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Nashimoto M, Asano Y, Matsui H, Machida Y, Hoshi K, Kurosumi M, Fukuma E. Comparison of locoregional recurrence risk among nipple-sparing mastectomy, skin-sparing mastectomy, and simple mastectomy in patients with ductal carcinoma in situ: a single-center study. Breast Cancer 2024; 31:1010-1017. [PMID: 39017823 DOI: 10.1007/s12282-024-01613-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 07/04/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND In invasive breast cancer, there are no differences among the mid- and long-term oncological safety results of nipple-sparing mastectomy (NSM), skin-sparing mastectomy (SSM), and simple mastectomy (SM). There are several reports comparing NSM and SSM with SM in the context of ductal carcinoma in situ (DCIS); however, the eligibility criteria vary among institutions, and there are no reports that compare all three surgical methods simultaneously within the same institution. This study aimed to compare the local recurrence and survival rates of the three techniques (NSM, SSM, and SM) in Japanese patients undergoing mastectomy for DCIS. METHODS Patients undergoing NSM, SSM, or SM at our institution between 2006 and 2015 were identified, and their outcomes were analyzed. RESULTS The mean follow-up period was 80.4 months (standard deviation [SD]: 37.1 months). NSM was performed in 152 cases, SSM in 49, and SM in 44. Five of 245 patients developed local recurrences. Four of these patients had invasive cancer. The primary endpoints of 5-year cumulative local recurrence were 2.4% (95% confidence interval [CI]: 0.0-5.0) for NSM, 2.2% (95% CI: 0.0-6.3) for SSM, and 0% (95% CI: 0.0-0.0) for SM. There were no significant differences among the 5-year local recurrence rates. CONCLUSIONS In this single-center, retrospective study, the oncological safety of SSM and NSM for DCIS was comparable to that of conventional SM.
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MESH Headings
- Humans
- Female
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/prevention & control
- Breast Neoplasms/surgery
- Breast Neoplasms/pathology
- Middle Aged
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Nipples/surgery
- Nipples/pathology
- Adult
- Retrospective Studies
- Aged
- Mastectomy, Simple/methods
- Organ Sparing Treatments/methods
- Follow-Up Studies
- Survival Rate
- Japan/epidemiology
- Mastectomy, Subcutaneous/methods
- Mastectomy, Subcutaneous/adverse effects
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Affiliation(s)
- Mika Nashimoto
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan.
| | - Yuko Asano
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Clinical Research Support Office, Kameda Medical Center, Chiba, Japan
| | - Youichi Machida
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
- Department of Radiology, Kameda Medical Center, Chiba, Japan
| | - Kazuei Hoshi
- Department of Pathology, Kameda Medical Center, Chiba, Japan
| | - Masafumi Kurosumi
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
- Department of Pathology, Kameda Medical Center, Chiba, Japan
| | - Eisuke Fukuma
- Breast Center, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba, Japan
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2
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Shinzaki W, Manabe H, Kubota M, Inui H, Hojo T, Ito T, Itani Y, Komoike Y. Breast cancer local recurrence after mastectomy with immediate latissimus dorsi myocutaneous flap reconstruction: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231177510. [PMID: 37325163 PMCID: PMC10265333 DOI: 10.1177/2050313x231177510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
Even though most local recurrences after autologous breast reconstruction occur in superficial tissue, they also occur in deep tissue in the reconstructed breast. A 49-year-old woman presented with a bloody discharge from the right nipple. Ultrasonography revealed a hypoechoic area in her right breast, which was diagnosed as ductal carcinoma in situ on histopathology. We performed nipple-sparing mastectomy and immediate reconstruction of the breast with a latissimus dorsi myocutaneous flap. At 6 years postoperatively, the patient presented with a palpable mass. Ultrasonography revealed a solid mass lesion subcutaneously in the right breast. Computed tomography revealed multiple enhanced solid mass lesions in the subcutaneous and deep tissues of the reconstructed breast. The mass in the deep tissue of the reconstructed breast was diagnosed as an invasive micropapillary carcinoma by biopsy. For local recurrence, we performed wide excision of the reconstructed breast. The masses in the subcutaneous and deep tissues of the reconstructed breast were diagnosed as invasive micropapillary carcinoma. Superficial recurrence was first detected by physical examination, and deep recurrence was later detected with further imaging. We present a case of local recurrences that occurred in the deep tissue, in addition to superficial tissue of the reconstructed breast.
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Affiliation(s)
- Wataru Shinzaki
- Division of Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama City, Japan
| | - Hironobu Manabe
- Division of Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama City, Japan
| | - Michiyo Kubota
- Division of Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama City, Japan
| | - Hiroki Inui
- Division of Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama City, Japan
| | - Toshiya Hojo
- Division of Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama City, Japan
| | - Toshikazu Ito
- Division of Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama City, Japan
| | - Yoshihito Itani
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Kindai University, Osakasayama City, Japan
| | - Yoshifumi Komoike
- Division of Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama City, Japan
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Frasson AL, Falcone AB, Miranda I, Souza ABAD, Vollbrecht B, Barbosa F, Frasson MARM, Lichtenfels M. Nipple-sparing Mastectomy with Immediate Implant-based Reconstruction for Patients with Pure Ductal Carcinoma in Situ. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:376-384. [PMID: 35623619 PMCID: PMC9948099 DOI: 10.1055/s-0042-1742315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The presence of an extensive intraductal component is associated to an increasing risk of relapse in the nipple-areola complex. The aim of the present study was to evaluate the outcomes of patients diagnosed with ductal carcinoma in situ (DCIS) who underwent nipple-sparing mastectomy (NSM) with immediate breast reconstruction using silicone implants. METHODS We retrospectively analyzed the postoperative complications and oncological safety of 67 breast cancer patients diagnosed with pure DCIS who underwent NSM with immediate breast reconstruction using silicone implants between 2004 and 2018. RESULTS Among the 127 NSM procedures performed, 2 hematomas (1.5%) and 1 partial nipple necrosis (0.7%) were observed. After a mean follow-up of 60 months, the local recurrence rate was of 8.9%, the disease-free survival rate was of 90%, and 1 of the patients died. CONCLUSION Despite the local recurrence rate, we showed that NSM with immediate breast reconstruction using silicone implants is a feasible surgical approach, with a low rate of complications and high survival rates for patients with a diagnosis of pure DCIS when breast-conserving surgery is not an option.
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Affiliation(s)
- Antônio Luiz Frasson
- Mastology Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ana Beatriz Falcone
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.,Mastology Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Isabela Miranda
- Mastology Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Betina Vollbrecht
- Mastology Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | - Martina Lichtenfels
- Mastology Service, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Blanckaert M, Vranckx J. Oncological safety of therapeutic 'nipple-sparing mastectomy' followed by reconstruction: a systematic review. Acta Chir Belg 2021; 121:155-163. [PMID: 33929924 DOI: 10.1080/00015458.2021.1922829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Breast cancer (BC) treatment traditionally consisted of radical and often mutilating surgery. Advances in the field of BC have led to new remedies, enabling the paradigm shift from radical to conservative surgery. New treatments such as nipple-sparing mastectomy (NSM) are becoming more popular, aiming to improve both oncological and aesthetic outcomes. However, evidence confirming the oncological safety of NSM is currently lacking, hindering its application. This systematic review sought to analyze NSM's oncological safety as an alternative to conventional mastectomy (CM). PATIENTS AND METHODS A systematic review was performed, respecting the PRISMA guidelines. Pubmed, Embase, and Web of Science databases were consulted and searched for keywords: 'nipple-sparing mastectomy' and 'mammaplasty', or combinations of synonyms. Only original studies published between 2000 and 2020 reporting tumor recurrence and/or survival rates with a minimum of 5-year follow-up were included. RESULTS From the 1675 unique records found, 14 studies were included, amounting to 5980 female BC patients who underwent NSM plus reconstruction. Included studies described either only ductal carcinoma in situ (DCIS, n = 1), only invasive BC (n = 3) or DCIS and invasive BC (n = 10). The most recurrent oncological metrics were 5-year local recurrence (0-10%), locoregional recurrence (0-7.4%), distant recurrence (1.6-15.6%), and overall survival rate (93.1-100%). CONCLUSION Based on long-term low BC recurrences and high survival rates, NSM is perceived to be non-inferior to CM from an oncological perspective. This identifies NSM plus reconstruction to be a safe curative treatment. Further studies should aim to elicit clear and applicable selection criteria in order to maximize NSM's potential.
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Affiliation(s)
- Maxim Blanckaert
- Department of Plastic and Reconstructive Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jan Vranckx
- Department of Plastic and Reconstructive Surgery, University Hospitals Leuven, Leuven, Belgium
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5
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Al-Khalili R, Alzeer A, Nguyen GK, Crane EP, Song JH, Jeon JL, Nellamattathil M, Makariou EV, Mango VL. Palpable Lumps after Mastectomy: Radiologic-Pathologic Review of Benign and Malignant Masses. Radiographics 2021; 41:967-989. [PMID: 33989071 DOI: 10.1148/rg.2021200161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patients who have undergone mastectomy, with or without reconstruction, are not universally screened with mammography or US. Therefore, clinical breast examination by the physician and patient-detected palpable abnormalities are crucial for detecting breast cancer or recurrence. Diagnostic US is the first-line modality for evaluation of postmastectomy palpable masses, with occasional adjunct use of diagnostic mammography for confirming certain benign masses. In the setting of a negative initial imaging evaluation with continued clinical concern, diagnostic MRI may aid in improving sensitivity. Knowledge of the typical multimodality imaging appearances and locations of malignant palpable abnormalities-such as invasive carcinoma recurrence, cancer in residual breast tissue, radiation-induced sarcoma, and metastatic disease-is crucial in diagnosis and treatment of these entities. In addition, familiarity with the range of benign palpable postmastectomy processes-including fat necrosis, fat graft, seroma, granuloma, neuroma, fibrosis, and infection-may help avoid unnecessary biopsies and reassure patients. The authors review common and rare benign and malignant palpable masses in mastectomy patients, describe multimodality diagnostic imaging evaluation of each entity, review radiologic and pathologic correlation, and acquaint the radiologist with management when these findings are encountered. ©RSNA, 2021.
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Affiliation(s)
- Rend Al-Khalili
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Ali Alzeer
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Giang-Kimthi Nguyen
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Erin P Crane
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Judy H Song
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Janice L Jeon
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Michael Nellamattathil
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Erini V Makariou
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
| | - Victoria L Mango
- From the Departments of Radiology (R.A.K., G.K.N., E.P.C., J.H.S., J.L.J., M.N., E.V.M.) and Pathology (A.A.), MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (V.L.M.)
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6
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Wu ZY, Kim HJ, Lee J, Chung IY, Kim JS, Lee SB, Son BH, Eom JS, Kim SB, Gong GY, Kim HH, Ahn SH, Ko B. Recurrence Outcomes After Nipple-Sparing Mastectomy and Immediate Breast Reconstruction in Patients with Pure Ductal Carcinoma In Situ. Ann Surg Oncol 2020; 27:1627-1635. [PMID: 31912259 DOI: 10.1245/s10434-019-08184-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Nipple-sparing mastectomy (NSM) has become increasingly prevalent for patients with ductal carcinoma in situ (DCIS) requiring mastectomy. However, few data regarding recurrence outcomes after NSM are available for this patient population. This study evaluated the locoregional recurrence (LRR) rate for patients with pure DCIS who underwent NSM followed by immediate breast reconstruction without adjuvant radiotherapy and investigated potential risk factors for LRR and/or nipple-areola complex recurrence (NR). METHODS A retrospective chart review was performed for 199 consecutive patients with pure DCIS who underwent NSM and immediate breast reconstruction between March 2003 and December 2015. Risk factors for LRR and NR were analyzed using univariate (Chi square test) and multivariate (Cox model) methods. RESULTS The median follow-up duration after surgery was 97 months (range, 39-186 months). At 10 years, the LRR rate was 4.5%, and the NR rate was 3%. The univariate analysis showed that high nuclear grade, negative receptor status, positive human epidermal growth factor receptor 2 (HER2) status, and negative hormone receptor/positive HER2 subtype were associated with increased risk for NR. The multivariate analysis demonstrated that negative progesterone receptor status was an independent risk factor for LRR. However, margin status and tumor-to-nipple distance (TND) were not associated with increased risk for either LRR or NR. CONCLUSIONS The study findings suggest that NSM can be a feasible surgical option even for DCIS with a TND of 1 cm or less if the retroareolar resection margin is negative for malignancy. Determining the molecular subtype of DCIS might be helpful in identifying patients at high risk for recurrence.
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Affiliation(s)
- Zhen Yu Wu
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea.,Department of Breast Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hee-Jeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - JongWon Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Il-Yong Chung
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Ji-Sun Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Sae-Byul Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Byung Ho Son
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Jin-Sup Eom
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Bae Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gyung-Yub Gong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hak-Hee Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sei Hyun Ahn
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - BeomSeok Ko
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea.
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7
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Is There a Preferred Incision Location for Nipple-Sparing Mastectomy? A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2019; 143:906e-919e. [DOI: 10.1097/prs.0000000000005502] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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8
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Nipple-sparing Mastectomy and Immediate Breast Reconstruction After Recurrence From Previous Breast Conservation Therapy. Ann Plast Surg 2019; 82:S95-S102. [DOI: 10.1097/sap.0000000000001696] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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9
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Lago V, Maisto V, Gimenez-Climent J, Vila J, Vazquez C, Estevan R. Nipple-sparing mastectomy as treatment for patients with ductal carcinoma in situ: A 10-year follow-up study. Breast J 2017; 24:298-303. [DOI: 10.1111/tbj.12947] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Víctor Lago
- Division of Gynecologic Oncology; University Hospital La Fe; Valencia Spain
| | - Vincenzo Maisto
- General Surgery Department; University Hospital Federico II di Napoli; Napoli Italy
| | - Julia Gimenez-Climent
- Division of Breast Surgery; General Surgery Department; Valencia Oncology Institute; Valencia Spain
| | - Jose Vila
- Division of Breast Surgery; Obstetrics and Gynecology Department; La Fe University Hospital; Valencia Spain
| | - Carlos Vazquez
- President of the Spanish Society of Senology and Breast Pathology; Madrid Spain
| | - Rafael Estevan
- Division of Breast Surgery; General Surgery Department; Valencia Oncology Institute; Valencia Spain
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Pechevy L, Carloni R, Guerid S, Vincent PL, Toussoun G, Delay E. Skin-Reducing Mastectomy in Immediate Reconstruction: How to Limit Complications and Failures. Aesthet Surg J 2017; 37:665-677. [PMID: 28171481 DOI: 10.1093/asj/sjw258] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In hypertrophic and/or very ptotic breasts, skin-reducing mastectomy (SRM) is challenging and the risk of complications is high. Few publications have reported the use of an autologous latissimus dorsi flap (ALDF) in this indication. Most studies opt for implant reconstructions, with a high failure rate. OBJECTIVES We aimed to identify and present the technical refinements that reduce the risk of reconstruction failure in patients with hypertrophic and/or ptotic breasts with breast cancer or at risk of breast cancer after SRM with immediate breast reconstruction (IBR) utilizing an ALDF. METHODS Our retrospective study, covering a period of 18 years, included a series of 60 patients with hypertrophic and/or ptotic breasts who underwent 67 SRM and IBR procedures utilizing an ALDF. The complications were recorded and the risk factors analyzed. RESULTS Sixty-seven SRMs were reviewed. Forty-nine procedures were performed with an inverted-T scar technique and 18 with a vertical scar technique. The nipple-areola complex (NAC) was preserved in 10 cases. There were eight (11.9%) cases of minor mastectomy flap necrosis after skin-reducing reconstructions, 16 (23.8%) wound dehiscences, no infections, no breast seromas, and no reconstruction failures. Smoking increased the risk of minor mastectomy flap necrosis (P = 0.048) and wound dehiscence (P = 0.002). Previous radiotherapy was associated with minor mastectomy flap necrosis (P = 0.001). CONCLUSIONS The use of an ALDF together with technical refinements that preserve the vascular supply of the skin envelope leads to successful IBR with consistently good aesthetic results. Above all, it avoids failure of the reconstruction in very large or ptotic breasts. LEVEL OF EVIDENCE 4
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Affiliation(s)
- Lolita Pechevy
- From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France
| | - Raphael Carloni
- From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France
| | - Samia Guerid
- From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France
| | - Pierre-Luc Vincent
- From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France
| | - Gilles Toussoun
- From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France
| | - Emmanuel Delay
- From the Department of Plastic and Reconstructive Surgery, Léon Bérard Center, Lyon, France
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11
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Mota BS, Riera R, Ricci MD, Barrett J, de Castria TB, Atallah ÁN, Bevilacqua JLB. Nipple- and areola-sparing mastectomy for the treatment of breast cancer. Cochrane Database Syst Rev 2016; 11:CD008932. [PMID: 27898991 PMCID: PMC5868722 DOI: 10.1002/14651858.cd008932.pub3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of breast cancer are still questionable. It is estimated that the local recurrence rates following nipple-sparing mastectomy are very similar to breast-conserving surgery followed by radiotherapy. OBJECTIVES To assess the efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of ductal carcinoma in situ and invasive breast cancer in women. SEARCH METHODS We searched the Cochrane Breast Cancer Group's Specialized Register, the Cochrane Center Register of Controlled Trials (CENTRAL), MEDLINE (via PubMed), Embase (via OVID) and LILACS (via Biblioteca Virtual em Saúde [BVS]) using the search terms "nipple sparing mastectomy" and "areola-sparing mastectomy". Also, we searched the World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.gov. All searches were conducted on 30th September 2014 and we did not apply any language restrictions. SELECTION CRITERIA Randomised controlled trials (RCTs) however if there were no RCTs, we expanded our criteria to include non-randomised comparative studies (cohort and case-control studies). Studies evaluated nipple-sparing and areola-sparing mastectomy compared to modified radical mastectomy or skin-sparing mastectomy for the treatment of ductal carcinoma in situ or invasive breast cancer. DATA COLLECTION AND ANALYSIS Two review authors (BS and RR) performed data extraction and resolved disagreements. We performed descriptive analyses and meta-analyses of the data using Review Manager software. We used Cochrane's risk of bias tool to assess studies, and adapted it for non-randomised studies, and we evaluated the quality of the evidence using GRADE criteria. MAIN RESULTS We included 11 cohort studies, evaluating a total of 6502 participants undergoing 7018 procedures: 2529 underwent a nipple-sparing mastectomy (NSM), 818 underwent skin-sparing mastectomy (SSM) and 3671 underwent traditional mastectomy, also known as modified radical mastectomy (MRM). No participants underwent areola-sparing mastectomy. There was a high risk of confounding for all reported outcomes. For overall survival, the hazard ratio (HR) for NSM compared to SSM was 0.70 (95% CI 0.28 to 1.73; 2 studies; 781 participants) and the HR for NSM compared to MRM was 0.72 (95% CI 0.46 to 1.13; 2 studies, 1202 participants). Local recurrence was evaluated in two studies, the HR for NSM compared to MRM was 0.28 (95% CI 0.12 to 0.68; 2 studies, 1303 participants). The overall risk of complications was different in NSM when compared to other types of mastectomy in general (RR 0.10, 95% CI 0.01 to 0.82, 2 studies, P = 0.03; 1067 participants). With respect to skin necrosis, there was no evidence of a difference with NSM compared to other types of mastectomy, but the confidence interval was wide (RR 4.22, 95% CI 0.59 to 30.03, P = 0.15; 4 studies, 1948 participants). We observed no difference among the three types of mastectomy with respect to the risk of local infection (RR 0.95, 95% CI 0.44 to 2.09, P = 0.91, 2 studies; 496 participants). Meta-analysis was not possible when assessing cosmetic outcomes and quality of life, but in general the NSM studies reported a favourable aesthetic result and a gain in quality of life compared with the other types of mastectomy. The quality of evidence was considered very low for all outcomes due to the high risk of selection bias and wide confidence intervals. AUTHORS' CONCLUSIONS The findings from these observational studies of very low-quality evidence were inconclusive for all outcomes due to the high risk of selection bias.
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Affiliation(s)
- Bruna S Mota
- Instituto do câncer de São Paulo (ICESP/FMUSP)Department of Obstetrics and GynecologyAv. Dr Arnaldo 251Sao PauloSao PauloBrazil01246‐000
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilSão PauloBrazil
| | - Rachel Riera
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilSão PauloBrazil
| | - Marcos Desidério Ricci
- Instituto do câncer de São Paulo (ICESP/FMUSP)Department of Obstetrics and GynecologyAv. Dr Arnaldo 251Sao PauloSao PauloBrazil01246‐000
| | - Jessica Barrett
- University Forvie Site, Robinson WayMRC Biostatistics Unit, Institute of Public HealthCambridgeUKCB2 0SR
- University of Cambridge, Strangeways Research LaboratoryCardiovascular Epidemiology Unit, Department of Public Health and Primary CareWort’s CausewayCambridgeUKCB1 8RN
| | - Tiago B de Castria
- Instituto do Câncer do Estado de São Paulo (ICESP/FMUSP)Clinical OncologyAv. Doutor Arnaldo 251 ‐ Cerqueira CésarSão PauloBrazil01246‐000
| | - Álvaro N Atallah
- Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em SaúdeCochrane BrazilSão PauloBrazil
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The Oncological Safety of Nipple-Sparing Mastectomy: A Systematic Review of the Literature with a Pooled Analysis of 12,358 Procedures. Arch Plast Surg 2016; 43:328-38. [PMID: 27462565 PMCID: PMC4959975 DOI: 10.5999/aps.2016.43.4.328] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 05/18/2016] [Accepted: 05/24/2016] [Indexed: 02/08/2023] Open
Abstract
Nipple-sparing mastectomy (NSM) is increasingly popular as a procedure for the treatment of breast cancer and as a prophylactic procedure for those at high risk of developing the disease. However, it remains a controversial option due to questions regarding its oncological safety and concerns regarding locoregional recurrence. This systematic review with a pooled analysis examines the current literature regarding NSM, including locoregional recurrence and complication rates. Systematic electronic searches were conducted using the PubMed database and the Ovid database for studies reporting the indications for NSM and the subsequent outcomes. Studies between January 1970 and January 2015 (inclusive) were analysed if they met the inclusion criteria. Pooled descriptive statistics were performed. Seventy-three studies that met the inclusion criteria were included in the analysis, yielding 12,358 procedures. After a mean follow up of 38 months (range, 7.4–156 months), the overall pooled locoregional recurrence rate was 2.38%, the overall complication rate was 22.3%, and the overall incidence of nipple necrosis, either partial or total, was 5.9%. Significant heterogeneity was found among the published studies and patient selection was affected by tumour characteristics. We concluded that NSM appears to be an oncologically safe option for appropriately selected patients, with low rates of locoregional recurrence. For NSM to be performed, tumours should be peripherally located, smaller than 5 cm in diameter, located more than 2 cm away from the nipple margin, and human epidermal growth factor 2-negative. A separate histopathological examination of the subareolar tissue and exclusion of malignancy at this site is essential for safe oncological practice. Long-term follow-up studies and prospective cohort studies are required in order to determine the best reconstructive methods.
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Fenoll C, Leclère FM, Hivelin M, Atlan M, Cothier-Savey I, Lantieri L, Le Masurier P. [Poly Implant Prothèse (PIP®) incidence of complications in breast reconstructive surgery: A retrospective comparative analysis]. ANN CHIR PLAST ESTH 2015; 60:478-83. [PMID: 26472480 DOI: 10.1016/j.anplas.2015.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/30/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION On 29 March 2010, the Poly Implant Prothèse (PIP(®)) breast prosthesis was withdrawn from the market by the ANSM. In this study we review our experience with PIP(®) implants in breast reconstruction. We compare our complications with other types of breast implants used during the same period at our institution. PATIENTS AND METHOD This is a retrospective study conducted at the Hospital René Huguenin of the Institut Curie (Paris, France). It includes 327 prostheses, from 268 patients who underwent surgery for breast reconstruction between February 2008 and February 2012: 69 PIP(®) (Group 1), 82 Mentor(®) (Group 2) and 179 Allergan(®) (Group 3). The objective of the study was to compare the rates of early and late complications for each prosthesis. Our results are compared with the current literature. RESULTS With regard to the rate of early complications (hematoma, infection, seroma, wound dehiscence), no difference was observed between the three groups (P not significant). However, the study found that 100% of the 13 PIP(®) implants with early complications required surgical revision. There were too few late complications (capsular contracture, prosthetic rupture) in our cohort to allow statistical comparison between the three groups (P not significant). We compare our results with the current literature. CONCLUSION This study highlights the lack of significant difference in the occurrence of early adverse events between the three groups of implants. This may explain the time taken for surgeons to become aware there was a problem with the PIP(®) implants. The low rate of late complications in our series does not allow statistical analysis between the three groups of implants.
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Affiliation(s)
- C Fenoll
- Service de chirurgie reconstructrice, hôpital René-Huguenin, institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France; Service de chirurgie plastique, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - F M Leclère
- Service de chirurgie plastique reconstructrice et esthétique, chirurgie de la main, chirurgie de réassignation sexuelle, centre François-Michelet, CHU de Pellegrin Bordeaux, 33000 Bordeaux, France; Laboratoire d'anatomie, université de Bordeaux, 33000 Bordeaux, France.
| | - M Hivelin
- Service de chirurgie plastique reconstructrice et esthétique, HEGP, 20, rue Leblanc, 75015 Paris, France
| | - M Atlan
- Chirurgie plastique reconstructrice et esthétique, CHU Tenon, 75020 Paris, France
| | - I Cothier-Savey
- Service de chirurgie reconstructrice, hôpital René-Huguenin, institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France
| | - L Lantieri
- Service de chirurgie plastique reconstructrice et esthétique, HEGP, 20, rue Leblanc, 75015 Paris, France
| | - P Le Masurier
- Service de chirurgie reconstructrice, hôpital René-Huguenin, institut Curie, 35, rue Dailly, 92210 Saint-Cloud, France
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A Novel Approach to the Management of Margin-positive DCIS in Nipple-sparing Mastectomy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2014; 2:e253. [PMID: 25506536 PMCID: PMC4255896 DOI: 10.1097/gox.0000000000000189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 07/29/2014] [Indexed: 11/26/2022]
Abstract
Summary: Nipple-sparing mastectomy (NSM) is gaining acceptance as an oncologically sound and cosmetically superior mastectomy technique. Debate exists over the management of positive margins near the nipple-areola complex. This case report presents a novel approach to the management of margin-positive ductal carcinoma in situ in NSM. A 50-year-old white female with invasive ductal carcinoma underwent NSM. Intraoperative pathology indicated the presence of DCIS-positive retroareolar margins. Revision through a direct vertical nipple incision allowed for adequate surgical revision and pathologic evaluation of the retroareolar breast tissue while maintaining the nipple-areola skin and primary mastectomy incision. This novel approach ensures negative margins, allows superior cosmetic outcome, and improves patient autonomy in decision making. The technique may translate to NSM patients with positive retroareolar margins or false-negative margins.
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