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Grant Y, Thiruchelvam PTR, Kovacevic L, Mossialos E, Al-Mufti R, Hogben K, Hadjiminas DJ, Leff DR. OUP accepted manuscript. BJS Open 2022; 6:6604296. [PMID: 35674701 PMCID: PMC9176201 DOI: 10.1093/bjsopen/zrac073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/08/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Following therapeutic mammoplasty (TM), the contralateral breast may require a later balancing procedure to optimize shape and symmetry. The alternative is to offer patients simultaneous TM with immediate contralateral symmetrization via a dual-surgeon approach, with the goal of reducing costs and minimizing the number of subsequent hospital appointments in an era of COVID-19 surges. The aim of this cost–consequence analysis is to characterize the cost–benefit of immediate bilateral symmetrization dual-operator mammoplasty versus staged unilateral single operator for breast cancer surgery. Method A prospective single-centre observational study was conducted at an academic teaching centre for breast cancer surgery in the UK. Pseudonymized data for clinicopathological variables and procedural care information, including the type of initial breast-conserving surgery and subsequent reoperation(s), were extracted from the electronic patient record. Financial data were retrieved using the Patient-Level Information and Costing Systems. Results Between April 2014 and March 2020, 232 women received either immediate bilateral (n = 44), staged unilateral (n = 57) for breast cancer, or unilateral mammoplasty alone (n = 131). The median (interquartile range (i.q.r.)) additional cost of unilateral mammoplasty with staged versus immediate bilateral mammoplasty was €5500 (€4330 to €6570) per patient (P < 0.001), which represents a total supplementary financial burden of €313 462 to the study institution. There was no significant difference between groups in age, Charlson comorbidity index, operating minutes, time to adjuvant radiotherapy in months, or duration of hospital stay. Conclusion Synchronous dual-surgeon immediate bilateral TM can deliver safe immediate symmetrization and is financially beneficial, without delay to receipt of adjuvant therapy, or additional postoperative morbidity.
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Affiliation(s)
- Yasmin Grant
- Correspondence to: Yasmin Grant, Clinical Research Fellow, Department of BioSurgery and Surgical Technology, Imperial College London, 10th Floor, QEQM Wing, St Mary’s Hospital, Paddington, London W2 1NY, UK (e-mail: )
| | - Paul T. R. Thiruchelvam
- Breast Unit, Imperial College Healthcare NHS Trust, London, UK
- Department of BioSurgery and Surgical Technology, Imperial College London, London, UK
| | - Lana Kovacevic
- Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Elias Mossialos
- Breast Unit, Imperial College Healthcare NHS Trust, London, UK
| | | | - Katy Hogben
- Breast Unit, Imperial College Healthcare NHS Trust, London, UK
| | | | - Daniel R. Leff
- Department of BioSurgery and Surgical Technology, Imperial College London, London, UK
- Breast Unit, Imperial College Healthcare NHS Trust, London, UK
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2
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Lee A, Kwasnicki RM, Khan H, Grant Y, Chan A, Fanshawe AEE, Leff DR. Outcome reporting in therapeutic mammaplasty: a systematic review. BJS Open 2021; 5:6459423. [PMID: 34894122 PMCID: PMC8665419 DOI: 10.1093/bjsopen/zrab126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/05/2021] [Indexed: 11/12/2022] Open
Abstract
Background Therapeutic mammaplasty (TM) is an oncological procedure which combines tumour resection with breast reduction and mastopexy techniques. Previous systematic reviews have demonstrated the oncological safety of TM but reporting of critically important outcomes, such as quality of life, aesthetic and functional outcomes, are limited, piecemeal or inconsistent. This systematic review aimed to identify all outcomes reported in clinical studies of TM to facilitate development of a core outcome set. Methods Medline, EMBASE, CINAHL and Web of Science were searched from inception to 5 August 2020. Included studies reported clinical outcomes following TM for adult women. Two authors screened articles independently for eligibility. Data were extracted regarding the outcome definition and classification type (for example, oncological, quality of life, etc.), time of outcome reporting and measurement tools. Results Of 5709 de-duplicated records, 148 were included in the narrative synthesis. The majority of studies (n = 102, 68.9 per cent) reported measures of survival and/or recurrence; approximately three-quarters (n = 75, 73.5 per cent) had less than 5 years follow-up. Aesthetic outcome was reported in half of studies (n = 75, 50.7 per cent) using mainly subjective, non-validated measurement tools. The time point at which aesthetic assessment was conducted was highly variable, and only defined in 48 (64.0 per cent) studies and none included a preoperative baseline for comparison. Few studies reported quality of life (n = 30, 20.3 per cent), functional outcomes (n = 5, 3.4 per cent) or resource use (n = 28, 18.9 per cent). Conclusion Given the oncological equivalence of TM and mastectomy, treatment decisions are often driven by aesthetic and functional outcomes, which are infrequently and inconsistently reported with non-validated measurement tools.
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Affiliation(s)
- Alice Lee
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Hasaan Khan
- Faculty of Medicine, Imperial College London, London, UK
| | - Yasmin Grant
- Department of BioSurgery, Imperial College London, London, UK
| | - Abigail Chan
- Faculty of Medicine, Imperial College London, London, UK
| | - Angela E E Fanshawe
- Department of Breast Surgery, Charing Cross Hospital, Imperial College NHS Trust, London, UK
| | - Daniel R Leff
- Department of Surgery and Cancer, Imperial College London, London, UK
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3
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Lee A, Kwasnicki RM, Leff DR. Outcomes and outcome measures reported in clinical studies of therapeutic mammaplasty: a systematic review protocol. BMJ Open 2021; 11:e046438. [PMID: 34135045 PMCID: PMC8211071 DOI: 10.1136/bmjopen-2020-046438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Therapeutic mammaplasty (TM) is an oncological procedure which combines tumour resection with breast reduction and mastopexy techniques. Previous systematic reviews have demonstrated oncological safety of TM, but poor and inconsistent reporting of quality-of-life, aesthetic and functional outcomes, often with non-validated measurement tools. Moreover, there is a paucity of patient-reported outcome measures. Standardisation of outcome reporting is required to enable study results to be compared and combined, for example, through core outcome set (COS) development. This systematic review aims to comprehensively describe the outcomes reported in clinical studies of TM, their respective outcome measures and the time points at which they were evaluated. The overall objective is to facilitate the development of a COS for TM. METHODS AND ANALYSIS A systematic review of clinical studies evaluating outcomes following TM will be completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following electronic databases have been searched from inception to 5 August 2020: Ovid MEDLINE, Embase, CINAHL and Web of Science. Primary outcomes will include the number of reported outcomes of various types (clinical, aesthetic, functional, quality-of-life and cost-effectiveness), whether these are patient-reported or clinician-reported, how outcomes are defined and the outcome measurement tool(s) used. The time point(s) at which outcomes were measured will be a secondary outcome. No studies will be excluded on the basis of methodological quality in order to generate a comprehensive list of reported outcomes and outcome measures; hence, risk of bias assessment is not required. The data will be described narratively. This protocol has been reported in line with PRISMA-Protocols. ETHICS AND DISSEMINATION This study does not involve human or animal participants, hence ethical approval is not required. The findings will be published in a peer-reviewed journal and presented at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42020200365.
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Affiliation(s)
- Alice Lee
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Daniel R Leff
- Department of Surgery and Cancer, Imperial College London, London, UK
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4
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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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Courtney A, O'Connell R, Rattay T, Kim B, Cutress RI, Kirwan CC, Gandhi A, Fairbrother P, Sharma N, Cartlidge CWJ, Horgan K, McIntosh SA, Leff DR, Vidya R, Potter S, Holcombe C, Copson E, Coles CE, Dave RV. The B-MaP-C study: Breast cancer management pathways during the COVID-19 pandemic. Study protocol. Int J Surg Protoc 2020; 24:1-5. [PMID: 32838092 PMCID: PMC7388760 DOI: 10.1016/j.isjp.2020.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 01/15/2023] Open
Abstract
Introduction Approximately 55,000 women in the United Kingdom are diagnosed with new breast cancer annually. Since emerging in December 2019, SARS-CoV-2 (coronavirus disease 2019, COVID-19) has become a global pandemic, affecting healthcare delivery worldwide. In response to the pandemic, multiple guidelines were issued to assist with rationalising breast cancer care. The primary aim of the B-MaP-C study is to audit and describe breast cancer management of patients newly diagnosed with breast cancer during the COVID-19 pandemic against pre-COVID-19 management practice in the UK. The implications of changes to management will be determined and the impact of a COVID-19 diagnosis on the patient’s breast cancer management will be determined. Methods and analysis This is a multi-centre collaborative audit of consecutive breast cancer patients undergoing treatment decisions during the acute and recovery phases of the COVID-19 pandemic. All patients with newly diagnosed primary breast cancer, whose treatment was decided in a multidisciplinary meeting from the 16th March 2020, are eligible for inclusion. Ethics and dissemination As this is an audit ethical approval is not required. Each participating centre is required to register the study locally and obtain local governance approvals prior to commencement of data collection. Local audit data will be available to individual participating units for governance purposes. The results of the data analysis will be submitted for publication, as well as disseminated via the ABS newsletter and a webinar. All data will be presented at national and international conferences, circumstances permitting. Registration details Each participating centre received local governance audit registration.
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Affiliation(s)
- Alona Courtney
- Department of Surgery and Cancer, Imperial College London, UK
| | - Rachel O'Connell
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
| | - Tim Rattay
- Department of Cancer Studies, Clinical Sciences Building, University of Leicester, Leicester LE2 2LX, UK
| | - Baek Kim
- Department of Breast Surgery, St. James's University Hospital, Leeds LS9 7TF, UK
| | - Ramsey I Cutress
- University of Southampton and University Hospital Southampton, Tremona Road, Southampton SO16 6YD UK
| | - Cliona C Kirwan
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester M23 9LT, UK.,Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oglesby Cancer Research Building, Manchester Cancer Research Centre, Wilmslow Road, Manchester M20 4BX, UK
| | - Ashu Gandhi
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester M23 9LT, UK.,Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oglesby Cancer Research Building, Manchester Cancer Research Centre, Wilmslow Road, Manchester M20 4BX, UK
| | | | - Nisha Sharma
- Breast Unit, Level 1 Chancellor Wing, St James's Hospital, Leeds LS9 7TF, UK
| | | | - Kieran Horgan
- Department of Breast Surgery, St. James's University Hospital, Leeds LS9 7TF, UK
| | - Stuart A McIntosh
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - Daniel R Leff
- Department of Surgery and Cancer, Imperial College London, UK
| | - Raghavan Vidya
- The Royal Wolverhampton NHS Trust, Wolverhampton Road, Wolverhampton WV10 0QP, UK
| | - Shelley Potter
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Canynge Hall, Whatley Road, Bristol BS8 2PS UK
| | - Chris Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - Ellen Copson
- University of Southampton and University Hospital Southampton, Tremona Road, Southampton SO16 6YD UK
| | | | - Rajiv V Dave
- The Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester M23 9LT, UK
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Kaviani A, Tabary M, Zand S, Araghi F, Patocskai E, Nouraie M. Oncoplastic Repair in Breast Conservation: Comprehensive Evaluation of Techniques and Oncologic Outcomes of 937 Patients. Clin Breast Cancer 2020; 20:511-519. [PMID: 32650989 DOI: 10.1016/j.clbc.2020.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/27/2020] [Accepted: 05/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Breast-conserving surgery, especially with oncoplastic breast surgery (OBS), is becoming the standard of care in the surgical management of breast cancer. We investigated the applied technique of OBS and oncologic outcomes in a large series of patients. PATIENTS AND METHODS This study was conducted between January 2008 and June 2018 in two centers in Iran. Patients underwent OBS. Early and late postoperative complications, oncologic outcomes, and follow-up data were documented. RESULTS Nine hundred thirty-seven patients with a mean ± standard deviation age of 48.1 ± 11.3 underwent OBS. Most of the patients were diagnosed with early-stage disease, of which the most common pathology was invasive ductal carcinoma (83.3%). Lateral oncoplasty was the most commonly used OBS technique (324 cases, 34.6%). The most common complication was seroma formation. Reduction-type OBS technique had the highest rate of complications (13.1%). Thirty-four patients (5.4%) experienced local recurrence, with a median recurrence time of 26.4 months. Nine patients (1.3%) died from cancer recurrence. CONCLUSION OBS is a safe procedure with minor complications and good oncologic outcomes. These techniques can be applied to most patients who are candidates for breast-conserving surgery.
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Affiliation(s)
- Ahmad Kaviani
- Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran; Department of Surgical Oncology, University of Montreal, Montreal, Canada.
| | | | - Sanaz Zand
- Research Department, Kaviani Breast Disease Institute (KBDI), Tehran, Iran
| | - Farnaz Araghi
- Skin Research Center, Shahid Beheshti Medical University, Tehran, Iran
| | - Erica Patocskai
- Department of Surgical Oncology, University of Montreal, Montreal, Canada
| | - Mehdi Nouraie
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
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Potter S, Trickey A, Rattay T, O'Connell RL, Dave R, Baker E, Whisker L, Skillman J, Gardiner MD, Macmillan RD, Holcombe C. Therapeutic mammaplasty is a safe and effective alternative to mastectomy with or without immediate breast reconstruction. Br J Surg 2020; 107:832-844. [PMID: 32073654 DOI: 10.1002/bjs.11468] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 10/14/2019] [Accepted: 11/17/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Therapeutic mammaplasty (TM) may be an alternative to mastectomy, but few well designed studies have evaluated the success of this approach or compared the short-term outcomes of TM with mastectomy with or without immediate breast reconstruction (IBR). Data from the national iBRA-2 and TeaM studies were combined to compare the safety and short-term outcomes of TM and mastectomy with or without IBR. METHODS The subgroup of patients in the TeaM study who underwent TM to avoid mastectomy were identified, and data on demographics, complications, oncology and adjuvant treatment were compared with those of patients undergoing mastectomy with or without IBR in the iBRA-2 study. The primary outcome was the percentage of successful breast-conserving procedures in the TM group. Secondary outcomes included postoperative complications and time to adjuvant therapy. RESULTS A total of 2916 patients (TM 376; mastectomy 1532; mastectomy and IBR 1008) were included in the analysis. Patients undergoing TM were more likely to be obese and to have undergone bilateral surgery than those having IBR. However, patients undergoing mastectomy with or without IBR were more likely to experience complications than the TM group (TM: 79, 21·0 per cent; mastectomy: 570, 37·2 per cent; mastectomy and IBR: 359, 35·6 per cent; P < 0·001). Breast conservation was possible in 87·0 per cent of patients who had TM, and TM did not delay adjuvant treatment. CONCLUSION TM may allow high-risk patients who would not be candidates for IBR to avoid mastectomy safely. Further work is needed to explore the comparative patient-reported and cosmetic outcomes of the different approaches, and to establish long-term oncological safety.
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Affiliation(s)
- S Potter
- Population Health Sciences, Bristol Medical School, Bristol, UK.,Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
| | - A Trickey
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - T Rattay
- Cancer Research Centre, University of Leicester, Leicester Royal Infirmary, Leicester, UK
| | | | - R Dave
- Nightingale Breast Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - E Baker
- Department of Breast Surgery, Airedale General Hospital, Keighley, UK
| | - L Whisker
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J Skillman
- Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - M D Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK.,Department of Plastic Surgery, Frimley Health NHS Foundation Trust, Slough, UK
| | - R D Macmillan
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
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8
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Barellini L, Marcasciano M, Lo Torto F, Fausto A, Ribuffo D, Casella D. Intraoperative Ultrasound and Oncoplastic Combined Approach: An Additional Tool for the Oncoplastic Surgeon to Obtain Tumor-Free Margins in Breast Conservative Surgery-A 2-Year Single-Center Prospective Study. Clin Breast Cancer 2019; 20:e290-e294. [PMID: 32144083 DOI: 10.1016/j.clbc.2019.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/17/2019] [Accepted: 10/19/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND The main goal of oncoplastic breast-conserving surgery (OBCS) is to obtain tumor-free resection margins after cancer excision with satisfactory cosmetic results. Positive tumor margins are associated with high rates of tumor recurrence requiring reoperation. The aim of this prospective clinical trial was to demonstrate the reliability of intraoperative ultrasound (IOUS) to obtain tumor-free resection margins in OBCS. PATIENTS AND METHODS Between December 2016 and March 2018, data from 130 patients with by T1-2 breast cancer, either invasive or in situ, who underwent OBCS were prospectively collected. The oncoplastic surgeon performed IOUS in the operating theater to localize the lesion and mark its skin projection. Then specimens were examined to assess the presence of the lesion and margin adequacy. Definitive histologic reports were reviewed, with a focus on margin status. RESULTS All patients experienced oncoplastic approaches, and lesions were always found on the specimen at the histologic report. In 126 cases (97%), margins were considered adequate. In 17 cases (13%), IOUS showed positive margins, and resection was contextually enlarged. In 12 of these (9%), the pathologic report confirmed the need for enlarged resection. This study shows that IOUS-guided surgery can obtain a high percentage of tumor-free resection margins in OBCS without scheduling conflicts between radiology, nuclear, and surgery departments. Full cooperation between radiologists and oncoplastic surgeons is required to achieve high-standard oncologic and reconstructive outcomes. CONCLUSION IOUS represent an additional tool for the breast surgeon to improve margin-free management of neoplastic lesions, preventing reoperations in patients undergoing oncoplastic surgery.
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Affiliation(s)
- Leonardo Barellini
- Unità di Oncologia Chirurgica Ricostruttiva della Mammella, "Spedali Riuniti" di Livorno, Breast Unit Integrata di Livorno, Livorno, Italia
| | - Marco Marcasciano
- Unità di Oncologia Chirurgica Ricostruttiva della Mammella, "Spedali Riuniti" di Livorno, Breast Unit Integrata di Livorno, Livorno, Italia; Department of Surgery "P. Valdoni," Unit of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Rome, Italy.
| | - Federico Lo Torto
- Department of Surgery "P. Valdoni," Unit of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Alfonso Fausto
- Department of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Diego Ribuffo
- Department of Surgery "P. Valdoni," Unit of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Donato Casella
- Unità di Oncologia Chirurgica Ricostruttiva della Mammella, "Spedali Riuniti" di Livorno, Breast Unit Integrata di Livorno, Livorno, Italia; Department of Surgery "P. Valdoni," Unit of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Rome, Italy
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9
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Spillane A, Flitcroft K. Do we need higher-level evidence of improved quality of life outcomes before promoting uptake of oncoplastic breast conservation surgery techniques? ANZ J Surg 2019; 89:626-627. [PMID: 31179634 DOI: 10.1111/ans.15162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 02/27/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew Spillane
- Breast and Surgical Oncology at The Poche Centre, Sydney, New South Wales, Australia.,Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,The Mater Hospital, Sydney, New South Wales, Australia.,Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Kathy Flitcroft
- Breast and Surgical Oncology at The Poche Centre, Sydney, New South Wales, Australia.,Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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10
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Opportunities and priorities for breast surgical research. Lancet Oncol 2018; 19:e521-e533. [DOI: 10.1016/s1470-2045(18)30511-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/14/2018] [Accepted: 07/02/2018] [Indexed: 12/13/2022]
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11
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O'Connell RL, Baker E, Trickey A, Rattay T, Whisker L, Macmillan RD, Potter S. Current practice and short-term outcomes of therapeutic mammaplasty in the international TeaM multicentre prospective cohort study. Br J Surg 2018; 105:1778-1792. [PMID: 30132807 DOI: 10.1002/bjs.10959] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/12/2018] [Accepted: 06/21/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Therapeutic mammaplasty, which combines breast reduction and mastopexy techniques with tumour excision, may extend the boundaries of breast-conserving surgery and improve outcomes for patients, but current practice is unknown and high-quality outcome data are lacking. This prospective multicentre cohort study aimed to explore the practice and short-term outcomes of the technique. METHODS Consecutive patients undergoing therapeutic mammaplasty at participating centres between 1 September 2016 and 30 June 2017 were recruited to the study. Demographic, preoperative, operative, oncological and complication data were collected. The primary outcome was unplanned reoperation for complications within 30 days of surgery. Secondary outcomes included re-excision rates and time to adjuvant therapy. RESULTS Overall, 880 patients underwent 899 therapeutic mammaplasty procedures at 50 centres. The most common indications were avoidance of poor cosmetic outcomes associated with standard breast-conserving surgery (702 procedures, 78·1 per cent) or avoidance of mastectomy (379, 42·2 per cent). Wise-pattern skin incisions were the most common (429 of 899, 47·7 per cent), but a range of incisions and nipple-areola pedicles were used. Immediate contralateral symmetrization was performed in one-third of cases (284 of 880, 32·3 per cent). In total, 205 patients (23·3 per cent) developed a complication, but only 25 (2·8 per cent) required reoperation. Median postoperative lesion size was 24·5 (i.q.r. 16-38) mm. Incomplete excision was seen in 132 procedures (14·7 per cent), but completion mastectomy was required for only 51 lesions (5·7 per cent). Median time to adjuvant therapy was 54 (i.q.r. 42-66) days. CONCLUSION Therapeutic mammaplasty is a safe and effective alternative to mastectomy or standard breast-conserving surgery. Further work is required to explore the impact of the technique on quality of life, and to establish cost-effectiveness.
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Affiliation(s)
- R L O'Connell
- Department of Breast Surgery, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - E Baker
- Department of Breast Surgery, Airedale General Hospital, Keighley, UK
| | - A Trickey
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - T Rattay
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - L Whisker
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - R D Macmillan
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Potter
- Population Health Sciences, Bristol Medical School, Bristol, UK.,Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
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12
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Romics L, Macaskill EJ, Fernandez T, Simpson L, Morrow E, Pitsinis V, Tovey S, Barber M, Masannat Y, Stallard S, Weiler-Mithoff E, Malyon A, Mansell J, Campbell EJ, Doughty J, Dixon JM. A population-based audit of surgical practice and outcomes of oncoplastic breast conservations in Scotland – An analysis of 589 patients. Eur J Surg Oncol 2018; 44:939-944. [DOI: 10.1016/j.ejso.2018.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/21/2018] [Accepted: 04/05/2018] [Indexed: 01/15/2023] Open
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Banks J, Ives C, Potter S, Holcombe C. The BRASS (BReast Angiosarcoma Surveillance Study): Protocol for a retrospective multicentre cohort study to evaluate the management and outcomes of angiosarcoma of the breast and chest wall. Int J Surg Protoc 2017; 5:5-10. [PMID: 31851741 PMCID: PMC6913564 DOI: 10.1016/j.isjp.2017.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/17/2017] [Accepted: 05/21/2017] [Indexed: 01/05/2023] Open
Abstract
•Multicentre retrospective study involving breast and plastic units across the UK.•Will produce valuable data regarding management and outcomes.•Will inform decision making and help shape a future definitive study.
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Affiliation(s)
- Jenny Banks
- Breast Unit, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK
- Breast Unit, Torbay and South Devon NHS Foundation Trust, Newton Road, Torquay Devon TQ2 7AA, UK
| | - Charlotte Ives
- Breast Unit, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter EX2 5DW, UK
- Breast Unit, Torbay and South Devon NHS Foundation Trust, Newton Road, Torquay Devon TQ2 7AA, UK
| | - Shelley Potter
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol BS8 2PS, UK
| | - Chris Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool L7 8XP, UK
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