 11/10/2022]
Affiliation(s)
- R. A. C. Vieira
- Department of Mastology and Breast reconstructionBarretos Cancer HospitalBarretos Brazil
- Postgraduate Course of Gynecology, Obstetrics and Mastology, Botucatu School of Medicine, UNESPBotucatu Sao Paulo Brazil
| | | | - V. D. Silva
- Department of PathologyBarretos Cancer HospitalBarretos Brazil
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