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Catanuto G, Rocco N, Fichera CG, Cinquerrui A, Rapisarda M, Chiodini P, Magnoni F, Dorangricchia P, Sebri V, Pravettoni G, Nava MB, Caruso F. Easy Anthropometric Measurements Are Representative of Baseline Values of Breast Q Values in Asymptomatic Women. Healthcare (Basel) 2024; 12:268. [PMID: 38275547 PMCID: PMC10815797 DOI: 10.3390/healthcare12020268] [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: 12/03/2023] [Revised: 01/13/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Measurements of breast morphology are a determinant of the assessment of any surgical procedure, either reconstructive or cosmetic. This study aims to investigate the association between easy anthropometric measurements and values of quality of life assessed in a sample of asymptomatic women. METHODOLOGY Healthy asymptomatic women were admitted for this study. The following measurements were assessed: height, weight, nipple to sternal notch distance, areola to infra-mammary fold distance (right vs. left), right-left nipple distance. The Breast Q questionnaire (Italian translation V.1, pre-op breast conservation surgery) in the following domains: satisfaction with breasts; psycho-social satisfaction; physical satisfaction; sexual satisfaction, which was used to assess breast-related quality of life. RESULTS One hundred and forty-five women responded to the breast Q questionnaire. The mean age of the sample was 44.3 years; the medium BMI was 24.1; Spearman correlation coefficients revealed that all the investigated values were negatively correlated to the "satisfaction with breasts" domain. Psychosexual satisfaction was associated with age; BMI; nipple to sternal notch distance. After normalization for age values, we observed that "satisfaction with breast" was, once again, highly correlated to BMI; nipple to sternal notch distance; areola to IMF distance. In all cases, the higher the values, the lower the scores. CONCLUSIONS Distances between easy relevant anatomical landmarks are representative of patients' breast-related quality of life in a population of asymptomatic women. These findings allow us to identify an ideal anthropometric framework that can be used as a validated surgical endpoint for cosmetic and oncological procedures.
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Affiliation(s)
- Giuseppe Catanuto
- Institution Humanitas Istituto Clinico Catanese, 95045 Misterbianco, Italy; (G.C.); (M.R.); (F.C.)
- GReTA Fondazione ETS (Group for Reconstructive and Therapeutic Advancements), 80123 Naples, Italy;
| | - Nicola Rocco
- GReTA Fondazione ETS (Group for Reconstructive and Therapeutic Advancements), 80123 Naples, Italy;
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80131 Naples, Italy
| | | | - Ada Cinquerrui
- Institution Humanitas Istituto Clinico Catanese, 95045 Misterbianco, Italy; (G.C.); (M.R.); (F.C.)
| | - Martina Rapisarda
- Institution Humanitas Istituto Clinico Catanese, 95045 Misterbianco, Italy; (G.C.); (M.R.); (F.C.)
| | - Paolo Chiodini
- Medical Statistics Unit, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Francesca Magnoni
- Division of Breast Surgery, European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | - Patrizia Dorangricchia
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy (V.S.); (G.P.)
| | - Valeria Sebri
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy (V.S.); (G.P.)
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology, IRCCS, 20141 Milan, Italy (V.S.); (G.P.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Maurizio Bruno Nava
- GReTA Fondazione ETS (Group for Reconstructive and Therapeutic Advancements), 80123 Naples, Italy;
| | - Francesco Caruso
- Institution Humanitas Istituto Clinico Catanese, 95045 Misterbianco, Italy; (G.C.); (M.R.); (F.C.)
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Pösteki G. Does rapid discharge after breast cancer surgery have an impact on wound healing and complications? COVID-19 pandemic experience. Int Wound J 2023; 20:3255-3261. [PMID: 37194655 PMCID: PMC10502246 DOI: 10.1111/iwj.14205] [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: 03/09/2023] [Accepted: 04/12/2023] [Indexed: 05/18/2023] Open
Abstract
The COVID-19 pandemic has challenged the health systems worldwide. Because of high volume of COVID-19 patients, all hospitals in our region were re-configured as COVID-19 centres and elective surgery procedures were cancelled. Our clinic was the only active centre in the region and grave increase in our patient volume urged our clinic to modify our discharge protocol. This retrospective study included all breast cancer patients underwent mastectomy and/or axillary dissection, in the Breast Surgery Clinic of Kocaeli State Hospital, a regional pandemic hospital, between December 2020 and January 2021. Patients were mostly discharged the day of surgery with drains because of congestion, while some of the patients had traditional stay, when beds were available. The patients were evaluated postoperatively (the first 30 days) in terms of wound complications, Clavien-Dindo classification grade, satisfaction, presence of pain and nausea, and treatment costs during the follow-up period of the study. Outcomes were compared between early discharged patients and patients who had traditional long stay. Compared with long-stay patients, in the early discharged group, postoperative wound complications was significantly lower (P < .01) with significant cost savings. There were no significant changes in variables such as surgery type, ASA class, satisfaction, need for additional medication and Clavien-Dindo between the groups. Adaptation to an early discharge protocol for breast cancer surgeries may be an efficient way of practicing surgery in a pandemic. Early discharge with drains may be beneficial for patients.
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Affiliation(s)
- Gökhan Pösteki
- Department of General SurgeryKocaeli State HospitalİzmitTurkey
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Bonci EA, Anacleto JC, Cardoso MJ. Sometimes it is better to just make it simple. De-escalation of oncoplastic and reconstructive procedures. Breast 2023; 69:265-273. [PMID: 36924556 PMCID: PMC10027565 DOI: 10.1016/j.breast.2023.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 03/11/2023] [Indexed: 03/14/2023] Open
Abstract
Simple breast conservation surgery (sBCS) has technically advanced onto oncoplastic breast procedures (OBP) to avoid mastectomy and improve breast cancer patients' psychosocial well-being and cosmetic outcome. Although OBP are time-consuming and expensive, we are witnessing an increase in their use, even for cases that could be managed with sBCS. The choice between keeping it simple or opting for more complex oncoplastic procedures is difficult. This review proposes a pragmatic approach in assisting this decision. Medical literature suggests that OBP and sBCS might be similar regarding local recurrence and overall survival, and patients seem to have higher satisfaction levels with the aesthetic outcome of OBP when compared to sBCS. However, the lack of comprehensive high-quality research assessing their safety, efficacy, and patient-reported outcomes hinders these supposed conclusions. Postoperative complications after OBP may delay the initiation of adjuvant RT. In addition, precise displacement of the breast volume is not effectively recorded despite surgical clips placement, making accurate dose delivery tricky for radiation oncologists, and WBRT preferable to APBI in complex OBP cases. With a critical eye on financial toxicity, patient satisfaction, and oncological outcomes, OBP must be carefully integrated into clinical practice. The thoughtful provision of informed consent is essential for decision-making between sBCS and OBP. As we look into the future, machine learning and artificial intelligence can potentially help patients and doctors avoid postoperative regrets by setting realistic aesthetic expectations.
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Affiliation(s)
- E-A Bonci
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal; Surgical Oncology Department, "Prof. Dr. Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania; Surgical Oncology and Gynecologic Oncology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - J Correia Anacleto
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal; Hospital CUF Cascais, Cascais, Portugal
| | - M-J Cardoso
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal; Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
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Aristokleous I, Öberg J, Pantiora E, Sjökvist O, Navia JE, Mani M, Karakatsanis A. Effect of standardised surgical assessment and shared decision-making on morbidity and patient satisfaction after breast conserving therapy: A cross-sectional study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:60-67. [PMID: 36088236 DOI: 10.1016/j.ejso.2022.08.021] [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: 03/02/2022] [Revised: 07/11/2022] [Accepted: 08/19/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The role of oncoplastic breast conserving therapy (OPBCT) on physical function, morbidity and patient satisfaction has yet to be defined. Additionally, technique selection should be individualised and incorporate patient preference. The study aim was to investigate differences between "standard" (sBCT) and oncoplastic breast conservation (OPBCT) in patient-reported outcomes (PROs) when patients have been assessed in a standardised manner and technique selection has been reached through shared decision-making (SDM). METHODS This is a cross-sectional study of 215 women treated at a tertiary referral centre. Standardised surgical assessment included breast and lesion volumetry, definition of resection ratio, patient-related risk factors and patient preference. Postoperative morbidity and patient satisfaction were assessed by validated PROs tools (Diseases of the Arm, Shoulder and Hand-DASH and Breast-Q). Patient experience was assessed by semi-structured interviews. RESULTS There was no difference of the median values between OPBCT and sBCT in postoperative morbidity of the upper extremity (DASH 3.3 vs 5, p = 0.656) or the function of the chest wall (Breast-Q 82 vs 82, p = 0.758). Postoperative satisfaction with breasts did not differ either (Breast-Q 65 vs 61, p = 0.702). On the individual level, women that opted for OPBCT after SDM had improved satisfaction when compared to baseline (+3 vs -1, p = 0.001). Shared decision-making changed patient attitude in 69.8% of patients, leading most often to de-escalation from mastectomy. CONCLUSIONS These findings support that a combination of standardised surgical assessment and SDM allows for tailored treatment and de-escalation of oncoplastic surgery without negatively affecting patient satisfaction and morbidity.
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Affiliation(s)
- Iliana Aristokleous
- Department of Surgery, Endocrine- and Breast Unit, Uppsala University Hospital, 75237, Uppsala, Sweden; Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden
| | - Johanna Öberg
- Department of Surgery, Endocrine- and Breast Unit, Uppsala University Hospital, 75237, Uppsala, Sweden; Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden
| | - Eirini Pantiora
- Department of Surgery, Endocrine- and Breast Unit, Uppsala University Hospital, 75237, Uppsala, Sweden; Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden
| | - Olivia Sjökvist
- Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden; Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, 75237, Uppsala, Sweden
| | - Jaime E Navia
- Department of Surgery, Endocrine- and Breast Unit, Uppsala University Hospital, 75237, Uppsala, Sweden; Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden
| | - Maria Mani
- Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden; Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, 75237, Uppsala, Sweden
| | - Andreas Karakatsanis
- Department of Surgery, Endocrine- and Breast Unit, Uppsala University Hospital, 75237, Uppsala, Sweden; Department of Surgical Sciences, Faculty of Medicine, Uppsala University, 75236, Uppsala, Sweden.
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Sgroi G, Russo G, Maglia A, Catanuto G, Barry P, Karakatsanis A, Rocco N, Pappalardo F. Evaluation of word embedding models to extract and predict surgical data in breast cancer. BMC Bioinformatics 2022; 22:631. [PMID: 36384559 PMCID: PMC9667561 DOI: 10.1186/s12859-022-05038-6] [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: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background Decisions in healthcare usually rely on the goodness and completeness of data that could be coupled with heuristics to improve the decision process itself. However, this is often an incomplete process. Structured interviews denominated Delphi surveys investigate experts' opinions and solve by consensus complex matters like those underlying surgical decision-making. Natural Language Processing (NLP) is a field of study that combines computer science, artificial intelligence, and linguistics. NLP can then be used as a valuable help in building a correct context in surgical data, contributing to the amelioration of surgical decision-making. Results We applied NLP coupled with machine learning approaches to predict the context (words) owning high accuracy from the words nearest to Delphi surveys, used as input. Conclusions The proposed methodology has increased the usefulness of Delphi surveys favoring the extraction of keywords that can represent a specific clinical context. It permits the characterization of the clinical context suggesting words for the evaluation process of the data. Supplementary Information The online version contains supplementary material available at 10.1186/s12859-022-05038-6.
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Salibian AA, Olson B, Shauly O, Patel KM. Oncoplastic breast reconstruction: Principles, current techniques, and future directions. J Surg Oncol 2022; 126:450-459. [PMID: 35452129 DOI: 10.1002/jso.26897] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 11/06/2022]
Abstract
Oncoplastic breast reconstruction has improved esthetic results after breast-conserving surgery with low complication rates and stable oncologic outcomes. Basic principles can be applied across different volume displacement and replacement techniques including restoration of breast shape and symmetry through esthetic incisions while eliminating dead space. Technique selection is guided by several factors including breast size, resection-to-breast ratio, and patient desires. A surgeon familiar with all techniques will allow individualization of treatment and optimization of outcomes.
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Affiliation(s)
- Ara A Salibian
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA
| | - Blade Olson
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA
| | - Orr Shauly
- Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA
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Hussein O, Roshdy S, Hamdy O, Denewer A. Pectoralis major myo-parenchymal flap for local reconstruction of partial mastectomy defects. Description of a new technique. Breast Dis 2021; 41:31-36. [PMID: 34275886 DOI: 10.3233/bd-201042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Breast conservation is the standard of care treatment for early breast cancer. Several oncoplastic approaches have been described for the reconstruction of partial breast defects. The multiplicity of techniques indicates that the ideal reconstructive technique is yet to be identified. There has been a recent emphasis on minimizing the magnitude of surgery. In this report, we describe our experience of using the pectoralis major muscle to fill relatively large post-tumorectomy breast defects. PATIENTS AND TECHNIQUE Nine patients were operated on for malignant breast lesions. Tumorectomy resection with surgical margin rendered a 40-50% breast defect. The parenchymal defect was repaired with an advancement muscle flap of the ipsilateral pectoralis major muscle. RESULTS All patients experienced a non-eventful postoperative course. The early cosmetic outcome was excellent in four patients, good in another four, and fair in one patient. CONCLUSION The pectoralis major flap is useful for local repair of upper half partial breast defects in non-ptosed, cup A-B breasts.
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Affiliation(s)
- Osama Hussein
- Surgery Department, Mansoura University Oncology Center, Mansoura, Egypt
| | - Sameh Roshdy
- Surgery Department, Mansoura University Oncology Center, Mansoura, Egypt
| | - Omar Hamdy
- Surgery Department, Mansoura University Oncology Center, Mansoura, Egypt
| | - Adel Denewer
- Surgery Department, Mansoura University Oncology Center, Mansoura, Egypt
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Circumspect use of oncoplastic breast surgery. Breast 2019; 49:201. [PMID: 31865283 PMCID: PMC7375647 DOI: 10.1016/j.breast.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 12/06/2019] [Indexed: 11/21/2022] Open
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