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De Luca A, Amabile MI, Frusone F, Tripodi D, Costanzo ML, La Torre G, Marcasciano M, Lo Torto F, Monti M, Vergine M, Ribuffo D. Breast cancer patients' postoperative outcomes in nipple-sparing mastectomy and reconstruction with subpectoral implant placement: a single center experience. Gland Surg 2024; 13:1164-1177. [PMID: 39175697 PMCID: PMC11336787 DOI: 10.21037/gs-24-58] [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: 02/13/2024] [Accepted: 05/09/2024] [Indexed: 08/24/2024]
Abstract
Background The continuous increase in the rate of nipple sparing mastectomy (NSM), the development of several reconstructive techniques and the following introduction of acellular derma matrix (ADM) has revolutionized implant-based breast reconstruction. This study aimed to investigate postoperative complications, health-related quality of life (HRQoL) and patients' satisfaction in patients undergoing NSM and breast reconstruction with or without ADM. Methods Enrolled patients were divided into three groups: immediate breast reconstruction (IBR) with definitive implant and ADM (Group A), IBR only with definitive prosthesis (Group B), and two-stage breast reconstruction (Group C). The postoperative complications, BREAST-Q outcomes and reoperations were compared. Results A total of 105 BC patients were enrolled and a total of 139 post-mastectomy breast reconstructions were performed. Seroma was the most prevalent complication observed: 8.3% in Group A, 2.9% in Group B and 5.7% in Group C. Postoperative infection occurred in two patients of Group A (5.6%), one patient of Group B (2.9%) and one of Group C (2.9%). Group A reported larger drain volume (1,125±243.5 cc), longer drain period (13.2±2.8 days), and the lowest incidence of capsular contracture (5.6%). The BREAST-Q patient-reported outcome measures document that all patients aged ≥50 years presented a higher score in "Satisfaction with breast" (P<0.001) and "Satisfaction with outcome" domains (P<0.05). Performing a bilateral breast reconstruction was associated to higher scores in "Physical wellbeing chest domain" (P<0.05). In addition, patients in Group A and Group B reported higher score in "Satisfaction with the breast" domain (P<0.001) but only in Group B we reported a higher score in "Satisfaction with outcome" (P<0.001). Conclusions Subpectoral IBR results in manageable complications and greater personal satisfaction. The ADM could improve breast reconstruction reducing the rate of capsular contracture. The prepectoral placement of ADM could minimize complications and optimize aesthetic results.
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Affiliation(s)
| | | | | | | | | | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Marco Marcasciano
- Plastic and Reconstructive Surgery Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Massimo Monti
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Massimo Vergine
- Department of Surgery, Sapienza University of Rome, Rome, Italy
| | - Diego Ribuffo
- Department of Surgery, Sapienza University of Rome, Rome, Italy
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Liu YT, Khan NH, Bordes MC, Reece GP, Francis AM, Chen TA, Bravo K, Markey MK. Impact of autologous breast reconstruction on bra fit. Support Care Cancer 2024; 32:105. [PMID: 38221586 DOI: 10.1007/s00520-023-08281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE To inform bra design by analyzing 3D surface images of breast cancer patients who underwent autologous breast reconstruction. METHODS We computed bra design measurements on 3D surface images of patients who underwent unilateral and bilateral autologous breast reconstruction. Breast measurements and right-left symmetry between preoperative baseline and postoperative time points were compared using either paired Student t-test or Wilcoxon signed-rank test, depending on the data's distribution. Regression analysis determined associations between measurements and patient characteristics such as age. Postoperative measurements and symmetry differences were also compared between autologous and implant-based breast reconstruction. RESULTS Among participants who underwent bilateral autologous breast reconstruction, the reconstructed breasts were smaller and positioned higher on the chest wall than their native breasts. For patients who underwent unilateral reconstruction, similar postoperative changes were observed in the contralateral breast due to symmetry procedures. Overall, for participants whose baseline breast measurements showed substantial asymmetry, unilateral reconstruction decreased right-left asymmetry whereas bilateral reconstruction amplified right-left asymmetry. Preoperative baseline breast measurements, age, and BMI were statistically significantly associated with most postoperative breast measurements for participants who underwent bilateral autologous reconstruction. Compared to implant-based reconstruction, autologous reconstruction resulted in fewer changes in breast shape and symmetry that are pertinent to bra fit. CONCLUSION Preoperative baseline breast measurements, age, and BMI can impact bra designs for breast cancer survivors who undergo autologous reconstruction due to size, shape, and symmetry changes. Bra needs of people who undergo autologous reconstruction differ from those who undergo implant-based reconstruction.
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Affiliation(s)
- Yen-Tung Liu
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Novera H Khan
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Mary Catherine Bordes
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory P Reece
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ashleigh M Francis
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tzuan A Chen
- HEALTH Research Institute, University of Houston, Houston, TX, USA
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Karen Bravo
- Independent Fashion Designer, Austin, TX, USA
| | - Mia K Markey
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA.
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Sousa CM, Queiroz IN, Drummond-Lage AP. Evaluation of intraoperative breast radiotherapy on local recurrence: a Brazilian cohort. Int J Radiat Biol 2024; 100:72-78. [PMID: 37733904 DOI: 10.1080/09553002.2023.2258190] [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: 02/22/2023] [Accepted: 08/24/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE Assess the local recurrence rate and global survival rate among women diagnosed with breast cancer who underwent intraoperative electron radiotherapy (IOERT) between 2007 and 2017, in a single private healthcare setting in Belo Horizonte, Brazil. MATERIAL AND METHODS This is a retrospective study based on medical records about the outcomes of patients submitted to breast-conserving surgery followed by IOERT. The collected variables included the patient's profile and tumor features, IOERT isodose, and outcomes. The quantitative data were presented in tables of frequency. The survival curves were created with the Kaplan-Meier method. In all tests, the adopted relevance level was 5%. The analyses were carried out with SPSS version 25.0. RESULTS AND CONCLUSIONS The samples consisted of 78 patients, among which a total of 14 (17.9%) recurrences were observed. The median time of recurrence was 49 months after the IOERT was performed. Of the 78 patients analyzed, 13 (16.7%) died, 5 (6.4%) of which were due to breast cancer. The global survival rate in 5 years was 94.9% and 90.4% in 10 years. The local recurrence rate in 5 years was 89.7% and 86.4% in 10 years. Our findings revealed a higher local recurrence rate than the literature data. However, our results also showed that patients classified as low-risk had an overall survival of 5 and 10 years similar to other studies in the literature, reaffirming that low-risk women can benefit from IOERT. Given this finding, it is reaffirmed that rigorous eligibility criteria for IOERT are critical to reducing local recurrence.
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Affiliation(s)
- Cintia Melo Sousa
- Departamento de Pós-Graduação, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Izabella Nobre Queiroz
- Departamento de Pós-Graduação, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Ana Paula Drummond-Lage
- Departamento de Pós-Graduação, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
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Kaidar-Person O, Antunes M, Cardoso JS, Ciani O, Cruz H, Di Micco R, Gentilini OD, Gonçalves T, Gouveia P, Heil J, Kabata P, Lopes D, Martinho M, Martins H, Mavioso C, Mika M, Montenegro H, Oliveira HP, Pfob A, Rotmensz N, Schinköthe T, Silva G, Tarricone R, Cardoso MJ. Evaluating the ability of an artificial-intelligence cloud-based platform designed to provide information prior to locoregional therapy for breast cancer in improving patient's satisfaction with therapy: The CINDERELLA trial. PLoS One 2023; 18:e0289365. [PMID: 37535564 PMCID: PMC10399739 DOI: 10.1371/journal.pone.0289365] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Breast cancer therapy improved significantly, allowing for different surgical approaches for the same disease stage, therefore offering patients different aesthetic outcomes with similar locoregional control. The purpose of the CINDERELLA trial is to evaluate an artificial-intelligence (AI) cloud-based platform (CINDERELLA platform) vs the standard approach for patient education prior to therapy. METHODS A prospective randomized international multicentre trial comparing two methods for patient education prior to therapy. After institutional ethics approval and a written informed consent, patients planned for locoregional treatment will be randomized to the intervention (CINDERELLA platform) or controls. The patients in the intervention arm will use the newly designed web-application (CINDERELLA platform, CINDERELLA APProach) to access the information related to surgery and/or radiotherapy. Using an AI system, the platform will provide the patient with a picture of her own aesthetic outcome resulting from the surgical procedure she chooses, and an objective evaluation of this aesthetic outcome (e.g., good/fair). The control group will have access to the standard approach. The primary objectives of the trial will be i) to examine the differences between the treatment arms with regards to patients' pre-treatment expectations and the final aesthetic outcomes and ii) in the experimental arm only, the agreement of the pre-treatment AI-evaluation (output) and patient's post-therapy self-evaluation. DISCUSSION The project aims to develop an easy-to-use cost-effective AI-powered tool that improves shared decision-making processes. We assume that the CINDERELLA APProach will lead to higher satisfaction, better psychosocial status, and wellbeing of breast cancer patients, and reduce the need for additional surgeries to improve aesthetic outcome.
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Affiliation(s)
- Orit Kaidar-Person
- Breast Cancer Radiation Therapy Unit, Sheba Medical Center, Ramat Gan, Israel
- School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Marilia Antunes
- Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
- Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Jaime S Cardoso
- Center for Research on Health and Social Care Management (CERGAS), SDA Bocconi University, Milan, Italy
- Champalimaud Foundation, Breast Unit, Lisbon, Portugal
| | - Oriana Ciani
- Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), Porto, Portugal
| | - Helena Cruz
- Faculty of Engineering, University of Porto (FEUP), Porto, Portugal
| | - Rosa Di Micco
- Breast Surgery Unit, San Raffaele University and Research Hospital, Milano, Italy
| | - Oreste D Gentilini
- Breast Surgery Unit, San Raffaele University and Research Hospital, Milano, Italy
| | - Tiago Gonçalves
- Center for Research on Health and Social Care Management (CERGAS), SDA Bocconi University, Milan, Italy
- Champalimaud Foundation, Breast Unit, Lisbon, Portugal
| | - Pedro Gouveia
- Faculty of Engineering, University of Porto (FEUP), Porto, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
| | - Jörg Heil
- Instituto Universitario de Lisboa (ISCTE), Lisboa, Portugal
| | | | - Daniela Lopes
- Faculty of Engineering, University of Porto (FEUP), Porto, Portugal
| | - Marta Martinho
- Faculty of Engineering, University of Porto (FEUP), Porto, Portugal
| | - Henrique Martins
- Faculty of Engineering, University of Porto (FEUP), Porto, Portugal
- Centro de Estatística e Aplicações, Faculdade de Ciências, Universidade de Lisboa (CEAUL), Lisboa, Portugal
| | - Carlos Mavioso
- Faculty of Engineering, University of Porto (FEUP), Porto, Portugal
| | - Martin Mika
- Department of Surgical Oncology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Helena Montenegro
- Center for Research on Health and Social Care Management (CERGAS), SDA Bocconi University, Milan, Italy
- Champalimaud Foundation, Breast Unit, Lisbon, Portugal
| | - Helder P Oliveira
- Center for Research on Health and Social Care Management (CERGAS), SDA Bocconi University, Milan, Italy
- Department of Obstetrics & Gynecology, Heidelberg University Hospital, Heidelberg, Germany
| | - André Pfob
- Instituto Universitario de Lisboa (ISCTE), Lisboa, Portugal
| | - Nicole Rotmensz
- Breast Surgery Unit, San Raffaele University and Research Hospital, Milano, Italy
| | - Timo Schinköthe
- Department of Surgical Oncology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Giovani Silva
- Faculdade de Ciências, Universidade de Lisboa, Lisboa, Portugal
- Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - Rosana Tarricone
- Institute for Systems and Computer Engineering, Technology and Science (INESC TEC), Porto, Portugal
| | - Maria-Joao Cardoso
- Faculty of Engineering, University of Porto (FEUP), Porto, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
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Liu YT, Khan NH, Bordes MC, Reece GP, Francis AM, Chen TA, Bravo K, Markey MK. Impact of Autologous Breast Reconstruction on Bra Fit. RESEARCH SQUARE 2023:rs.3.rs-2891426. [PMID: 37214881 PMCID: PMC10197764 DOI: 10.21203/rs.3.rs-2891426/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Purpose To inform bra design by analyzing 3D surface images of breast cancer patients who underwent autologous breast reconstruction. Methods We computed bra design measurements on 3D surface images of patients who underwent unilateral and bilateral autologous breast reconstruction. Breast measurements and right-left symmetry between preoperative baseline and postoperative time points were compared using either paired Student t test or Wilcoxon signed rank test, depending on the data's distribution. Regression analysis determined associations between measurements and patient characteristics such as age. Postoperative measurements and symmetry differences were also compared between autologous and implant-based breast reconstruction. Results Among participants who underwent bilateral autologous breast reconstruction, the reconstructed breasts were smaller and positioned higher on the chest wall than their native breasts. For patients who underwent unilateral reconstruction, similar postoperative changes were observed in the contralateral breast due to symmetry procedures. Overall, for participants whose baseline breast measurements showed substantial asymmetry, unilateral reconstruction decreased right-left asymmetry whereas bilateral reconstruction amplified right-left asymmetry. Preoperative baseline breast measurements, age, and BMI were statistically significantly associated with most postoperative breast measurements for participants who underwent bilateral autologous reconstruction. Compared to implant-based reconstruction, autologous reconstruction resulted in fewer changes in breast shape and symmetry that are pertinent to bra fit. Conclusion Preoperative baseline breast measurements, age, and BMI can impact bra designs for breast cancer survivors who undergo autologous reconstruction due to size, shape, and symmetry changes. Bra needs of people who undergo autologous reconstruction differ from those who undergo implant-based reconstruction.
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Coelho A, Kendir C, Barrenho E, Klazinga N, Paiva C, Abreu de Sousa J, Gonçalves-Monteiro S, Redondo P, Bastos A, Nogueira A, Guedes FB, Costa AS, Gaspar T. Patient-Reported Outcomes and Experiences Assessment in Women with Breast Cancer: Portuguese Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2931. [PMID: 36833626 PMCID: PMC9957006 DOI: 10.3390/ijerph20042931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
In 2020, female breast cancer was the most commonly diagnosed cancer worldwide, representing the type of cancer with the highest incidence among women and the second most common cause of cancer death among women in all OECD countries. The conventional measures addressing the burden of breast cancer by measuring mortality, incidence, and survival do not entirely reflect the quality of life and patients experience when receiving breast cancer care. The main objective of this study is to capture patient-reported outcomes and experiences in women with breast cancer in Portugal using methods developed for international benchmarking purposes, such as the OECD Patient-reported Indicators Surveys. The study included 378 women with breast cancer, with the age distribution being 19.8% aged 15 to 49 years and 80.2% aged 50 years and over. The data collection procedure and analysis followed the "OECD Breast Cancer Patient Reported Outcomes Working Group" protocol, allowing subsequent comparability with data from other OECD member countries. Most women were satisfied with the treatment outcome regarding the shape of their lumpectomy breast when wearing a bra (96.1%) and with the equal size of both breasts (78.3%). Findings on the WHO QOL-BREF showed that women manifest a lower score in well-being when compared with the general population or populations living with chronic diseases. This study shows the feasibility of implementing and using patient-reported metrics (PROM and PREM) in breast cancer services in Portugal. Measuring PROMs and PREMs from Portuguese women receiving breast cancer care provides insightful evidence into the quality and value of cancer care.
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Affiliation(s)
- Anabela Coelho
- Comprehensive Health Research Centre (CHRC), Nursing Department, University of Évora, 7004-516 Évora, Portugal
- H&TRC-Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1549-020 Lisbon, Portugal
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, 1099-085 Lisbon, Portugal
| | - Candan Kendir
- Organisation for Economic Co-Operation and Development, 75016 Paris, France
| | - Eliana Barrenho
- Organisation for Economic Co-Operation and Development, 75016 Paris, France
| | - Niek Klazinga
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Cláudia Paiva
- Breast Unit, Centro Hospitalar e Universitário do Porto, 4099-001 Porto, Portugal
| | - Joaquim Abreu de Sousa
- Department of Surgical Oncology, Portuguese Oncology Institute of Porto (IPO Porto), 4200-072 Porto, Portugal
- Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), 4200-072 Porto, Portugal
| | - Salomé Gonçalves-Monteiro
- Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), 4200-072 Porto, Portugal
- Outcomes Research Lab, Management, Outcomes Research and Economics in Healthcare Group (MOREHealth), Portuguese Oncology Institute of Porto (IPO Porto), 4200-072 Porto, Portugal
| | - Patrícia Redondo
- Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), 4200-072 Porto, Portugal
- Outcomes Research Lab, Management, Outcomes Research and Economics in Healthcare Group (MOREHealth), Portuguese Oncology Institute of Porto (IPO Porto), 4200-072 Porto, Portugal
| | - Ana Bastos
- Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), 4200-072 Porto, Portugal
- Breast Clinic, Portuguese Oncology Institute of Porto (IPO Porto), 4200-072 Porto, Portugal
| | - Armanda Nogueira
- Porto Comprehensive Cancer Center (Porto.CCC) & RISE@CI-IPOP (Health Research Network), 4200-072 Porto, Portugal
- Quality of Life Office, Portuguese Oncology Institute of Porto (IPO Porto), 4200-072 Porto, Portugal
| | - Fábio Botelho Guedes
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
| | - Andreia Silva Costa
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), 1600-096 Lisbon, Portugal
- Católica Research Centre for Psychological, Family and Social Wellbeing, Faculdade de Ciências Humanas, Universidade Católica Portuguesa, 1649-023 Lisbon, Portugal
| | - Tânia Gaspar
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, 1649-028 Lisbon, Portugal
- Digital Human-Environment Interaction Labs (HEI-LAB), Universidade Lusófona de Humanidades e Tecnologias, 1749-024 Lisbon, Portugal
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