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Chen Q, Qu L, He Y, Deng Y, Zhou Q, Yi W. Comparative effectiveness of nipple-sparing mastectomy and breast-conserving surgery on long-term prognosis in breast cancer. Front Endocrinol (Lausanne) 2023; 14:1222651. [PMID: 38053723 PMCID: PMC10694201 DOI: 10.3389/fendo.2023.1222651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/30/2023] [Indexed: 12/07/2023] Open
Abstract
Background The frequency of nipple-sparing mastectomy (NSM) surgery is presently increasing. Nonetheless, there is a paucity of long-term prognosis data on NSM. This study compared the long-standing prognosis of NSM in relation to breast-conserving surgery (BCS). Methods Population-level data for 438,588 female breast cancer patients treated with NSM or BCS and postoperative radiation from 2000 to 2018 were identified in the Surveillance, Epidemiology, and End Results (SEER) database; 321 patients from the Second Xiangya Hospital of Central South University were also included. Propensity score matching (PSM) was performed to reduce the influence of selection bias and confounding variables to make valid comparisons. The Kaplan-Meier analysis, log-rank test, and Cox regression were applied to analyze the data. Results There were no significant differences in long-term survival rates between patients who underwent NSM and those who underwent BCS+radiotherapy (BCS+RT), as indicated by the lack of significant differences in overall survival (OS) (p = 0.566) and breast cancer-specific survival (BCSS) (p = 0.431). Cox regression indicated that NSM and BCS+RT had comparable prognostic values (p = 0.286) after adjusting for other clinicopathological characteristics. For OS and BCSS, subgroup analysis showed that the majority of patients achieved an analogous prognosis whether they underwent NSM or BCS. The groups had comparable recurrence-free survival (RFS), with no significant difference found (p = 0.873). Conclusions This study offers valuable insights into the long-term safety and comparative effectiveness of NSM and BCS in the treatment of breast cancer. These findings can assist clinicians in making informed decisions on a case-by-case basis.
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Affiliation(s)
- Qitong Chen
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Clinical Research Center for Breast Disease in Hunan Province, Changsha, Hunan, China
| | - Limeng Qu
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Clinical Research Center for Breast Disease in Hunan Province, Changsha, Hunan, China
| | - Yeqing He
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Clinical Research Center for Breast Disease in Hunan Province, Changsha, Hunan, China
| | - Yueqiong Deng
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Clinical Research Center for Breast Disease in Hunan Province, Changsha, Hunan, China
| | - Qin Zhou
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Clinical Research Center for Breast Disease in Hunan Province, Changsha, Hunan, China
| | - Wenjun Yi
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Clinical Research Center for Breast Disease in Hunan Province, Changsha, Hunan, China
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Vingan PS, Kim M, Rochlin D, Allen RJ, Nelson JA. Prepectoral Versus Subpectoral Implant-Based Reconstruction: How Do We Choose? Surg Oncol Clin N Am 2023; 32:761-776. [PMID: 37714642 DOI: 10.1016/j.soc.2023.05.007] [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] [Indexed: 09/17/2023]
Abstract
Aspects of a patient's lifestyle, their state of health, breast size, and mastectomy skin flap quality are factors that influence the suggested plane of dissection in implant-based breast reconstruction. This article aims to review developments in prosthetic breast reconstruction and provide recommendations to help providers choose whether prepectoral or subpectoral reconstruction in the best approach for each of their patients.
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Affiliation(s)
- Perri S Vingan
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Danielle Rochlin
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Robert J Allen
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Ryan JF, Lesniak DM, Cordeiro E, Campbell SM, Rajaee AN. Surgeon Factors Influencing Breast Surgery Outcomes: A Scoping Review to Define the Modern Breast Surgical Oncologist. Ann Surg Oncol 2023; 30:4695-4713. [PMID: 37036590 DOI: 10.1245/s10434-023-13472-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/26/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Modern breast surgical oncology incorporates many aspects of care including preoperative workup, surgical management, and multidisciplinary collaboration to achieve favorable oncologic outcomes and high patient satisfaction. However, there is variability in surgical practice and outcomes. This review aims to identify modifiable surgeon factors influencing breast surgery outcomes and provide a definition of the modern breast surgical oncologist. METHODS A systematic literature search with additional backward citation searching was conducted. Studies describing modifiable surgeon factors with associated breast surgery outcomes such as rates of breast conservation, sentinel node biopsy, re-excision, complications, acceptable esthetic outcome, and disease-free and overall survival were included. Surgeon factors were categorized for qualitative analysis. RESULTS A total of 91 studies met inclusion criteria describing both modifiable surgeon factor and outcome data. Four key surgeon factors associated with improved breast surgery outcomes were identified: surgical volume (45 studies), use of oncoplastic techniques (41 studies), sub-specialization in breast surgery or surgical oncology (9 studies), and participation in professional development activities (5 studies). CONCLUSIONS On the basis of the literature review, the modern breast surgical oncologist has a moderate- to high-volume breast surgery practice, understands the use and application of oncoplastic breast surgery, engages in additional training opportunities, maintains memberships in relevant societies, and remains up to date on key literature. Surgeons practicing in breast surgical oncology can target these modifiable factors for professional development and quality improvement.
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Affiliation(s)
- Joanna F Ryan
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - David M Lesniak
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Erin Cordeiro
- Department of Surgery, University of Ottawa, Ottawa, Canada
| | - Sandra M Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - A Nikoo Rajaee
- Department of Surgery, University of Alberta, Edmonton, Canada.
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Portnow LH, Majid S, Maduram A, Chesebro AL, Karimova EJ, Chung SH, Gombos EC. Breast Malignancies After Mastectomy With Autologous or Implant Reconstruction. JOURNAL OF BREAST IMAGING 2022; 4:649-660. [PMID: 38417000 DOI: 10.1093/jbi/wbac068] [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: 06/30/2022] [Indexed: 03/01/2024]
Abstract
There are multiple indications for mastectomy for breast cancer, including extent of tumor, inability to achieve negative margins after re-excision, patient preference, or prevention in women with a high lifetime risk of breast cancer. Multiple types of autologous or implant reconstruction options are available for cosmesis. Although rare, breast cancers after mastectomy can occur, and it is important for both surgeons and radiologists to be aware of the associated risk factors, common locations, and classic imaging features of these malignancies. This article reviews the types of mastectomies, reconstruction options, and information about the location, presentation, and prognosis of cancers in the reconstructed breast.
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Affiliation(s)
- Leah H Portnow
- Brigham and Women's Hospital, Department of Radiology, Breast Imaging, Boston, MA, USA
| | - Sana Majid
- Brigham and Women's Hospital, Department of Radiology, Breast Imaging, Boston, MA, USA
| | - Amy Maduram
- Brigham and Women's Hospital, Department of Radiology, Breast Imaging, Boston, MA, USA
| | - Allyson L Chesebro
- Brigham and Women's Hospital, Department of Radiology, Breast Imaging, Boston, MA, USA
| | - E Jane Karimova
- Brigham and Women's Hospital, Department of Radiology, Breast Imaging, Boston, MA, USA
| | - Stephanie H Chung
- Brigham and Women's Hospital, Department of Radiology, Breast Imaging, Boston, MA, USA
| | - Eva C Gombos
- Brigham and Women's Hospital, Department of Radiology, Breast Imaging, Boston, MA, USA
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Roy PG, Yan Z, Nigam S, Maheshwari K. Aesthetic breast surgery: putting in context-a narrative review. Gland Surg 2021; 10:2832-2846. [PMID: 34733731 DOI: 10.21037/gs-20-892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 07/12/2021] [Indexed: 01/13/2023]
Abstract
Objective This review article summarises the latest evidence for commonly undertaken procedures in aesthetic breast surgery with a focus on key principles of breast augmentation, reduction, and mastopexy. The paper also outlines various approaches and controversies as well as complications such as breast implant associated anaplastic large cell lymphoma (BIA-ALCL) and breast implant illness (BII) which are increasingly being recognised and becoming a challenge to manage. Background Changing trends of aesthetic breast surgery over the decades has warranted a continuous evolution of this field. The ability to deliver safe and appropriate care is dependent upon sound reconstructive principles and proper training. The lack of uniformity in either is a cause of concern. The impact of social media and changing perception of body image can also no longer be overlooked in the field of aesthetics and reconstruction. Methods Review of literature including recent journals, textbook chapters, online databases like PubMed, and current government and surgical society guidelines. Conclusions Breast reconstruction is based on sound surgical principles and it is imperative to follow these for the practice of this speciality. There are two important issues that revolve around this aspect of surgery. First relates to the urgent need to invest time and effort in improving regulations and outcomes in the cosmetic surgery industry. Second, it is crucial to promote and prioritize the development and training in this field as the principles of aesthetic breast surgery underpins oncoplastic breast surgery for management of cancer.
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Affiliation(s)
- Pankaj G Roy
- Department of Breast Surgery, Oxford University Hospital NHSFT, Oxford, UK
| | - Zhiyan Yan
- Department of Breast Surgery, Oxford University Hospital NHSFT, Oxford, UK
| | - Shashank Nigam
- Department of Breast Surgery, Oxford University Hospital NHSFT, Oxford, UK
| | - Kavish Maheshwari
- Department of Plastic Surgery, Bedfordshire Hospitals NHS Trust, Bedfordshire, UK
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Understanding the Evidence and Improving Outcomes with Implant-Based Prepectoral Breast Reconstruction. Plast Reconstr Surg 2021; 148:437e-450e. [PMID: 34432700 DOI: 10.1097/prs.0000000000008229] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Describe the risks, benefits, and safety profile of prepectoral breast reconstruction. 2. Have knowledge of primary immediate and delayed prepectoral breast reconstruction techniques and secondary procedures required. 3. Describe data on outcomes of prepectoral breast reconstruction. SUMMARY Once considered to have an unacceptable complication profile, prepectoral breast reconstruction is increasing in popularity because of decreased surgical invasiveness and postoperative pain and the absence of animation deformity. Short-term outcomes studies comparing prepectoral breast reconstruction to partially submuscular techniques demonstrate similarly acceptable rates of postoperative complications. Aesthetic outcomes demonstrate similar rates of capsular contracture but increased rippling and implant palpability of the upper pole. Postoperative functional data are limited but overall show decreased pain and more rapid return of function but equivalent satisfaction on the BREAST-Q. Long-term aesthetic data and rates of revision are lacking.
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Yu J, Han ZY, Li T, Feng WZ, Yu XL, Luo YC, Wu H, Jiang J, Wang JD, Liang P. Microwave Ablation Versus Nipple Sparing Mastectomy for Breast Cancer ≤5 cm: A Pilot Cohort Study. Front Oncol 2020; 10:546883. [PMID: 33117685 PMCID: PMC7576845 DOI: 10.3389/fonc.2020.546883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/21/2020] [Indexed: 12/24/2022] Open
Abstract
Objectives Compared with nipple sparing mastectomy (NSM), microwave ablation (MWA) is one relatively new modality indicated for selected breast cancer with nipple sparing and with little of evidence-based medical research for decision-making. The objective of this study was to compare the effect of ultrasound-guided percutaneous MWA and NSM for breast cancer. Materials and Methods A retrospective cohort study was conducted in a single institution from 2014 to 2020. Women with invasive ductal carcinoma of the breast ≤ 5cm treated by MWA or NSM were enrolled. The primary end point was tumor progression and secondary end points included survival, cosmetic results, and complications. Results 21 patients in the MWA group and 43 in the NSM group were evaluated. The mean tumor size was 2.3 cm (range, 0.3-5.0 cm). Median follow-up was 26.7 months (range, 14.6-62.5 months). The mean age of MWA was 24 years older than that of the NSM group. All the patients achieved technique effectiveness. One local tumor progression and one ipsilateral breast recurrence occurred at 42 and 28 months after MWA, respectively. One ipsilateral breast recurrence and two bone metastasis occurred at 31.2, 34, and 30.5 months after NSM. Two groups had no significant difference in tumor progression (P = 0.16). No participants in both groups developed cancer related death (P > 0.99) and major complications (P > 0.99). However, MWA needed less hospitalization time (P < 0.001) and achieved better cosmetic results (P < 0.001). Conclusions MWA achieved similar short term effect for breast cancer control and better cosmetic satisfaction compared with NSM in selected patients. MWA provides appropriate option for elderly patients who are unfit for surgery.
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Affiliation(s)
- Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhi-Yu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ting Li
- Department of Ultrasound, People's Hospital of Sanya, Sanya, China
| | - Wen-Zhe Feng
- Department of Laboratory Medicine, The Fourth Hospital of Baotou City, Baotou, China
| | - Xiao-Ling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Yan-Chun Luo
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Han Wu
- Department of Ultrasound, Qingdao Municipal Hospital, Qingdao, China
| | - Jian Jiang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jian-Dong Wang
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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The Influence of Patient Exposure to Breast Reconstruction Approaches and Education on Patient Choices in Breast Cancer Treatment. Ann Plast Surg 2020; 83:206-210. [PMID: 30300225 PMCID: PMC6687412 DOI: 10.1097/sap.0000000000001661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The landscape of surgical and medical management and patient choices for breast cancer treatment changes as breast reconstruction and oncoplastic approaches improve and diversify. Increased access to breast reconstruction, in addition to patient education, influences the breast cancer patient. Therefore, the examination of the possible impact of reconstructive surgery on all stages of the breast cancer management per se seemed timely. METHODS Plastic surgery consults were arranged for 520 new patients diagnosed with breast cancer (2012-2016) including patients with noninvasive breast cancer but at high risk of further cancer development. To test the plastic surgery impact on patient choices regarding the management of the cancer, a subset of 90 patients was identified to test the plastic surgery impact on patient choices. These patients were referred to plastic surgery, following the first round of consultations by surgical and medical oncologists with only the preliminary oncological management plan defined. After a plastic surgery consultation, but prior to finalization of the overall oncological management plan, they were surveyed on the subject of modification of their personal choices and requests pertaining to their cancer management. RESULTS In this subset of 90 patients 40 (44%) returned to their surgical or medical oncologist considering changes of the primary management plan after their plastic surgery consultation. Twenty-six (28%) ultimately altered their plan, and the following patient-driven changes were made: mastectomy as opposed to lumpectomy (18 patients [20%]), contralateral prophylactic mastectomy (11 patients [12%]), nipple/areola removal as opposed to nipple/areola sparing suggested by the oncologists (5 patients [6%]), oncoplastic breast reduction as part of lumpectomy (5 patients [6%]), and other modifications (3 patients [3%]). CONCLUSIONS Decisions for altering the preliminary oncologic plan or choosing a specific alternative (eg, lumpectomy plus radiation vs mastectomy) resulted from patient education on (1) reconstructive options, (2) aesthetic pitfalls and results. and (3) their interfacing with the oncological outcomes. Ultimately, plastic surgeons influence the multispecialty breast cancer management and patient decision-making process. Therefore, oncological literacy for plastic surgeons is essential to provide state-of-the-art breast cancer care and avoidance of suboptimal patient decisions.
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Oncoplastic Procedures in Preparation for Nipple-Sparing Mastectomy and Autologous Breast Reconstruction: Controlling the Breast Envelope. Plast Reconstr Surg 2020; 145:914-920. [PMID: 32221203 DOI: 10.1097/prs.0000000000006657] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nipple-sparing mastectomy has been associated with superior aesthetic outcomes and oncologic safety. However, traditional contraindications, such as breast ptosis/macromastia, have excluded a large number of patients. The purpose of this study was to determine whether a staged approach would expand the indications for nipple-areolar complex preservation and permit greater control over nipple-areolar complex position and skin envelope following autologous reconstruction. METHODS A retrospective analysis was conducted of female patients with a diagnosis of breast cancer or BRCA mutation with grade 2 or 3 ptosis and/or macromastia who underwent bilateral (oncoplastic) reduction/mastopexy (stage 1) followed by bilateral nipple-sparing mastectomy with immediate reconstruction with free abdominal flaps (stage 2). The authors were specifically interested in the incidence of mastectomy skin necrosis and nipple-areolar complex necrosis and malposition following stage 2. RESULTS Sixty-one patients with a mean age of 45.1 years (range, 28 to 62 years) and mean body mass index of 32.6 kg/m (range, 23.4 to 49.0 kg/m) underwent reconstruction with 122 flaps. The mean interval between stage 1 and 2 was 16.9 weeks (range, 3 to 31 weeks). Clear margins were obtained in all cases of invasive cancer and in situ disease following stage 1. Complications following stage 2 included partial nipple-areolar complex necrosis (n = 5, 8.2 percent), complete nipple-areolar complex necrosis (n = 4, 6.6 percent), nipple-areolar complex malposition (n = 1, 1.6 percent), and mastectomy skin necrosis (n = 4, 6.6 percent). No flap loss was noted in this series. CONCLUSION Patients with moderate to severe breast ptosis and/or macromastia who wish to undergo mastectomy with reconstruction can be offered nipple-sparing approaches safely if a staged algorithm is implemented. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Y-Peg-in-a-Round-Hole Closure for Immediate Periareolar Mastectomy Expander Reconstruction. Ann Plast Surg 2018; 82:145-151. [PMID: 30562206 DOI: 10.1097/sap.0000000000001690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Mastectomies closed with a linear scar can distort the resulting shape of the breast. We present our novel Y-peg-in-a-round-hole closure method of the mastectomy scar, which improves the shape of the reconstructed breast while maintaining reliable healing, implant coverage, and minimum scar size for covering by tattoo. MATERIALS AND METHODS A retrospective review of all breast reconstruction cases performed by the senior surgeon during the period from January 2010 to January 2017 was undertaken. Data were analyzed for wound healing problems, infection rates and mastectomy skin flap necrosis. RESULTS Data were extracted for 126 consecutive patients with 154 breast reconstructions. Twelve breasts (7.7%) experienced wound healing problems, for which 7 (4.5%) required revisionary surgery. Eighteen breasts (11.7%) developed an infection requiring antibiotics, of which 8 (5.2%) needed a further operation. Four breasts (2.6%) needed removal of the implant. No patients were lost to follow-up. CONCLUSION After nipple resecting mastectomy, the Y-peg-in-a-round-hole scar minimizes radial size and contour deformity but allows for reliable wound healing.
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