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Vieira RADC, Paulinelli RR, de Oliveira-Junior I. Extreme oncoplasty: past, present and future. Front Oncol 2024; 13:1215284. [PMID: 38352300 PMCID: PMC10862476 DOI: 10.3389/fonc.2023.1215284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/08/2023] [Indexed: 02/16/2024] Open
Abstract
Breast surgery has evolved from mastectomy to breast-conserving surgery (BCS). Breast oncoplastic surgery later emerged with the inclusion and development of techniques used in plastic surgery for breast neoplasms. Recently, a new paradigm has been considered for mastectomy candidates with large multifocal and multicentric tumours, designated extreme oncoplasty (EO), which has allowed new techniques to be applied to tumours that would have been ineligible for BCS before. There are few publications and no uniform descriptions grouping all the technical possibilities and new indications together. We performed this a review with the objective of evaluating the indications and surgeries performed in the EO context, representing a new perspective for BCS. We observed new indications as extensive microcalcifications, locally advanced breast carcinoma with partial response to chemotherapy, small to moderate-sized non-ptotic central tumours and extreme ptosis. Small breasts are able for EO since the presence of ptosis. New surgeries are reported as disguised geometric compensation, perforators flaps, local/regional flaps, latissimus dorsi miniflap and partial breast amputation. It is important to decrease barriers to oncoplastic surgery if we want to increase the use of EO and BCS rates.
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Affiliation(s)
- René Aloisio da Costa Vieira
- Postgraduate Program in Tocogynecology, Botucatu School of Medicine, Botucatu, SP, Brazil
- Postgraduate Program in Oncology, Barretos Cancer Hospital, Barretos, SP, Brazil
- Department of Surgical Oncology, Division of Breast Surgical Oncology, Muriaé Cancer Hospital, Muriaé, MG, Brazil
- Department of Gynecology and Obstetrics, University of Goiás, Goiania, GO, Brazil
| | - Regis Resende Paulinelli
- Postgraduate Program in Tocogynecology, Botucatu School of Medicine, Botucatu, SP, Brazil
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - Idam de Oliveira-Junior
- Postgraduate Program in Tocogynecology, Botucatu School of Medicine, Botucatu, SP, Brazil
- Postgraduate Program in Oncology, Barretos Cancer Hospital, Barretos, SP, Brazil
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Barretos, SP, Brazil
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Çakmak GK, Emiroğlu S, Sezer A, Canturk NZ, Yeniay L, Kuru B, Karanlık H, Soyder A, Gökgöz Ş, Sakman G, Ucuncu M, Akcay MN, Girgin S, Gurdal SO, Emiroglu M, Ozbas S, Öz AB, Arici C, Toktas O, Demircan O, Çalık A, Polat AK, Maralcan G, Demirer S, Ozmen V. Surgical Trends in Breast Cancer in Turkey: An Increase in Breast-Conserving Surgery. JCO Glob Oncol 2021; 6:285-292. [PMID: 32109157 PMCID: PMC7051798 DOI: 10.1200/jgo.19.00275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Breast cancer is the most frequent cancer in women, and there is a great variability in surgical practice for treating that cancer in different countries. The aims of this study were to analyze the effect of guidelines from the Turkish Federation of Breast Diseases Societies on academic institutions that have breast centers and to evaluate surgical practice in Turkey in 2018. PATIENTS AND METHODS Between January and March 2019, a survey was sent to breast surgeons who were working in breast centers in academic institutions. The sampling frame included 24 academic institutions with breast centers in 18 cities in Turkey to evaluate interdisciplinary differences among breast centers and seven regions in Turkey regarding patients’ choices, surgical approaches, and academic institutions. RESULTS All surgeons responded to the survey, and all 4,381 patients were included. Most of the surgeons (73.9%) were working in a breast center. Multidisciplinary tumor boards were performed in 87% of the breast centers. The average time between clinical evaluation and initiation of treatment was 29 days; the longest time was in Southeast Anatolia (66 days). Only 6% of patients had ductal carcinoma in situ. Sentinel lymph node biopsy was available in every region across the country and was performed in 64.5% of the patients. In 2018, the overall breast-conserving surgery rate was 57.3% in Turkey, and it varied from 72.2% in the Black Sea region to 33.5% in Central Anatolia (P < .001). Oncoplastic breast surgery options were available at all breast centers. However, 25% of the breast centers from the Black Sea region and half the breast centers from Eastern Anatolia and the Mediterranean region did not perform this type of surgery. CONCLUSION Increasing rates of nonpalpable breast cancer and decreasing rates of locoregional recurrences favored breast-conserving surgery, especially in developed countries. Guidelines from the Turkish Federation of Breast Diseases Societies resulted in more comprehensive breast centers and improved breast health in Turkey.
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Affiliation(s)
- Güldeniz Karadeniz Çakmak
- Department of Surgery, The School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Selman Emiroğlu
- Department of Surgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Atakan Sezer
- Department of Surgery, The School of Medicine, Trakya University, Edirne, Turkey
| | - Nuh Zafer Canturk
- Department of Surgery, The School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Levent Yeniay
- Department of Surgery, The School of Medicine, Ege University, Izmir, Turkey
| | - Bekir Kuru
- Department of Surgery, The School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Hasan Karanlık
- Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Aykut Soyder
- Department of Surgery, The School of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Şehsuvar Gökgöz
- Department of Surgery, The School of Medicine, Uludag University, Bursa, Turkey
| | - Gürhan Sakman
- Department of Surgery, The School of Medicine, Cukurova University, Adana, Turkey
| | | | - Mufide Nuran Akcay
- Department of Surgery, The School of Medicine, Ataturk University, Erzurum, Turkey
| | - Sadullah Girgin
- Department of Surgery, The School of Medicine, Dicle University, Diyarbakır, Turkey
| | - Sibel Ozkan Gurdal
- Department of Surgery, The School of Medicine, Namık Kemal University, Tekirdag, Turkey
| | | | | | - Abdullah Bahadir Öz
- Department of Surgery, The School of Medicine, Erciyes University, Kayseri, Turkey
| | - Cumhur Arici
- Department of Surgery, The School of Medicine, Akdeniz University, Antalya, Turkey
| | - Osman Toktas
- Department of Surgery, The School of Medicine, Van Yüzüncü Yil University, Van, Turkey
| | | | - Adnan Çalık
- Department of Surgery, The School of Medicine, Karadeniz Teknik University, Trabzon, Turkey
| | - Ayfer Kamali Polat
- Department of Surgery, The School of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Gokturk Maralcan
- Department of Surgery, The School of Medicine, Sanko University, Gaziantep, Turkey
| | - Seher Demirer
- Department of Surgery, The School of Medicine, Ankara University, Ankara, Turkey
| | - Vahit Ozmen
- Department of Surgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey
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