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Wignarajah P, Malata CM, Benson JR. Oncoplastic and reconstructive breast surgery. Front Oncol 2023; 13:1176915. [PMID: 37448512 PMCID: PMC10338173 DOI: 10.3389/fonc.2023.1176915] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/15/2023] [Indexed: 07/15/2023] Open
Abstract
This article provides an overview of the principles and techniques of oncoplastic and reconstructive breast surgery for patients with early-stage breast cancer. Oncoplastic breast surgery (OPBS) with partial breast reconstruction is a natural evolution in the application of breast conserving surgery and permits wide surgical resection of tumours that might otherwise mandate mastectomy and whole breast reconstruction. These reconstructive techniques must be optimally selected and integrated with ablative breast surgery together with non-surgical treatments such as radiotherapy and chemotherapy that may be variably sequenced with each other. A multidisciplinary approach with shared decision-making is essential to ensure optimal clinical and patient-reported outcomes that address oncological, aesthetic, functional and psychosocial domains. Future practice of OPBS must incorporate routine audit and comprehensive evaluation of outcomes.
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Affiliation(s)
- Primeera Wignarajah
- Department of Breast Surgery, Royal Marsden Hospital NHS Trust, London, United Kingdom
- Department of Breast Surgery, Cambridge Breast Unit, Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Charles M Malata
- Department of Breast Surgery, Cambridge Breast Unit, Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Plastic and Reconstructive Surgery, Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Anglia Ruskin University School of Medicine, Cambridge/Chelmsford, United Kingdom
| | - John R Benson
- Department of Breast Surgery, Cambridge Breast Unit, Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Anglia Ruskin University School of Medicine, Cambridge/Chelmsford, United Kingdom
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2
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Joukainen S, Laaksonen E, Vanninen R, Kaarela O, Sudah M. Dual-Layer Rotation: A Versatile Therapeutic Mammoplasty Technique. Ann Surg Oncol 2022; 29:6716-6727. [PMID: 35711016 PMCID: PMC9492593 DOI: 10.1245/s10434-022-11977-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022]
Abstract
Background Multifocal or complex breast lesions are a challenge for breast-conserving surgery, particularly surgery in small breasts or those located in the upper inner quadrant. The dual-layer rotation technique exploits the idea of manipulating the skin and glandular tissue in separate layers to fill the resection cavity via vertical mammoplasty if skin excision is not required, except in the central area. Methods The authors performed a retrospective review of consecutive breast cancer patients who underwent DLR mammoplasty between 2017 and 2019 at a single institution. Clinical data, reoperations, surgical complications, delays in adjuvant treatments, and the need for late revisional surgery were evaluated. Aesthetic outcomes were evaluated objectively and subjectively from photographs. Results The study included 46 breasts of 40 patients. Tumors were located in the UIQ (30%, 14/46) or in multiple quadrants (22%, 10/46). One third (33%, 13/40) of the patients had a small breast cup size (A–B). Negative margins were primarily achieved in 45 of the 46 breasts. Major complications occurred in three patients, who needed reoperation, and adjuvant therapy was delayed for one of these patients. Late refinement surgery was needed for two patients. The objective and subjective aesthetic outcomes were good or excellent regardless of the tumor position. Conclusion As a novel oncoplastic approach, DLR mammoplasty offers a one-step procedure to treat selected breast cancer patients with challenging resection defects due to different breast sizes or lesion locations. The technique preserves the breast’s natural appearance.
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Affiliation(s)
- Sarianna Joukainen
- Division of Plastic Surgery, Department of Surgery, Kuopio University Hospital, Kuopio, Finland.
| | - Elina Laaksonen
- Division of Plastic Surgery, Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.,Cancer Center of Eastern Finland, University of Eastern Finland, Kuopio, Finland
| | - Outi Kaarela
- Division of Plastic Surgery, Department of Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Mazen Sudah
- Diagnostic Imaging Center, Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
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3
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Lesniak DM, Millochau J, Wang KC, Atlan M, Otmezguine Y, Sarfati I, Nos C, Clough KB. Breast-conserving therapy can be offered to women with prior breast augmentation. Eur J Surg Oncol 2020; 46:1456-1462. [PMID: 32457015 DOI: 10.1016/j.ejso.2020.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/04/2020] [Accepted: 05/10/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Breast cancer in women with cosmetic breast implants is increasingly common. Over the past decade, there has been a push for mastectomy and reconstruction in these patients, based on a fear of poor aesthetic results from small breast volume, and radiation-induced capsular contracture. At the Paris Breast Centre, augmented women routinely undergo lumpectomy with whole-breast irradiation (BCT). MATERIALS AND METHODS A consecutive cohort of 50 augmented women, who had attempted BCT for early breast cancer at our institution between 2003 and 2018, were retrospectively identified. Post-treatment complications, oncologic outcomes, capsular contracture rates, long-term cosmetic outcomes, and patient-reported outcomes were evaluated. RESULTS The median follow-up was 51 months. Margins were involved in 7 women (14%); 4 of whom underwent successful re-excision, and 3 had a mastectomy, for an early mastectomy rate of 6%. There were no early complications, nor cases of early implant loss. Long-term aesthetic results were evaluated using our 5-point scale: An excellent (5), or good (4) result was obtained in 68%. Significant capsular contracture (Baker grade 3 or 4) developed in 34%, of which, 5 women underwent capsulotomy and fat grafting; 4 of 5 downstaging their Baker grade. The estimated 5-year local recurrence rate was 2.3%. Ninety-five percent of participants would recommend BCT to augmented women. CONCLUSION BCT is feasible and safe in augmented women with good long-term aesthetic results, and should be considered to avoid unnecessary mastectomy.
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Affiliation(s)
- David M Lesniak
- Oncologic and Oncoplastic Breast Surgery, The Paris Breast Centre- L'Institut du Sein Paris, 9 av. Mac Mahon, 75017, Paris, France
| | - Jenny Millochau
- Oncologic and Oncoplastic Breast Surgery, The Paris Breast Centre- L'Institut du Sein Paris, 9 av. Mac Mahon, 75017, Paris, France
| | - Kuan-Chi Wang
- Oncologic and Oncoplastic Breast Surgery, The Paris Breast Centre- L'Institut du Sein Paris, 9 av. Mac Mahon, 75017, Paris, France
| | - Michael Atlan
- Plastic and Reconstructive Surgery, Hôpital Tenon, AP-HP, 4 rue de la Chine, 75020, Paris, France
| | - Yves Otmezguine
- Radiation Oncology, Centre Clinique de la Porte de Saint-Cloud, 30 rue de Paris, 92100, Boulogne, France
| | - Isabelle Sarfati
- Oncologic and Oncoplastic Breast Surgery, The Paris Breast Centre- L'Institut du Sein Paris, 9 av. Mac Mahon, 75017, Paris, France
| | - Claude Nos
- Oncologic and Oncoplastic Breast Surgery, The Paris Breast Centre- L'Institut du Sein Paris, 9 av. Mac Mahon, 75017, Paris, France
| | - Krishna B Clough
- Oncologic and Oncoplastic Breast Surgery, The Paris Breast Centre- L'Institut du Sein Paris, 9 av. Mac Mahon, 75017, Paris, France.
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Mitchell DC, Ayers B, Patel AU, Chacon MA, Wood K, Barrus B, Prasad SM, Gosev I, Christiano JG. Bilateral pectoralis major flaps for salvage of left ventricular assist device deep pocket infection. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-019-01554-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Zhu L, Li S, Tan L, Zhang X, Wu J, Su F, Chen K, Song E. In pursuit of a flawless aphrodite: paving the way to scarless oncoplastic breast surgery. Cancer Commun (Lond) 2019; 39:82. [PMID: 31796126 PMCID: PMC6891967 DOI: 10.1186/s40880-019-0422-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/30/2019] [Indexed: 01/26/2023] Open
Affiliation(s)
- Liling Zhu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, P.R. China
| | - Shunrong Li
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, P.R. China
| | - Luyuan Tan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, P.R. China
| | - Xiaolan Zhang
- Department of Breast Surgery, Guangzhou Concord Cancer Center, Guangzhou, 510045, Guangdong, P.R. China
| | - Jiannan Wu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, P.R. China
| | - Fengxi Su
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, P.R. China.,Sufengxi Clinic, Guangzhou, 510000, Guangdong, P.R. China
| | - Kai Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P.R. China. .,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, P.R. China.
| | - Erwei Song
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P.R. China. .,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, P.R. China.
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Rodriguez GJZ, Chavez MD, Valencia GGC, Concha JMC, Castre MRG, Mantilla R. Oncoplastic surgery for the conservative treatment of breast cancer in Perú's National Cancer Institute. Ecancermedicalscience 2018; 12:815. [PMID: 29662528 PMCID: PMC5880228 DOI: 10.3332/ecancer.2018.815] [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: 10/30/2017] [Indexed: 11/24/2022] Open
Abstract
Background Oncoplastic surgery for breast cancer (OPS) has been a surgical trend for the past 25 years. In 2012, OPS has been introduced as the standard treatment for a selected group of patients at the National Cancer Institute of Peru (INEN). The aim of this study is to describe our findings. Methods This is a retrospective and descriptive study that identified demographics, tumour-pathologic features and includes patients solely treated since diagnosis until late follow-up at INEN. These OPS patients were identified from the conservative treatment patients group by review of medical charts and creation of a database for periods December 2005 through December 2015. Results A total of 146 patients were ruled in by the inclusion criteria. All patients were Peruvian females, 56.2% being 51 or older. 93.8% had core biopsy diagnosis of breast cancer and 52.1% located at the upper outer quadrant. 79.5% patients had upfront OPS and the round block (43.2%) and reduction/mastopexy (23.3%) were the most used techniques. pT2 was the most frequent size (54.7%). We achieved negative margins in 134 patients (93.2%) in a single procedure. Of 29 patients, who had neoadjuvant treatment, 11 achieved pCR. Only 5.5% had pN2 or higher. 95.2% received complimentary external beam radiotherapy. Conclusions OPS has proven to be a reliable surgical option, both for aesthetic and oncologic outcomes. Important points for achieving these results are breast surgeons having properly trained under the OPS philosophy and knowing the patients’ characteristics for correct technique selection.
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Affiliation(s)
- Gonzalo Javier Ziegler Rodriguez
- Clínica Ricardo Palma, Av Javier Prado 1066, San Isidro 15036, Lima, Peru.,Clinica Ziegler, Av Guardia Civil 990, San Isidro 15036, Lima, Peru
| | - Marcelo Diaz Chavez
- Clinica Ziegler, Av Guardia Civil 990, San Isidro 15036, Lima, Peru.,Hospital Nivel IV Guillermo Almenara Irigoyen
| | | | | | | | - Raul Mantilla
- Breast Surgical Oncology Department, National Cancer Institute of Perú (INEN)
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Tan MP. Simplifying Level 2 Oncoplastic Surgery for Lower Inner Quadrant Breast Cancers. Ann Surg Oncol 2017; 24:594-595. [PMID: 29094251 DOI: 10.1245/s10434-017-6165-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Mona P Tan
- MammoCare The Breast Clinic & Surgery, Singapore, Singapore.
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Gurleyik G, Karagulle H, Eris E, Aker F, Ustaalioglu BO. Oncoplastic surgery; volume displacement techniques for breast conserving surgery in patients with breast cancer. Acta Chir Belg 2017; 117:169-175. [PMID: 28052717 DOI: 10.1080/00015458.2016.1272916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Surgical management of breast cancer has drastically changed. Breast-conserving surgery (BCS) has now become a commonly used method for its treatment. Oncoplastic techniques are widely applied with satisfactory aesthetic results. We evaluated the aesthetic and oncological outcomes of BCS with glandular tissue displacement techniques. METHODS Seventy-five patients with invasive breast cancer were surgically treated by oncoplastic techniques. Preoperative evaluations, including breast and tumor size, localizations and features, were performed by physical examination, imaging methods, and histopathological analysis. Appropriate volume displacement techniques were planned according to breast and tumor size and localization. Early and late aesthetic results were evaluated. RESULTS The mean age of the patients was 54 years, and mean tumor size was 25 mm. Tumors were located in the upper-outer quadrant in 44% of patients. Glandular flaps were used in 55 (73%) patients. Racquet mammoplasty was the most preferred method. Nipple areolar complex (NAC) recentralization was performed in 26 (47.3%) of 55 patients with glandular tissue displacement. Therapeutic reduction mammoplasty was performed in 20 patients. All patients underwent adjuvant radiotherapy. After an average follow-up of 24 months, neither locoregional recurrence nor distant metastases were observed. Aesthetic results of the oncoplastic BCS method were very good in 54 (72%) patients. CONCLUSION Breast remodeling by glandular flap displacement after a wide local excision should be the primary aim in patients with breast cancer for better aesthetic outcomes. NAC recentralization is the primary component that could be considered for achieving better results. BCS associated with oncoplastic techniques allows wide excision of larger tumors and provides good and satisfactory aesthetic results at long-term follow-up.
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Affiliation(s)
- Gunay Gurleyik
- Department of Surgery, Haydarpasa Numune Research Hospital, Istanbul, Turkey
| | - Hikmet Karagulle
- Department Radiology, Haydarpasa Numune Research Hospital, Istanbul, Turkey
| | - Esra Eris
- Department of Surgery, Haydarpasa Numune Research Hospital, Istanbul, Turkey
| | - Fugen Aker
- Department of Pathology, Haydarpasa Numune Research Hospital, Istanbul, Turkey
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Tan MP, Sitoh NY, Sitoh YY. Optimising Breast Conservation Treatment for Multifocal and Multicentric Breast Cancer: A Worthwhile Endeavour? World J Surg 2016; 40:315-22. [PMID: 26560151 DOI: 10.1007/s00268-015-3336-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Breast conservation treatment (BCT) is an accepted treatment modality for early breast cancer. However, multifocal and multicentric breast cancer (MFMCBC) is a relative contraindication to BCT. This study was performed to compare BCT rates in MFMCBC and unifocal tumours and its outcomes. METHODS A retrospective analysis was performed for patients with breast malignancies who underwent operative treatment between 2009 and 2011. Successful BCT was defined as the ability to obtain clear margins for all tumour foci through a single incision with acceptable resultant cosmesis. RESULTS A total of 160 patients were analysed, of which 40 were MFMCBC. Thirty-four of the 40 patients with MFMCBC underwent BCT (85 %). After a mean follow-up period of 55 months, there were no local recurrences in patients with MFMCBC. CONCLUSION BCT was achieved in 85 % of the patients with MFMCBC in this cohort without evidence of poorer local control. Further investigation is needed to confirm this finding for its potential contribution to improved survival outcomes.
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Affiliation(s)
- Mona P Tan
- Breast Surgery, MammoCare, 38 Irrawaddy Road, #06-21, Singapore, Singapore.
| | - Nadya Y Sitoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yih Yiow Sitoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Clough KB, Benyahi D, Nos C, Charles C, Sarfati I. Oncoplastic Surgery: Pushing the Limits of Breast-Conserving Surgery. Breast J 2015; 21:140-6. [DOI: 10.1111/tbj.12372] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Claude Nos
- L'Institut du Sein - Paris Breast Center; Paris France
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Atiyeh B, Dibo S, Zgheib E, Abbas J. Skin sparing/skin reducing mastectomy (SSM/SRM) and the concept of oncoplastic breast surgery. Int J Surg 2014; 12:1115-22. [PMID: 25178261 DOI: 10.1016/j.ijsu.2014.08.401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/24/2014] [Accepted: 08/28/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION With the better understanding of breast cancer history and biology, improved diagnostic modalities and the shift towards minimally invasive surgeries, indications for prophylactic mastectomy, skin sparing or skin reducing mastectomies (SSM/SRM) with nipple areolar complex (NAC) preservation coupled with immediate breast reconstruction are gaining popularity. The authors share their experience and conception with mastectomy and immediate alloplastic breast reconstruction with the esthetic circumvertical mammoplasty pattern combined with the dermal barrier buttress flap. MATERIAL AND METHODS The described technique was performed for 28 patients presenting for mastectomy and immediate alloplastic breast reconstruction. With close collaboration between the oncologic and plastic surgeons, mastectomy was performed in all cases with the esthetic circumvertical mammoplasty pattern. To achieve safe excision and optimal reconstruction, the standard incisions could be custom designed to fit oncologic requirements and allow the creation of a dermal barrier flap used as a buttress separating the implant from the suture line. CONCLUSION The circumvertical mastectomy pattern combined with the dermal barrier buttress flap is a versatile option allowing safe reconstruction regardless of the tumor and necessary skin excision location.
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Affiliation(s)
- Bishara Atiyeh
- Euro-Mediterranean Council for Burns and Fire Disasters, Beirut, Lebanon; Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Saad Dibo
- Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Elias Zgheib
- Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Jaber Abbas
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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