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Cammarata E, Toia F, Rossi M, Cipolla C, Vieni S, Speciale A, Cordova A. Implant-Based Breast Reconstruction after Risk-Reducing Mastectomy in BRCA Mutation Carriers: A Single-Center Retrospective Study. Healthcare (Basel) 2023; 11:1741. [PMID: 37372859 DOI: 10.3390/healthcare11121741] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Women with BRCA gene mutations have a higher lifetime risk of developing breast cancer. Furthermore, cancer is usually diagnosed at a younger age compared to the wild-type counterpart. Strategies for risk management include intensive surveillance or risk-reducing mastectomy. The latter provides a significant reduction of the risk of developing breast cancer, simultaneously ensuring a natural breast appearance due to the preservation of the skin envelope and the nipple-areola complex. Implant-based breast reconstruction is the most common technique after risk-reducing surgery and can be achieved with either a submuscular or a prepectoral approach, in one or multiple stages. This study analyzes the outcomes of the different reconstructive techniques through a retrospective review on 46 breasts of a consecutive, single-center case series. Data analysis was carried out with EpiInfo version 7.2. Results of this study show no significant differences in postoperative complications between two-stage tissue expander/implant reconstruction and direct-to-implant (DTI) reconstruction, with DTI having superior aesthetic outcomes, especially in the prepectoral subgroup. In our experience, the DTI prepectoral approach has proven to be a safe and less time-consuming alternative to the submuscular two-stage technique, providing a pleasant reconstructed breast and overcoming the drawbacks of subpectoral implant placement.
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Affiliation(s)
- Emanuele Cammarata
- Plastic and Reconstructive Surgery Unit, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Francesca Toia
- Plastic and Reconstructive Surgery Unit, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Matteo Rossi
- Plastic and Reconstructive Surgery Unit, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Calogero Cipolla
- Oncological Surgery Unit, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Salvatore Vieni
- Oncological Surgery Unit, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Antonino Speciale
- Plastic and Reconstructive Surgery Unit, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Adriana Cordova
- Plastic and Reconstructive Surgery Unit, Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
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Green VL. Breast Cancer Risk Assessment and Management of the High-Risk Patient. Obstet Gynecol Clin North Am 2022; 49:87-116. [DOI: 10.1016/j.ogc.2021.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Mathelin C, Barranger E, Boisserie-Lacroix M, Boutet G, Brousse S, Chabbert-Buffet N, Coutant C, Daraï E, Delpech Y, Duraes M, Espié M, Fornecker L, Golfier F, Grosclaude P, Hamy AS, Kermarrec E, Lavoué V, Lodi M, Luporsi É, Maugard CM, Molière S, Seror JY, Taris N, Uzan C, Vaysse C, Fritel X. [Non-genetic indications for risk reducing mastectomies: Guidelines of the National College of French Gynecologists and Obstetricians (CNGOF)]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:107-120. [PMID: 34920167 DOI: 10.1016/j.gofs.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To determine the value of performing a risk-reducting mastectomy (RRM) in the absence of a deleterious variant of a breast cancer susceptibility gene, in 4 clinical situations at risk of breast cancer. DESIGN The CNGOF Commission of Senology, composed of 26 experts, developed these recommendations. A policy of declaration and monitoring of links of interest was applied throughout the process of making the recommendations. Similarly, the development of these recommendations did not benefit from any funding from a company marketing a health product. The Commission of Senology adhered to the AGREE II (Advancing guideline development, reporting and evaluation in healthcare) criteria and followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to assess the quality of the evidence on which the recommendations were based. The potential drawbacks of making recommendations in the presence of poor quality or insufficient evidence were highlighted. METHODS The Commission of Senology considered 8 questions on 4 topics, focusing on histological, familial (no identified genetic abnormality), radiological (of unrecognized cancer), and radiation (history of Hodgkin's disease) risk. For each situation, it was determined whether performing RRM compared with surveillance would decrease the risk of developing breast cancer and/or increase survival. RESULTS The Commission of Senology synthesis and application of the GRADE method resulted in 11 recommendations, 6 with a high level of evidence (GRADE 1±) and 5 with a low level of evidence (GRADE 2±). CONCLUSION There was significant agreement among the Commission of Senology members on recommendations to improve practice for performing or not performing RRM in the clinical setting.
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Affiliation(s)
- Carole Mathelin
- CHRU, avenue Molière, 67200 Strasbourg, France; ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France.
| | | | | | - Gérard Boutet
- AGREGA, service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalier universitaire de Bordeaux, groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - Susie Brousse
- CHU de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France.
| | | | - Charles Coutant
- Département d'oncologie chirurgicale, centre Georges-François-Leclerc, 1, rue du Pr-Marion, 21079 Dijon cedex, France.
| | - Emile Daraï
- Hôpital Tenon, service de gynécologie-obstétrique, 4, rue de la Chine, 75020 Paris, France.
| | - Yann Delpech
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice, France.
| | - Martha Duraes
- CHU de Montpellier, 191, avenue du Doyen-Giraud, 34295 Montpellier cedex, France.
| | - Marc Espié
- Hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - Luc Fornecker
- Département d'onco-hématologie, ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France.
| | - François Golfier
- Centre hospitalier Lyon Sud, bâtiment 3B, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite, France.
| | | | | | - Edith Kermarrec
- Hôpital Tenon, service de radiologie, 4, rue de la Chine, 75020 Paris, France.
| | - Vincent Lavoué
- CHU, service de gynécologie, 16, boulevard de Bulgarie, 35200 Rennes, France.
| | | | - Élisabeth Luporsi
- Oncologie médicale et oncogénétique, CHR Metz-Thionville, hôpital de Mercy, 1, allée du Château, 57085 Metz, France.
| | - Christine M Maugard
- Service de génétique oncologique clinique, unité de génétique oncologique moléculaire, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg, France.
| | | | | | - Nicolas Taris
- Oncogénétique, ICANS, 17, rue Albert-Calmette, 67033 Strasbourg, France.
| | - Catherine Uzan
- Hôpital Pitié-Salpetrière, 47, boulevard de l'Hôpital, 75013 Paris, France.
| | - Charlotte Vaysse
- Service de chirurgie oncologique, CHU Toulouse, institut universitaire du cancer de Toulouse-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France.
| | - Xavier Fritel
- Centre hospitalo-universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France.
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Mathelin C, Barranger E, Boisserie-Lacroix M, Boutet G, Brousse S, Chabbert-Buffet N, Coutant C, Daraï E, Delpech Y, Duraes M, Espié M, Golfier F, Hamy AS, Kermarrec E, Lavoué V, Lodi M, Luporsi É, Maugard C, Molière S, Seror JY, Taris N, Uzan C, Vaysse C, Fritel X. [Techniques and complications of non-genetic risk reducing mastectomies: Guidelines of the National College of French Gynecologists and Obstetricians (CNGOF)]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:121-129. [PMID: 34922037 DOI: 10.1016/j.gofs.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Based on an updated review of the international literature covering the different surgical techniques and complications of risk reducing mastectomies (RRM) in non-genetic context, the Commission of Senology (CS) of the College National des Gynécologues Obstétriciens Français (CNGOF) aimed to establish recommendations on the techniques to be chosen and their implementation. DESIGN The CNGOF CS, composed of 24 experts, developed these recommendations. A policy of declaration and monitoring of links of interest was applied throughout the process of making the recommendations. Similarly, the development of these recommendations did not benefit from any funding from a company marketing a health product. The CS adhered to and followed the AGREE II (Advancing guideline development, reporting and evaluation in healthcare) criteria and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method to assess the quality of the evidence on which the recommendations were based. The potential drawbacks of making recommendations in the presence of poor quality or insufficient evidence were highlighted. METHODS The CS considered 6 questions in 4 thematic areas, focusing on oncologic safety, risk of complications, aesthetic satisfaction and psychological impact, and preoperative modalities. RESULTS The application of the GRADE method resulted in 7 recommendations, 6 with a high level of evidence (GRADE 1±) and 1 with a low level of evidence (GRADE 2±). CONCLUSION There was significant agreement among the CS members on recommendations for preferred surgical techniques and practical implementation.
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Affiliation(s)
- C Mathelin
- CHRU, avenue Molière, 67200 Strasbourg, France; ICANS, 17, rue Albert-Calmette, 67033 Strasbourg cedex, France.
| | - E Barranger
- Centre Antoine-Lacassagne, 36, avenue de Valombrose, 06189 Nice, France
| | | | - G Boutet
- AGREGA, service de chirurgie gynécologique et médecine de la reproduction, centre Aliénor d'Aquitaine, centre hospitalier universitaire de Bordeaux, groupe hospitalier Pellegrin, place Amélie-Raba-Léon, 33 000 Bordeaux, France
| | - S Brousse
- CHU de Rennes, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France
| | | | - C Coutant
- Département d'oncologie chirurgicale, centre Georges-François-Leclerc, 1, rue du Pr Marion, 21079 Dijon cedex, France
| | - E Daraï
- Hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - Y Delpech
- Centre Antoine Lacassagne, 33, avenue de Valombrose, 06189 Nice, France
| | - M Duraes
- CHU de Montpellier, 191, avenue du Doyen-Giraud, 34295 Montpellier cedex, France
| | - M Espié
- Hôpital St Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - F Golfier
- Centre hospitalier Lyon Sud, bâtiment 3B, 165, chemin du Grand-Revoyet, 69495 Pierre Benite, France
| | - A S Hamy
- Institut Curie, 26, rue d'Ulm, 75248 Paris, France
| | - E Kermarrec
- Service de radiologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - V Lavoué
- Service de gynécologie, CHU, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - M Lodi
- CHU, avenue Molière, 67200 Strasbourg, France
| | - É Luporsi
- Oncologie médicale et oncogénétique, hôpital de Mercy, CHR Metz-Thionville, 1, allée du Château, 57085 Metz, France
| | - C Maugard
- Service de génétique oncologique clinique et unité de génétique oncologique moléculaire, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67200 Strasbourg
| | - S Molière
- Imagerie du sein, CHRU, avenue Molière 67200 Strasbourg, France
| | - J-Y Seror
- Cabinet privé, 9 ter boulevard Montparnasse, 75006 Paris, France
| | - N Taris
- Oncogénétique, ICANS, 17, rue Albert Calmette, 67033 Strasbourg, France
| | - C Uzan
- Hôpital Pitié-Salpetrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - C Vaysse
- Service de chirurgie oncologique, CHU de Toulouse, institut universitaire du cancer de Toulouse-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - X Fritel
- Centre hospitalo-universitaire de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
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Loving VA, Luiten RC, Siettmann JM, Mina LA. A Breast Radiology Department-operated, Proactive Same-day Program Identifies Pathogenic Breast Cancer Mutations in Unaffected Women. Acad Radiol 2022; 29 Suppl 1:S239-S245. [PMID: 33339730 DOI: 10.1016/j.acra.2020.12.005] [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: 10/28/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/01/2022]
Abstract
RATIONALE AND OBJECTIVES Pathogenic mutations in some genes elevate women's breast cancer risk, necessitating risk-reduction strategies. Unfortunately, women are underscreened for cancer risk, and when identified as potentially high risk, women seldom pursue genetic counseling or testing. To improve cancer risk management, this project determined the feasibility of radiology-operated, proactive, same-day risk assessment and genetic testing programs to diagnose high-risk women undergoing breast imaging. MATERIALS AND METHODS The Comprehensive Assessment, Risk & Education Program launched on June 5, 2019. Data was tracked through July 22, 2020. Women undergoing breast imaging completed questionnaires that calculated Tyrer-Cuzick risk and assessed genetic testing eligibility using National Comprehensive Cancer Network criteria. To encourage eligible women's genetic testing adherence, pretest counseling and saliva sample collection occurred that same day in the imaging center. Samples were tested by a 34-multigene panel. Genetic counselors called women with positive results. Women with negative results or variants of uncertain significance were mailed notifications. Summary statistics were calculated. RESULTS A total of 3345 women completed questionnaires. 1080 (32.3%) met genetic testing criteria. 468/1080 (43.3%) submitted genetic samples, and 416/1080 (38.5%) completed testing. Of 416 completed tests, 269 (64.7%) tested negative, 109 (26.2%) had variants of uncertain significance, and 38 (9.1%) diagnosed pathogenic mutations. 13/38 (34.2%) women with pathogenic mutations implemented risk-reduction strategies at our institution. CONCLUSION Breast imaging centers can operate same-day cancer risk assessment and genetic testing programs, identifying high-risk women that conventional risk assessment methods may not have diagnosed. These proactive programs add value to radiology departments' cancer care beyond traditional imaging services.
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Affiliation(s)
- Vilert A Loving
- Banner MD Anderson Cancer Center, Division of Diagnostic Imaging, Gilbert, Arizona (V.A.L.).
| | - Rebecca C Luiten
- Banner MD Anderson Cancer Center, Division of Cancer Medicine, Gilbert, Arizona (R.C.L., J.M.S., L.A.M.)
| | - Jennifer M Siettmann
- Banner MD Anderson Cancer Center, Division of Cancer Medicine, Gilbert, Arizona (R.C.L., J.M.S., L.A.M.)
| | - Lida A Mina
- Banner MD Anderson Cancer Center, Division of Cancer Medicine, Gilbert, Arizona (R.C.L., J.M.S., L.A.M.)
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Maruccia M, Elia R, Tedeschi P, Gurrado A, Moschetta M, Testini M, Giudice G. Prepectoral breast reconstruction: an ideal approach to bilateral risk-reducing mastectomy. Gland Surg 2021; 10:2997-3006. [PMID: 34804886 DOI: 10.21037/gs-21-339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/26/2021] [Indexed: 12/11/2022]
Abstract
Background Bilateral risk-reducing mastectomy (BRRM) has increased its popularity in the last years because of its aim to minimise the chances of developing breast cancer in high-risk patients. Women undergoing this procedure must be considered highly demanding patients given the need to combine aesthetical, functional and preventive desires. This study aims to present the authors' experience in performing BRRM followed by single-stage prepectoral reconstruction (PPBR) with implant completely covered by acellular dermal matrix (ADM) and to report indications, surgical techniques, functional and aesthetic results. Methods A single-centre prospective data collection was carried out from January 2017 to January 2021 of patients at high risk of developing breast cancer undergoing BRRM and immediate PPBR with ADM. Patients were subdivided into two groups according to the breast shape: Group A had small and medium size breasts and Group B had large and ptotic breasts. Oncological and surgical outcomes were collected. Satisfaction with reconstruction and related quality of life were evaluated through the BREAST-Q questionnaire. Results A total of twenty-three patients met the inclusion criteria. Seventeen patients were included in group A and six patients in group B. Average follow-up was 18.4 months. Minor complications occurred in four breasts: one seroma, one hematoma and two cases of wound dehiscence. Capsular contracture was not observed. All patients were satisfied with the final result according to the post-operative BREAST-Q questionnaire. Conclusions Immediate prepectoral breast reconstruction could represent the ideal reconstruction option after BRRM and should be offered to all women that fulfil the inclusion criteria.
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Affiliation(s)
- Michele Maruccia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Piazza Giulio Cesare, Bari, Italy
| | - Rossella Elia
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Piazza Giulio Cesare, Bari, Italy
| | - Pasquale Tedeschi
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Piazza Giulio Cesare, Bari, Italy
| | - Angela Gurrado
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Piazza Giulio Cesare, Bari, Italy
| | - Marco Moschetta
- Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, University of Bari Aldo Moro, Piazza Giulio Cesare, Bari, Italy
| | - Mario Testini
- Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Piazza Giulio Cesare, Bari, Italy
| | - Giuseppe Giudice
- Division of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Piazza Giulio Cesare, Bari, Italy
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Analysis of Secondary Surgeries after Immediate Breast Reconstruction for Cancer Compared with Risk Reduction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3312. [PMID: 33425618 PMCID: PMC7787276 DOI: 10.1097/gox.0000000000003312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022]
Abstract
Background: This study sets out to compare reconstructive practice between patients undergoing immediate breast reconstruction (IBR) for cancer and those who opted for risk reduction (RR), with an emphasis on examining patterns of secondary surgery. Methods: Data collection was performed for patients undergoing mastectomy and IBR at a teaching hospital breast unit (2013–2016). Results: In total, 299 patients underwent IBR (76% cancer versus 24% RR). Implant-based IBR rate was similar in both groups (58% cancer versus 63% RR). Reconstruction loss (5.3% cancer versus 4.2% RR) and complication (16% cancer versus 12.9% RR) rates were similar. Cancer patients were more likely to undergo secondary surgery (68.4% versus 56.3%; P = 0.025), including contralateral symmetrization (22.8% versus 0%) and conversion to autologous reconstruction (5.7% versus 1.4%). Secondary surgeries were mostly planned for cancer patients (72% planned versus 28% unplanned), with rates unaffected by adjuvant therapies. This distribution was different in RR patients (51.3% planned versus 48.7% unplanned). The commonest secondary procedure was lipomodeling (19.7% cancer versus 23.9% RR). For cancer patients, complications resulted in a significantly higher unplanned secondary surgery rate (82.5% versus 38.8%; P = 0.001) than patients without complications. This was not evident in the RR patients, where complications did not lead to a significantly higher unplanned surgery rate (58.9% versus 35.2%; P = 0.086). Conclusions: Most of the secondary surgeries were planned for cancer patients. However, complications led to a significantly higher rate of unplanned secondary surgery. Approximately 1 in 4 RR patients received unplanned secondary surgery, which may be driven by the desire to achieve an optimal aesthetic outcome.
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