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Acea Nebril B, García Novoa A, García Jiménez L, Díaz Carballada C, Bouzón Alejandro A, Conde Iglesias C. Immediate breast reconstruction by prepectoral polyurethane implant: Preliminary results of the prospective study PreQ-20. Cir Esp 2023; 101:187-197. [PMID: 36108952 DOI: 10.1016/j.cireng.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/02/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In recent years, mastectomy and reconstruction techniques have evolved towards less aggressive procedures, improving the satisfaction and quality of life of women. For this reason, mastectomy has become a valid option for both women with breast cancer and high-risk women. The objective of this study is to analyze the safety of mastectomy and immediate prepectoral reconstruction with polyurethane implant in women with breast cancer and risk reduction. METHOD Observational prospective study to evaluate the feasibility and safety of immediate reconstruction using prepectoral polyurethane implant. All women (with breast cancer or high risk for breast cancer) who underwent skin-sparing or skin-and-nipple-sparing mastectomy with immediate reconstruction with a prepectoral polyurethane implant were included. Women with breast sarcomas, disease progression during primary systemic therapy (PST), delayed, autologous or retropectoral reconstruction, and those who did not wish to participate in the study were excluded. Surgical procedures were performed by both senior and junior surgeons. All patients received the corresponding complementary treatments. All adverse events that occurred during follow-up and the risk factors for developing them were analyzed. RESULTS 159 reconstructions were performed in 102 women, 80.4% due to breast carcinoma. Fourteen patients developed complications, the most frequent being seroma and wound dehiscence. Eight women required a reoperation (5.0%), seven of them due to implant exposure. Four reconstructions (2.5%) resulted in loss of the implant. Three patients progressed from their oncological process: a local relapse in the mastectomy flap, an axillary progression and a systemic progression. CONCLUSIONS Prepectoral reconstruction with a polyurethane implant is a procedure with a low incidence of postoperative complications (8.8%) and implant loss (2.5%). Its use is safe with perioperative cancer treatments (neoadjuvant chemotherapy and radiotherapy).
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Affiliation(s)
- Benigno Acea Nebril
- Unidad de Mama, Servicio de Cirugía General y Aparato Digestivo, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Alejandra García Novoa
- Unidad de Mama, Servicio de Cirugía General y Aparato Digestivo, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain.
| | - Lourdes García Jiménez
- Unidad de Mama, Servicio de Cirugía General y Aparato Digestivo, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Carlota Díaz Carballada
- Unidad de Mama, Servicio de Cirugía General y Aparato Digestivo, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Alberto Bouzón Alejandro
- Unidad de Mama, Servicio de Cirugía General y Aparato Digestivo, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Carmen Conde Iglesias
- Unidad de Mama, Servicio de Cirugía General y Aparato Digestivo, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
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Acea-Nebril B, García-Novoa A, Cereijo-Garea C, Conde Iglesias C, Bouzón Alejandro A, Díaz Carballada C. Safety and Quality of Life in Women with Immediate Reconstruction with Polyurethane Implants after Neoadjuvant Chemotherapy: Outcomes from The Preq-20 Trial. Cancers (Basel) 2023; 15:cancers15041113. [PMID: 36831457 PMCID: PMC9954288 DOI: 10.3390/cancers15041113] [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: 01/22/2023] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION Various studies have evaluated the impact of neoadjuvant chemotherapy (NAC) on the complications of breast cancer surgery, most of which were retrospective and did not assess the variables related to postoperative risk factors. The aim of this study is to analyse the safety and satisfaction of women included in the PreQ-20 trial who underwent NAC and who underwent mastectomy and immediate reconstruction with prepectoral polyurethane implants. MATERIAL AND METHODS The patients included in the study belong to the prospective study PreQ-20. The study group consisted of patients who underwent immediate reconstruction after primary systemic therapy. The control groups consisted of patients with immediate reconstruction and adjuvant chemotherapy (control group 1) and patients with an infiltrating carcinoma or in situ ductal carcinoma who did not require chemotherapy (control group 2). RESULTS The study included 157 women, 58 (36.9%) of whom underwent primary systemic therapy. The indication for genetic study was significantly greater for the study group (87.9%) than for control groups 1 (49.1%) or 2 (30.4%). Seventy-two (45.9%) of the patients underwent bilateral mastectomy (BM), a procedure that was performed significantly more frequently in the study group (69%) than in control groups 1 (30.2%) or 2 (34.8%). The incidence rate for BM after complete pathologic response was 78%. There were no statistically significant differences in the number of complications between the groups. Implant loss was significantly more frequent in control group 1 (13.2%) than in the study group (3.4%) and control group 2 (2.2%). CONCLUSIONS Mastectomy with prepectoral polyurethane implant reconstruction in patients with neoadjuvant chemotherapy presented a similar incidence of complications compared with patients who underwent primary surgery. There is a high rate of BM in women with NAC.
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Affiliation(s)
- Benigno Acea-Nebril
- Breast Unit, Department of General Surgery, University Hospital Complex A Coruña, 15006 A Coruña, Spain
| | - Alejandra García-Novoa
- Breast Unit, Department of General Surgery, University Hospital Complex A Coruña, 15006 A Coruña, Spain
- Correspondence: ; Tel.: +34-674089387
| | | | - Carmen Conde Iglesias
- Breast Unit, Ginecology Service, University Hospital Complex A Coruña, 15006 A Coruña, Spain
| | - Alberto Bouzón Alejandro
- Breast Unit, Department of General Surgery, University Hospital Complex A Coruña, 15006 A Coruña, Spain
| | - Carlota Díaz Carballada
- Breast Unit, Ginecology Service, University Hospital Complex A Coruña, 15006 A Coruña, Spain
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Reconstrucción mamaria inmediata mediante implante prepectoral de poliuretano. Resultados preliminares del estudio prospectivo PreQ-20. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bipedicled Nipple-Sparing Mastectomy Versus Traditional Nipple-Sparing Mastectomy: Comparison of 2 Alternative Techniques in Order to Save Nipple-Areola Complex. Ann Plast Surg 2019; 84:366-374. [PMID: 31850968 DOI: 10.1097/sap.0000000000002166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nipple-areola complex-sparing mastectomy (NSM) represents, when a mastectomy is unavoidable, the best treatment possible that can be offered to attenuate the negative impact of surgery on patients' quality of life. Unfortunately, NSM can be used only in selected patients with small and nonptotic breasts. In order to save the nipple-areola complex (NAC) also in patients with large and ptotic breast, otherwise subjected to a skin-sparing mastectomy with the sacrifice of the NAC, we described the bipedicled nipple-sparing mastectomy (BNSM). The aim of this study is to obtain a formal outcome assessment of BNSM and analyze the complications rate of this technique compared with traditional NSM. We furthermore attempt to describe the surgical procedures present in the literature that allow to preserve NAC also in large and ptotic breasts presenting the complication rates observed and comparing with our technique. Aesthetic outcome has also been evaluated. METHODS We retrospectively reviewed 42 procedures of consecutive patients undergoing immediate reconstruction with tissue expanders after NSM (20 patients) or BNSM (19 patients). We divided them in 2 groups focused on surgical complications and aesthetic outcome. RESULTS On a total of 42 procedures, the principal major complication was dehiscence of surgical wound procedures needing 1-day surgery revision occurring in 3 (14.3%) of the BNSM group and 1 (4.8%) of the NSM group, whereas as principal minor complication 4 partial NAC necrosis not requiring surgery in BNSM (19%) and 2 (9.5%) in NSM. No tissue expanders required explantation. Concerning cosmetic results, the overall appearance of the breast and NAC was acceptable in 85.7 % and 77.2%, respectively, in the NSM group and 80.7% and 66.7%, respectively, in the BNSM group. CONCLUSIONS Bipedicled nipple-sparing mastectomy is a valid technique to improve patients' quality of life in large and ptotic breasts otherwise candidate to a skin-sparing mastectomy, but only a progressive learning curve can minimize complications. No significant statistical differences have been observed in terms of complication rates and aesthetical outcomes between the 2 groups. An accurate selection of patients is mandatory in order to obtain low complication rates and good aesthetical outcome.
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Bille C, Dalaei F, Thomsen JB. Identifying the dissection plane for mastectomy-description and visualization of our technique. Gland Surg 2019; 8:S276-S280. [PMID: 31709167 PMCID: PMC6819889 DOI: 10.21037/gs.2019.05.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/06/2019] [Indexed: 11/06/2022]
Abstract
In this visualized surgery paper, we present our experience identifying the optimal dissection plane in nipple-sparing mastectomy using hydrodissection through an inframammary incision. The surgical technique comprises of preoperative magnetic resonance imaging (MRI) aiming to assess the thickness and expected quality of the mastectomy flaps, an inframammary incision, and hydrodissection to assist the surgeon in identifying the optimal dissection plane. This surgical method results in an adequate resection of breast parenchyma to obtain the best oncological outcome, while retaining the maximum amount of subcutaneous adipose tissue on the skin flaps to achieve a superior aesthetic result resembling the natural breast. The mastectomy flap thickness and quality can then be assessed prior to an immediate reconstruction.
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Affiliation(s)
- Camilla Bille
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Farima Dalaei
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Jørn Bo Thomsen
- Department of Plastic Surgery, Odense University Hospital and Lillebaelt Hospital, Vejle, Denmark
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Abstract
Hereditary breast cancers, mainly due to BRCA1 and BRCA2 mutations, account for only 5-10% of this disease. The threshold for genetic testing is a 10% likelihood of detecting a mutation, as determined by validated models such as BOADICEA and Manchester Scoring System. A 90-95% reduction in breast cancer risk can be achieved with bilateral risk-reducing mastectomy in unaffected BRCA mutation carriers. In patients with BRCA-associated breast cancer, there is a 40% risk of contralateral breast cancer and hence risk-reducing contralateral mastectomy is recommended, which can be performed simultaneously with surgery for unilateral breast cancer. Other options for risk management include surveillance by mammogram and breast magnetic resonance imaging, and chemoprevention with hormonal agents. With the advent of next-generation sequencing and development of multigene panel testing, the cost and time taken for genetic testing have reduced, making it possible for treatment-focused genetic testing. There are also drugs such as the PARP inhibitors that specifically target the BRCA mutation. Risk management multidisciplinary clinics are designed to quantify risk, and offer advice on preventative strategies. However, such services are only possible in high-income settings. In low-resource settings, the prohibitive cost of testing and the lack of genetic counsellors are major barriers to setting up a breast cancer genetics service. Family history is often not well documented because of the stigma associated with cancer. Breast cancer genetics services remain an unmet need in low- and middle-income countries, where the priority is to optimise access to quality treatment.
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Direct-To-Implant and 2-Stage Breast Reconstruction After Nipple Sparing Mastectomy. Ann Plast Surg 2019; 83:392-395. [DOI: 10.1097/sap.0000000000001893] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A New Human-Derived Acellular Dermal Matrix for Breast Reconstruction Available for the European Market: Preliminary Results. Aesthetic Plast Surg 2018; 42:434-441. [PMID: 29302735 DOI: 10.1007/s00266-017-1069-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/20/2017] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The introduction of acellular dermal matrices (ADMs) contributed to the growing diffusion of direct-to-implant breast reconstruction (DTI-BR) following mastectomy for breast cancer. According to specific legislations, European specialists could not benefit from the use of human-derived ADMs, even though most evidence in the literature are available for this kind of device, showed optimal outcomes in breast reconstruction. The Skin Bank of the Bufalini Hospital (Cesena, Italy) obtained in 2009 the approval for the production and distribution of a new human cadaver-donor-derived ADM (named with the Italian acronym, MODA, for matrice omologa dermica acellulata) from the Italian National Transplant Center and National Health Institute. We report preliminary results of MODA application in direct-to-implant breast reconstruction following nipple-areola complex (NAC)-sparing mastectomy for breast cancer treatment. MATERIALS AND METHODS We prospectively enrolled all women undergoing NAC-sparing mastectomy for breast cancer and DTI-BR in our breast surgical unit from June 2015 to January 2017. We enrolled a selected population without previous chest wall irradiation, not being heavy tobacco smokers or diabetic, with a BMI < 30 kg/m2 and requiring less than 550 cc silicone implants. We assessed short-term outcomes, defined as postoperative complications presenting in the first 30 postoperative days and long-term outcomes at 6 and 12 months. RESULTS From June 2015 to January 2017, we treated 56 breasts. At a mean follow-up of 14 months, we observed only two minor complications described as limited wound dehiscences, conservatively managed with complete resolution without implant exposure or re-intervention. CONCLUSIONS Our preliminary results show very good performance of MODA in direct-to-implant breast reconstruction following NAC-sparing mastectomy for breast cancer treatment. This is particularly relevant for the European market, where no other human-derived devices are available for breast reconstruction due to regulatory restrictions. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Izquierdo-Luna JS, Campos-Salcedo JG, Estrada-Carrasco CE, Torres-Gómez JJ, López-Silvestre JC, Zapata-Villalba MA. Robot-assisted laparoscopic partial nephrectomy with hydrodissection. Actas Urol Esp 2016; 40:333-6. [PMID: 26778652 DOI: 10.1016/j.acuro.2015.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/17/2015] [Accepted: 11/18/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Nephron-sparing surgery is reporting satisfactory oncological results, with improved quality of life. The laparoscopic approach is technically complex and requires advanced skills; however, the use of robotic systems facilitates the transition to this procedure. With improved strategies for diagnosis and follow-up, as well as ablative technologies, the role of partial nephrectomy continuous to evolve. The use of water-jet technology to dissect and resect organs helps create anatomical planes in a relatively blood-free field, which improves vision and does not cause heat damage. MATERIAL AND METHODS We present the case of a patient with an incidental diagnosis of a complex right renal cyst managed with robot-assisted laparoscopic partial nephrectomy using hydrodissection for tumour resection. RESULTS The surgery was performed with 2 robotic arms. Four ports were routinely placed, the colon was mobilised, and the tumour was dissected. Tumour delimitation was performed with laparoscopic ultrasound, and the renal artery was clamped. We then performed the tumour resection assisted by a laparoscopic water-jet applicator, operated by the assistant through an auxiliary port. The renal parenchyma was reconstructed in 2 planes, without knots, and the arterial clamp was withdrawn at 23minutes. The resection margins were negative. CONCLUSIONS The use of water-jet technology to assist with the renal tumour resection during minimally invasive nephron-sparing surgery facilitates the dissection, making it more fluid and atraumatic. Simultaneously, the technique provides a clean surgical field, which improves visibility. This procedure can help decrease ischaemia times, thereby positively affecting the patient's evolution without compromising the oncological results.
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Affiliation(s)
- J S Izquierdo-Luna
- Departamento de Urología, Hospital Central Militar, México Distrito Federal, México.
| | - J G Campos-Salcedo
- Departamento de Urología, Hospital Central Militar, México Distrito Federal, México
| | - C E Estrada-Carrasco
- Departamento de Urología, Hospital Central Militar, México Distrito Federal, México
| | - J J Torres-Gómez
- Departamento de Urología, Hospital Central Militar, México Distrito Federal, México
| | - J C López-Silvestre
- Departamento de Urología, Hospital Central Militar, México Distrito Federal, México
| | - M A Zapata-Villalba
- Departamento de Urología, Hospital Central Militar, México Distrito Federal, México
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Abstract
Breast conservative therapy (BCT) is established as a safe option for most women with early breast cancer (BC). The best conservative mastectomy that can be performed, when mastectomy is unavoidable, is nipple-areola-complex sparing mastectomy (NSM), which allows the complete glandular dissection preserving the skin envelope and the nipple areola complex. In the treatment of BC, the cosmetic outcomes have become fundamental goals, as well as oncologic control. NSM is nowadays considered an alternative technique to improve the overall quality of life for women allowing excellent cosmetic results because it provides a natural appearing breast. The breast surgeon must pay attention to details and skin incision must be planned to minimize vascular impairment to the skin and the nipple. Preservation of the blood supply to the nipple is one of the most important concern during NSM because nipple or areolar necrosis is a well-described complication of this surgery. Another issue associated with the nipple preservation and the surgical technique is oncological safety related to nipple-areola-complex (NAC) involvement in patients with invasive BC. The authors present their experience on 252 NSM performed in the Breast Surgery Unit in Forlì. Careful selection of patients for this surgical procedure is imperative and many patients are not ideal candidates for this procedure because of concerns about nipple-areolar viability as women with significant large/ptotic breast, pre-existing breast scars and history of active cigarette smoking. To extend the benefits of nipple preservation to patients who are perceived to be at higher risk for nipple necrosis the authors describe technical modifications of NSM to allow nipple preservation and obtain good cosmetic outcomes.
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Affiliation(s)
- Camilla Rossi
- Breast Surgery Unit, G.B. Morgagni-Pierantoni Hospital, AUSL della Romagna sede di Forlì (FC), Via Carlo Forlanini, 34. 47100 Forlì, Italy
| | - Matteo Mingozzi
- Breast Surgery Unit, G.B. Morgagni-Pierantoni Hospital, AUSL della Romagna sede di Forlì (FC), Via Carlo Forlanini, 34. 47100 Forlì, Italy
| | - Annalisa Curcio
- Breast Surgery Unit, G.B. Morgagni-Pierantoni Hospital, AUSL della Romagna sede di Forlì (FC), Via Carlo Forlanini, 34. 47100 Forlì, Italy
| | - Federico Buggi
- Breast Surgery Unit, G.B. Morgagni-Pierantoni Hospital, AUSL della Romagna sede di Forlì (FC), Via Carlo Forlanini, 34. 47100 Forlì, Italy
| | - Secondo Folli
- Breast Surgery Unit, G.B. Morgagni-Pierantoni Hospital, AUSL della Romagna sede di Forlì (FC), Via Carlo Forlanini, 34. 47100 Forlì, Italy
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Abstract
Conservative mastectomies provide removal of the entire breast parenchyma, saving the outer covering of the mammary gland with the possibility of performing an immediate reconstruction preserving women body image. We rationalised and systematically organized our reconstructive algorythms giving a new different light to mastectomies, the so-called "conservative mastectomies", an oxymoron indicating skin-sparing mastectomies (SSM), nipple-areola complex-sparing mastectomies (NSM) and skin-reducing mastectomies (SRM). Eventhough randomized controlled trials comparing conservative mastectomies with traditional mastectomy and breast conserving surgery would be auspicable in order to achieve higher levels of evidence, we could confidently conclude that conservative mastectomies offer the psychological advantages of good cosmesis and maintenance of woman body image without compromising the oncological safety of mastectomy.
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Affiliation(s)
- Maurizio Bruno Nava
- 1 Scuola di Oncologia Chirurgica Ricostruttiva, Via Besana, Milano, Italy ; 2 Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S.Pansini 5, 80131 Naples, Italy ; 3 Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina 829, 95126 Catania, Italy
| | - Nicola Rocco
- 1 Scuola di Oncologia Chirurgica Ricostruttiva, Via Besana, Milano, Italy ; 2 Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S.Pansini 5, 80131 Naples, Italy ; 3 Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina 829, 95126 Catania, Italy
| | - Giuseppe Catanuto
- 1 Scuola di Oncologia Chirurgica Ricostruttiva, Via Besana, Milano, Italy ; 2 Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S.Pansini 5, 80131 Naples, Italy ; 3 Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina 829, 95126 Catania, Italy
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Abstract
INTRODUCTION Besides the diffusion of breast reconstructive techniques, several "conservative" approaches in mastectomy have been developed, in order to perform an immediate reconstruction with better aesthetic results: the skin-sparing mastectomy (SSM), the nipple-areola complex (NAC)-sparing mastectomy (NSM) and the skin-reducing mastectomy (SRM). During the last decade, SSMs and NSMs have gained widespread acceptance and are currently considered standard treatment for early breast cancer. We would like to investigate the evidence behind this radical shift towards conservative mastectomies, where there has been a renewed interest worldwide. METHODS We reviewed English literature by consulting the following databases: Medline, Embase, Cochrane Register of Controlled Trials, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal and Clinicaltrials.gov. The objective is to include any randomized controlled trial (RCT) comparing a "conservative mastectomy" technique to breast conservative surgery or modified radical mastectomy (MRM) for the treatment of early-stage breast cancer. In the absence of randomized trials, we took into account prospective cohorts and retrospective series for a narrative description of available evidence. RESULTS Our review included 58 studies [19 prospective cohorts (34%) and 39 retrospective series (66%)] considering NSM and immediate reconstruction and ten studies [1 prospective cohort (10%) and 9 (90%) retrospective series] considering SSM and immediate reconstruction. In the NSM group, 29 studies reported data about complication rates and 42 studies presented data on NAC partial or complete necrosis. In the NSM group 45 studies and all the studies in the SSM group presented data on local and NAC recurrence. CONCLUSIONS In order to achieve higher levels of evidence, RCTs comparing conservative mastectomies to traditional mastectomy and breast conservative surgery would be desirable. However we can conclude that conservative mastectomies offer the psychological advantages of good cosmetics and maintenance of woman body image without compromising the oncological safety of mastectomy.
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Affiliation(s)
- Nicola Rocco
- 1 Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy ; 2 Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina 829, 95126 Catania, Italy ; 3 Scuola di Oncologia Chirurgica Ricostruttiva, Via Besana 4, 20122 Milano, Italy
| | - Giuseppe Catanuto
- 1 Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy ; 2 Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina 829, 95126 Catania, Italy ; 3 Scuola di Oncologia Chirurgica Ricostruttiva, Via Besana 4, 20122 Milano, Italy
| | - Maurizio Bruno Nava
- 1 Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S. Pansini 5, 80131 Naples, Italy ; 2 Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Via Messina 829, 95126 Catania, Italy ; 3 Scuola di Oncologia Chirurgica Ricostruttiva, Via Besana 4, 20122 Milano, Italy
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Santoro S, Loreti A, Cavaliere F, Costarelli L, La Pinta M, Manna E, Mauri M, Scavina P, Santini E, De Paula U, Toto V, Fortunato L. Neoadjuvant chemotherapy is not a contraindication for nipple sparing mastectomy. Breast 2015; 24:661-6. [PMID: 26343944 DOI: 10.1016/j.breast.2015.08.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/28/2015] [Accepted: 08/05/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Nipple-sparing mastectomy (NSM) has been recently implemented to improve cosmetic outcome after mastectomy, but it is rarely considered today after neoadjuvant chemotherapy (NCH). PATIENTS AND METHODS Among 275 NSMs performed from January 2007 to January 2015, 186 cases, with a minimum follow-up of 12 months, were carried out for invasive or intraductal carcinoma. Patients were considered for NSM if there were no clinical and radiological evidence of invasion or close proximity (<1 cm) to the nipple-areola complex (NAC). We compared patients operated with NSM after NCH (Group I N = 51) with those who underwent primary surgery (Group II, N = 135). RESULTS At a median follow-up of 35 months, 166/186 patients were alive and disease-free (89.7%). Three local relapses (1.6%) were observed, all in the skin flap outside the NAC in Group I: (6%; p < 0.01). No NAC recurrences have been recorded, in either group. Nipple loss due to full thickness necrosis or resection for insufficient margins was recorded in 31 cases (17%); 12 in Group I (24%) and 19 in Group II (14%) (P = 0.1). This event decreased by half in the second part of the study (21/93 vs 10/93) (P = 0.03). CONCLUSIONS NSM after NCH is not associated with a statistically significant difference in terms of post-operative complications, total nipple loss for necrosis or margins, and results improve with experience. The loco-regional relapse rate was higher after NCH, yet it was consistent with traditional mastectomy in the high-risk setting. There is no need to avoid NSM after NCH for locally advanced cancers, if the retro-areolar margins of resection are clear at the time of surgery.
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Affiliation(s)
- Stefano Santoro
- Breast Center -Department of Surgery, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy
| | - Andrea Loreti
- Breast Center -Department of Surgery, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy
| | - Francesco Cavaliere
- Breast Center -Department of Surgery, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy
| | - Leopoldo Costarelli
- Breast Center - Division of Pathology, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy
| | - Massimo La Pinta
- Breast Center -Department of Surgery, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy
| | - Elena Manna
- Breast Center -Department of Surgery, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy
| | - Maria Mauri
- Breast Center - Division of Oncology, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy
| | - Paola Scavina
- Breast Center - Division of Oncology, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy
| | - Elena Santini
- Breast Center - Division of Radiology, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy
| | - Ugo De Paula
- Breast Center - Division of Radiation Oncology, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy
| | - Vito Toto
- Breast Center -Department of Surgery, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy
| | - Lucio Fortunato
- Breast Center -Department of Surgery, San Giovanni-Addolorata Hospital Rome, Via Amba Aradam, 9, 00184 Rome, Italy.
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Folli S, Mingozzi M, Curcio A, Buggi F, Rossi C. Nipple-Sparing Mastectomy: An Alternative Technique for Large Ptotic Breasts. J Am Coll Surg 2015; 220:e65-9. [DOI: 10.1016/j.jamcollsurg.2015.01.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/03/2015] [Accepted: 01/03/2015] [Indexed: 10/24/2022]
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Fortunato L, Loreti A, Andrich R, Costarelli L, Amini M, Farina M, Santini E, Vitelli CE. When mastectomy is needed: Is the nipple-sparing procedure a new standard with very few contraindications? J Surg Oncol 2013; 108:207-12. [DOI: 10.1002/jso.23390] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 07/09/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Lucio Fortunato
- Breast Unit, Department of Surgery; San Giovanni-Addolorata Hospital; Rome Italy
| | - Andrea Loreti
- Breast Unit, Department of Surgery; San Giovanni-Addolorata Hospital; Rome Italy
| | - Renato Andrich
- Breast Unit, Department of Surgery; San Giovanni-Addolorata Hospital; Rome Italy
| | | | - Mostafà Amini
- Department of Pathology; San Giovanni-Addolorata Hospital; Rome Italy
| | - Massimo Farina
- Breast Unit, Department of Surgery; San Giovanni-Addolorata Hospital; Rome Italy
| | - Elena Santini
- Department of Radiology; San Giovanni-Addolorata Hospital; Rome Italy
| | - Carlo E. Vitelli
- Breast Unit, Department of Surgery; San Giovanni-Addolorata Hospital; Rome Italy
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Nipple-areola-complex sparing mastectomy: five years of experience in a single centre. Updates Surg 2013; 65:289-94. [DOI: 10.1007/s13304-013-0226-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 07/18/2013] [Indexed: 10/26/2022]
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Bury S, Crosby M, Babiera GV. Nipple-sparing mastectomy: considerations and techniques. BREAST CANCER MANAGEMENT 2013. [DOI: 10.2217/bmt.12.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Nipple-sparing mastectomy (NSM) is the next step in the natural progression of tissue preservation breast cancer surgery. NSM selection criteria are a balance between oncologic and cosmetic considerations; accurate ascertainment of nipple involvement is critical. Further selection should be based on patients with the greatest likelihood of viable flaps and the ability to maintain symmetrical breasts. Surgical technique focuses on incision selection and creating thin flaps with removal of the majority of breast tissue. Risk assessment for long-term recurrence is necessary with proponents for pre-, intra- and post-operative assessment. Prospective studies show low rates of local recurrence of the nipple–areolar complex and are comparable to skin-sparing mastectomy with short-term follow-up in highly select groups of patients. Extended follow-up will be helpful in determining long-term outcomes. Nipple necrosis is an outcome that should be considered. Studies may support improved quality of life and patient satisfaction with NSM, and it is likely to be a safe and feasible procedure that may benefit carefully selected patients.
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Affiliation(s)
- Sean Bury
- The University of Texas Medical School at Houston, 6431 Fannin Street, Houston, TX 77030, USA
| | - Melissa Crosby
- The University of Texas MD Anderson Cancer Center, Department of Plastic Surgery, 1400 Hermann Pressler Drive, Unit 1488, Houston, TX 77030, USA
| | - Gildy V Babiera
- The University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, 1400 Hermann Pressler Drive, Unit 1484, Houston, TX 77030, USA
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Lohsiriwat V, Rotmensz N, Botteri E, Intra M, Veronesi P, Martella S, Garusi C, De Lorenzi F, Manconi A, Lomeo G, Rietjens M, Schorr M, Kneubil MC, Petit JY. Do clinicopathological features of the cancer patient relate with nipple areolar complex necrosis in nipple-sparing mastectomy? Ann Surg Oncol 2012; 20:990-6. [PMID: 23070785 DOI: 10.1245/s10434-012-2677-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND The selections of nipple-sparing mastectomy (NSM) are principally depending on oncologic indication and oncologic safety. The main complication of NSM is nipple areolar complex (NAC) necrosis, and it is usually related to surgical technique. However, the patients' clinicopathological factors should be also considered. METHOD We retrospectively reviewed 934 consecutive NSM patients during 2002-2007 at the European Institute of Oncology, Milan, Italy. We identified a group of patient who had NAC excision because of NAC necrosis and compared this group with those who had successful NAC conservation. We analyzed the association between the risk of NAC necrosis and the clinicopathological features of the patients. RESULTS Among 934 NSM, 772 were invasive cancers and 162 were in situ cancers. Of the 934, 40 NAC (4.2%) were removed during the postoperative period because of necrosis. When we considered age, BMI, menopausal status, smoking status, tumor size, axillary lymph node status, in situ or invasive cancer histology, presence of extensive situ component, grading, estrogen receptor, progesterone receptor, HER2/neu overexpression, Ki-67 proliferative index, and peritumoral vascular invasion, no association was observed between patients' clinicopathological features and NAC necrosis incidence. CONCLUSIONS In our study, clinicopathological features have no significant impact on necrosis complication in therapeutic NSMs. Positive retroareolar margin is the risk of necrosis. Further studies are required to avoid bias due to the different cancer treatments such as different reconstruction techniques and intraoperative radiation protocols. The correlation between breast morphology and NAC necrosis should also be investigated in the future.
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Affiliation(s)
- Visnu Lohsiriwat
- Division of Plastic Surgery, European Institute of Oncology, Milan, Italy.
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