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Fortenbery GW, Todd L, Nazir N, Dalla S, Collins M. Oncoplastic Breast Reconstruction in Morbidly Obese Patients: An Acceptable Practice. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5601. [PMID: 38348460 PMCID: PMC10861004 DOI: 10.1097/gox.0000000000005601] [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: 08/14/2023] [Accepted: 12/28/2023] [Indexed: 02/15/2024]
Abstract
Background Breast cancer is the most common noncutaneous malignancy amongst women. Lumpectomy with adjuvant radiation is a mainstay of surgical treatment. Oncoplastic breast reconstruction reduces the resultant breast deformity. Obesity is a risk factor for the development of complications after breast reconstruction. This study's purpose was to determine if oncoplastic breast reconstruction is a safe procedure in obese patients. Methods A single institution retrospective chart review was performed on women undergoing oncoplastic breast reduction from 2009 to 2021. Patients were then divided into groups based on body mass index (BMI). A statistical analysis was performed comparing rates of complications and time to adjuvant therapy. Results An estimated 340 patients were identified with an average age of 56.2 years (140 with BMI <30 kg/m2, 87 with BMI 30-34.9 kg/m2, 62 with BMI 35-39.9 kg/m2, and 51 with BMI >40 kg/m2). There was a significant difference between the BMI greater than 40 kg per m2 and BMI less than 30 kg per m2 group in the number of returns to the operating room (P = 0.0096), major complications (P = 0.0002), and minor complications (P = 0.0051). Average time to adjuvant treatment was 47 days and there was no statistically significant difference between the groups (P = 0.1691). Conclusions There was a significant difference in major and minor complications between the BMI groups; however, there was no delay in the time to adjuvant therapy. Therefore, we conclude that with appropriate counseling on surgical risks, oncoplastic breast reduction is an acceptable option for breast cancer patients after lumpectomy, regardless of BMI.
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Affiliation(s)
- Grey W. Fortenbery
- From the Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kans
| | - Lauren Todd
- University of Kansas School of Medicine, Kansas City, Kans
| | - Niaman Nazir
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kans
| | - Shreeya Dalla
- University of Kansas School of Medicine, Kansas City, Kans
| | - Meredith Collins
- From the Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kans
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Revisiting Reduction Mammaplasty: Complications of Oncoplastic and Symptomatic Macromastia Reductions. Plast Reconstr Surg 2023; 151:267-276. [PMID: 36696305 DOI: 10.1097/prs.0000000000009828] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Oncoplastic breast reduction has been shown to be an effective and safe approach to breast conservation surgery in women with macromastia. However, there remains a paucity of data investigating the comparative outcomes. This study seeks to delineate the complication profiles for oncoplastic and symmetrizing breast reductions versus mammaplasty for benign macromastia. METHODS A retrospective review was conducted of all consecutively performed reduction mammaplasty cases at a single institution by two plastic surgeons over a 2-year period. RESULTS A total of 632 breasts were analyzed: 502 reduction mammaplasties, 85 symmetrizing reductions, and 45 oncoplastic reductions in 342 patients. Mean age was 43.9 ± 15.93 years, mean body mass index was 29.15 ± 5.66 kg/m2, and mean reduction weight was 610.03 ± 313.13 g. Regarding surgical technique, a medial pedicle was used in 86% of cases. There were similar postoperative complication outcomes for nipple necrosis, wound healing, scar revision, fat necrosis, seroma, hematoma, and overall complication rates for all procedures. However, the rate of postoperative revision among reduction mammaplasty (2%), oncoplastic reduction (6.7%), and symmetrizing reduction (5.9%) was significantly different (P = 0.027). In univariate analysis, diabetes (P = 0.011), smoking (P = 0.007), higher body mass index (P = 0.003), larger reduction weight (P = 0.011), longer nipple-to-inframammary fold measurement (P = 0.014), and longer sternal notch-to-nipple measurement (P = 0.039) were all significant risk factors for a surgical complication in reductions performed for any indication. Using a multivariate logistic regression model, diabetes (P = 0.047), smoking (P = 0.025), and higher body mass index (P = 0.002) were all retained as statistically significant risk factors. CONCLUSION The complication profiles for both oncoplastic breast reductions and breast reductions for symptomatic macromastia are similar and acceptably low. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Abstract
OBJECTIVE The aim of this study was to evaluate the long-term oncologic outcome after oncoplastic surgery (OPS). BACKGROUND OPS combines wide tumor excision with reduction mammoplasty techniques thus extending breast conserving surgery to large tumors that might else be proposed a mastectomy. Little data are available about the oncologic results for breast conserving surgery of these larger tumors. METHODS From January 2004 until March 2016, a total of 350 oncoplastic breast reductions were prospectively entered into a database. Patients were included if their breast reshaping included a reduction mammoplasty with skin excision (Level 2 oncoplastic techniques). RESULTS Histologic subtypes were: invasive ductal carcinoma in 219 cases (62.6%), ductal carcinoma in situ (DCIS) in 88 cases (25.1%), and invasive lobular carcinoma in 43 (12.3%) cases. Seventy-three of the invasive cancers (27.9%) received neoadjuvant chemotherapy. The mean resection weight was 177 grams. The mean pathological tumor size was 26 mm (range 0-180 mm) and varied from 23 mm (4-180 mm) for invasive cancers to 32 mm (0-100 mm) for DCIS. Specimen margins were involved in 12.6% of the cases; 10.5% of invasive ductal, 14.7% of DCIS, and 20.9% of invasive lobular. The overall breast conservation rate was 92% and varied from 87.4% for DCIS to 93.5% for the invasive cancers. Thirty-one patients (8.9%) developed one or more postoperative complications, inducing a delay in postoperative treatments in 4.6% of patients. The median follow up was 55 months. The cumulative 5-year incidences for local, regional, and distant recurrences were 2.2%, 1.1%, and 12.4%, respectively. CONCLUSIONS Oncoplastic breast reductions allow wide resections with free margins and can be used for large cancers as an alternative to mastectomy.
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Lin JY, Bluebond-Langner R, Choi E, Cheston S, Nichols EM, Cohen RJ, Bentzen SM, Drogula C, Kesmodel S, Bellavance E, Rosenblatt P, Tkaczuk K, Slezak S, Feigenberg SJ. Effect of reduction mammoplasty on acute radiation side effects and use of lumpectomy cavity boosts. Pract Radiat Oncol 2017; 7:e299-e308. [DOI: 10.1016/j.prro.2017.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/02/2017] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
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Mansell J, Weiler-Mithoff E, Stallard S, Doughty JC, Mallon E, Romics L. Oncoplastic breast conservation surgery is oncologically safe when compared to wide local excision and mastectomy. Breast 2017; 32:179-185. [PMID: 28214785 DOI: 10.1016/j.breast.2017.02.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/30/2017] [Accepted: 02/08/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Support for the oncological safety of oncoplastic breast conservation surgery (OBCS) is mostly based on evidence comparing recurrence rates after OBCS to wide local excision (WLE). However, OBCS is often indicated for larger cancers and oncological results should also be compared to patients treated with mastectomy. In this study we compared recurrence and survival following OBCS, mastectomy and WLE. METHODS Patients treated with OBCS between 2009 and 2012 were identified from a prospectively maintained database. For comparison, consecutive patients treated with WLE or mastectomy with or without immediate reconstruction (Ms ± IR) over the same time period were identified. Histological variables of patients were compared using Fisher Exact or Chi squared tests, and recurrence and survival were compared using Kaplan-Meier and Cox regression survival analysis. RESULTS 980 patients' data were analysed (OBCS: n = 104; WLE: n = 558; Ms ± IR: n = 318). Tumour size, grade, nodal status, ER, and PR expression of patients treated with OBCS were all significantly more adverse compared with patients treated with WLE (p < 0.001). These histological variables were similar in patients treated with Ms ± IR and OBCS. 5-year local recurrence rates were similar in all three groups (WLE: 3.4 per cent, OBCS: 2 per cent, Ms ± IR: 2.6 per cent; log rank = 0.973), while distant recurrence rates were higher after Ms ± IR and OBCS (Ms ± IR:13.1 per cent, OBCS:7.5 per cent, WLE:3.3 per cent; log rank: p < 0.001). CONCLUSION OBCS is oncologically safe in patients even when histological results are similar to patients treated with Ms ± IR.
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Affiliation(s)
- J Mansell
- Department of Surgery, New Victoria Hospital Glasgow, UK
| | | | - S Stallard
- Department of Surgery, Gartnavel General Hospital Glasgow, UK
| | - J C Doughty
- Department of Surgery, Gartnavel General Hospital Glasgow, UK
| | - E Mallon
- Department of Pathology, Queen Elizabeth University Hospital, UK
| | - L Romics
- Department of Surgery, New Victoria Hospital Glasgow, UK; Department of Surgery, Gartnavel General Hospital Glasgow, UK.
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Emiroglu M, Salimoglu S, Karaali C, Sert I, Gungor O, Sert F, Aydın C. Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: Oncological long-term outcomes. Asian J Surg 2017; 40:41-47. [DOI: 10.1016/j.asjsur.2015.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 05/27/2015] [Accepted: 06/17/2015] [Indexed: 10/23/2022] Open
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De La Cruz L, Blankenship SA, Chatterjee A, Geha R, Nocera N, Czerniecki BJ, Tchou J, Fisher CS. Outcomes After Oncoplastic Breast-Conserving Surgery in Breast Cancer Patients: A Systematic Literature Review. Ann Surg Oncol 2016; 23:3247-58. [DOI: 10.1245/s10434-016-5313-1] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Indexed: 11/18/2022]
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Piper ML, Sbitany H. The Optimal Approach to Post-Mastectomy and Post-Lumpectomy Breast Reconstruction. CURRENT BREAST CANCER REPORTS 2016. [DOI: 10.1007/s12609-016-0210-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Yiannakopoulou E, Mathelin C. Oncoplastic breast conserving surgery and oncological outcome: Systematic review. Eur J Surg Oncol 2016; 42:625-30. [DOI: 10.1016/j.ejso.2016.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 01/02/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022] Open
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Piper ML, Esserman LJ, Sbitany H, Peled AW. Outcomes Following Oncoplastic Reduction Mammoplasty. Ann Plast Surg 2016; 76 Suppl 3:S222-6. [DOI: 10.1097/sap.0000000000000720] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: long term aesthetic, functional and satisfaction outcomes. Contemp Oncol (Pozn) 2016; 20:256-60. [PMID: 27647991 PMCID: PMC5013678 DOI: 10.5114/wo.2015.55272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 07/13/2015] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY Despite the increase in studies concerning oncoplastic reduction mammoplasty (ORM), data showing long-term aesthetic and patient satisfaction for ORM in patients with macromastia remain limited. Therefore, this study evaluated the long-term results of tumorectomy and concomitant bilateral ORM for early-stage breast cancer patients with macromastia in terms of cosmesis, patient satisfaction, and functional outcomes. MATERIAL AND METHODS Retrospective data of patients with macromastia undergoing ORM for breast cancer between 1996 and 2011 were examined and evaluated regarding the aesthetic results, patient satisfaction, and functional outcomes. RESULTS The median age of the 82 patients was 50 years. The median follow-up was 120 months (range: 28-212 months). The median breast volume was 1402 cm(3), and the median weight of the excised breast material was 679 g. A good or excellent evaluation of the cosmetic outcome was as follows: self-evaluation: 84.1% at the early-stage, 80.3% at the later stage; panel evaluation: 75.4% at the late-stage. Median patient satisfaction rates were 9.1% for early-stage disease and 8.8% for late-stage disease. Reduced mobility and intertrigo improved by three-fold during the post-operative period. CONCLUSIONS ORM for early-stage breast cancer in women with macromastia results in good cosmesis in both the early-stage and long-term, and is quite acceptable for use in patients. Patients reacted favorably to the prospect of having their breast cancer and macromastia treated in a single session, and positive results continued over the long-term.
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A Comparative Retrospective Analysis of Complications After Oncoplastic Breast Reduction and Breast Reduction for Benign Macromastia. Ann Plast Surg 2015; 75:370-5. [DOI: 10.1097/sap.0000000000000159] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Santos G, Urban C, Edelweiss MI, Zucca-Matthes G, de Oliveira VM, Arana GH, Iera M, Rietjens M, de Lima RS, Spautz C, Kuroda F, Anselmi K, Capp E. Long-Term Comparison of Aesthetical Outcomes After Oncoplastic Surgery and Lumpectomy in Breast Cancer Patients. Ann Surg Oncol 2015; 22:2500-2508. [DOI: 10.1245/s10434-014-4301-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Piper M, Peled AW, Sbitany H. Oncoplastic breast surgery: current strategies. Gland Surg 2015; 4:154-63. [PMID: 26005647 DOI: 10.3978/j.issn.2227-684x.2015.03.01] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/04/2015] [Indexed: 11/14/2022]
Abstract
The surgical management of breast cancer has dramatically evolved over the past 20 years, with oncoplastic surgery gaining increased popularity. This field of breast surgery allows for complete resection of tumor, preservation of normal parenchyma tissue, and the use of local or regional tissue for immediate breast reconstruction at the time of partial mastectomy. These techniques extend the options for breast conservation surgery, improve aesthetic outcomes, have high patient satisfaction and result in better control of tumor margins. This article will detail the approach to evaluating and treating patients undergoing oncoplastic reconstruction. Different oncoplastic approaches will be described and applied to an oncoplastic reconstructive algorithm. Surgical complications, oncologic outcomes and aesthetic outcomes are reviewed.
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Affiliation(s)
- Merisa Piper
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California, San Francisco, CA, USA
| | - Anne Warren Peled
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California, San Francisco, CA, USA
| | - Hani Sbitany
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of California, San Francisco, CA, USA
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Emiroğlu M, Sert İ, İnal A. The Role of Oncoplastic Breast Surgery in Breast Cancer Treatment. THE JOURNAL OF BREAST HEALTH 2015; 11:1-9. [PMID: 28331682 PMCID: PMC5351526 DOI: 10.5152/tjbh.2014.2215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 07/01/2014] [Indexed: 11/22/2022]
Abstract
The aim of this study is to discuss indications, advantages, disadvantages, oncologic and aesthetic results of Oncoplastic Surgery (OBS). Pubmed and Medline database were searched for articles published between 1998 and 2014 for keywords: oncoplastic breast surgery, therapeutic mammoplasty, oncoplastic breast reduction, synchrenous reconstructions. Role of OBS in breast cancer surgery, its aspects to be considered, its value and results have been interpreted. This technique has advantages by providing more extensive tumourectomy, yielding better aesthetic results compared with breast conserving surgery, allowing oncoplastic reduction in breast cancer patients with macromastia, with higher patient satisfaction and quality of life and by being inexpensive due to single session practice. As for its disadvantages are: re-excision is more difficult, risk for mastectomy is higher, it is depent on the Surgeron's experience, it has a risk for delay in adjuvant therapies and its requirement for additional imaging studies during management. Main indications are patients with small tumour/breast volume, macromastia, multifocality, procedures which can disrupt breast cosmesis such as surgeries for upper inner breas tquadrient tumours. Contraindications are positive margin problems after wide excision, diffuse malign microcalsifications, inflammatory breast cancer, history of radiotherapy and patients' preferences. Despite low evidence level, Oncoplastic Breast Surgery seems to be both reliable and acceptable in terms of oncologic and aesthetic aspects. Oncoplastic Breast Surgery increase the application rate of breast conserving surgery by obviating practical limitations and improve the results of breast conserving surgery. Correct patient and technique choice in OBS is vital for optimization of post surgical.
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Affiliation(s)
- Mustafa Emiroğlu
- Clinic of General Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
| | - İsmail Sert
- Clinic of General Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Abdullah İnal
- Clinic of General Surgery, Bursa Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
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Abstract
UNLABELLED When immediate reconstruction is applied to breast conservation therapy (BCT), the benefits extend well beyond the minimization of poor cosmetic results. The purpose of this analysis was to compare literature outcomes between BCT alone and BCT with the oncoplastic approach. METHODS A meta-analysis was performed in PubMed using key words "oncoplastic," "partial breast reconstruction," and "breast conservation therapy." Case reports, series with less than 10 patients, and those with less than 1-year follow-up were excluded from the analysis. The 3 comparative groups included BCT with oncoplastic reduction techniques (Group A), BCT with oncoplastic flap techniques (Group B), and BCT alone (Group C). RESULTS Comparisons were made on 3165 patients in the BCT with oncoplastic group (Groups A and B, 41 papers) and 5494 patients in the BCT alone group (Group C, 20 papers). Demographics were similar, and tumor size was larger in the oncoplastic group (2.7 vs 1.2 cm). The weight of the lumpectomy specimen was 4 times larger in the oncoplastic group. The positive margin rate was significantly lower in the oncoplastic group (12% vs 21%, P < 0.0001). Reexcision was more common in the BCT alone group (14.6% vs 4%, P < 0.0001), however, completion mastectomy was more common in the oncoplastic group (6.5% vs 3.79%, P < 0.0001). The average follow-up was longer in the BCT alone group (64 vs 37 months). Local recurrence was 4% in the oncoplastic group and 7% in the BCT alone group. Satisfaction with the aesthetic outcome was significantly higher in the oncoplastic group (89.5% vs 82.9%, P < 0.001). CONCLUSIONS The oncoplastic approach to BCT allows a generous resection with subsequent reduction in positive margins. The true value on local recurrence remains to be determined. Patients are more satisfied with outcomes when the oncoplastic approach is used.
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Barnea Y, Inbal A, Barsuk D, Menes T, Zaretski A, Leshem D, Weiss J, Schneebaum S, Gur E. Oncoplastic reduction using the vertical scar superior-medial pedicle pattern technique for immediate partial breast reconstruction. Can J Surg 2014; 57:E134-40. [PMID: 25078939 DOI: 10.1503/cjs.031213] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Oncoplastic breast reduction in women with medium to large breasts has reportedly benefitted them both oncologically and cosmetically. We present our experience with an oncoplastic breast reduction technique using a vertical scar superior-medial pedicle pattern for immediate partial breast reconstruction. METHODS All patients with breast tumours who underwent vertical scar superior-medial pedicle reduction pattern oncoplastic surgery at our centre between September 2006 and June 2010 were retrospectively studied. Follow-up continued from 12 months to 6 years. RESULTS Twenty women (age 28-72 yr) were enrolled: 16 with invasive carcinoma and 4 with benign tumours. They all had tumour-free surgical margins, and no further oncological operations were required. The patients expressed a high degree of satisfaction from the surgical outcome in terms of improved quality of life and a good cosmetic result. CONCLUSION The vertical scar superior-medial pedicle reduction pattern is a versatile oncoplastic technique that allows breast tissue rearrangement for various tumour locations. It is oncologically beneficial and is associated with high patient satisfaction.
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Affiliation(s)
- Yoav Barnea
- The Department of Plastic and Reconstructive Surgery, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Amir Inbal
- The Department of Plastic and Reconstructive Surgery, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israell
| | - Daphna Barsuk
- The Breast Health Center, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tehila Menes
- The Breast Health Center, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arik Zaretski
- The Department of Plastic and Reconstructive Surgery, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - David Leshem
- The Department of Plastic and Reconstructive Surgery, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Jerry Weiss
- The Department of Plastic and Reconstructive Surgery, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Schlomo Schneebaum
- The Breast Health Center, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Gur
- The Department of Plastic and Reconstructive Surgery, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
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[An original oncoplastic reduction mammaplasty technique for breast cancers with high risk of incomplete excision]. ACTA ACUST UNITED AC 2014; 42:160-7. [PMID: 24582294 DOI: 10.1016/j.gyobfe.2014.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 12/30/2013] [Indexed: 11/22/2022]
Abstract
Oncoplastic reduction mammaplasty (ORM), like breast-conserving treatments for cancer, has a risk of incomplete excision, and sometimes requires complementary mastectomy. In that case difficulties may occur due to skin shortness induced by recent surgery. Review of bibliography brings evidence that some factors are predictive of incomplete excision. When a patient has one or more of these factors, surgeon should anticipate complementary mastectomy. Horizontal ORM should be reminded for they allow secondary mastectomy in a horizontal way to be performed. An adaptation of the inverted T pattern is proposed, also permitting mastectomy in a horizontal way. These solutions allow neither to alter skin healing nor to compromise the future breast reconstruction.
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Therapeutic mammaplasty – Impact on the delivery of chemotherapy. Int J Surg 2014; 12:51-5. [DOI: 10.1016/j.ijsu.2013.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/22/2013] [Accepted: 10/25/2013] [Indexed: 11/20/2022]
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Quality of information reporting in studies of standard and oncoplastic breast-conserving surgery. Breast 2013; 23:104-11. [PMID: 24388734 DOI: 10.1016/j.breast.2013.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 11/30/2013] [Accepted: 12/07/2013] [Indexed: 11/20/2022] Open
Abstract
The aim of this systematic review was to establish the completeness of reporting of key patient, tumour, treatment, and outcomes information in the randomized-controlled trials (RCTs) of standard breast-conserving surgery (sBCS) considered to be the 'gold-standard', and to compare this with the reporting of the same key criteria for all published studies of oncoplastic breast-conserving surgery (oBCS). Pubmed (1966 to 1st April 2013), Ovid MEDLINE (1966 to 1st April 2013), EMBASE (1980 to 1st April 2013), and the Cochrane Database of Systematic Reviews (Issue 4, 2013) were searched separately for the following terms: (i) 'oncoplastic AND breast AND surgery'; and (ii) 'therapeutic AND mammaplasty'. Only English language and full text articles were reviewed. Following a pilot evaluation of all studies, key reporting criteria were identified. 16 RCTs of sBCS (n = 11,767 patients) were included, and 53 studies met the inclusion criteria for oncoplastic BCS (n = 3236 patients), none of which were RCTs. No study reported all of the criteria identified, with a mean of 64% of key criteria (range, 55-75%) reported in studies of sBCS, and 54% of criteria (range, 10-85%) reported in studies of oBCS. It is therefore evident that there is much room for improvement in the quality of reporting is BCS studies. Standards are proposed to give future studies of BCS a framework for reporting key information and outcomes.
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Hicks G, Turton P, Rajan S, Nunn A, Sharma N, Achuthan R. The role of magnetic resonance imaging in preoperative planning for patients undergoing therapeutic mammoplasty. ISRN ONCOLOGY 2013; 2013:260260. [PMID: 24455305 PMCID: PMC3877648 DOI: 10.1155/2013/260260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 11/12/2013] [Indexed: 11/17/2022]
Abstract
Background. Assessment of the ratio between tumour volume and breast volume in therapeutic mammoplasty is paramount. Traditionally based on clinical assessment and conventional breast imaging, the role of breast magnetic resonance imaging (MRI) in this context has not been established. Methods. Data was collected from all women undergoing therapeutic mammoplasty (TM) between 2006 and 2011. Each case was discussed at an MDT where MRI was considered to facilitate surgical planning. The contribution of MRI to disease assessment and surgical outcome was then reviewed. Results. 35 women underwent TM, 15 of whom had additional MRI. 33% of patients within the MRI subgroup had abnormalities not seen on either mammography or USS. Of those undergoing MRI, 1/15 patients required completion mastectomy versus 3 patients requiring completion mastectomy and 1 patient requiring further wide local excision (4/20) in the conventional imaging group. No statistical difference was seen between size on MRI and size on mammography versus final histological size, but a general trend for greater correlation between size on MRI and final histological size was seen. Conclusion. MRI should be considered in selected patients undergoing therapeutic mammoplasty. Careful planning can identify those who are most likely to benefit from MRI, potentially reducing the need for further surgery.
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Affiliation(s)
- Gareth Hicks
- Breast Unit, St. James' University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Philip Turton
- Breast Unit, St. James' University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Sree Rajan
- Breast Unit, St. James' University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - April Nunn
- Breast Unit, St. James' University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Nisha Sharma
- Breast Unit, St. James' University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Raj Achuthan
- Breast Unit, St. James' University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
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From radical mastectomy to breast-conserving therapy and oncoplastic breast surgery: a narrative review comparing oncological result, cosmetic outcome, quality of life, and health economy. ISRN ONCOLOGY 2013; 2013:742462. [PMID: 24167743 PMCID: PMC3791839 DOI: 10.1155/2013/742462] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 07/30/2013] [Indexed: 11/22/2022]
Abstract
Surgical management of breast cancer has evolved considerably over the last two decades. There has been a major shift toward less-invasive local treatments, from radical mastectomy to breast-conserving therapy (BCT) and oncoplastic breast surgery (OBS). In order to investigate the efficacy of each of the three abovementioned methods, a literature review was conducted for measurable outcomes including local recurrence, survival, cosmetic outcome, quality of life (QOL), and health economy. From the point of view of oncological result, there is no difference between mastectomy and BCT in local recurrence rate and survival. Long-term results for OBS are not available. The items assessed in the QOL sound a better score for OBS in comparison with mastectomy or BCT. OBS is also associated with a better cosmetic outcome. Although having low income seems to be associated with lower BCT and OBS utilization, prognosis of breast cancer is worse in these women as well. Thus, health economy is the matter that should be studied seriously. OBS is an innovative, progressive, and complicated subspeciality that lacks published randomized clinical trials comparing surgical techniques and objective measures of outcome, especially from oncologic and health economy points of view.
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Schaverien MV, Stallard S, Dodwell D, Doughty JC. Use of boost radiotherapy in oncoplastic breast-conserving surgery - a systematic review. Eur J Surg Oncol 2013; 39:1179-85. [PMID: 23988230 DOI: 10.1016/j.ejso.2013.07.240] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 07/10/2013] [Accepted: 07/29/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND The use of local boost radiotherapy to the tumour bed has been demonstrated in randomised-controlled trials to reduce local recurrence rates following breast-conserving surgery (BCS) and is the standard of care. Oncoplastic BCS techniques with parenchymal rearrangement present new challenges to the localisation of the tumour bed and therefore delivery of local boost radiotherapy. The aim of this review was to evaluate the reporting of boost radiotherapy in the oncoplastic BCS literature. METHODS Pubmed, Ovid MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched for studies reporting oncoplastic BCS using volume displacement techniques. RESULTS 24 studies met the inclusion criteria (n = 1933 patients). Use of boost radiotherapy was reported in 11 studies, in 2 of which it was for the treatment of incomplete or close margins, and marking of the tumour bed was only reported in 8 studies. None of the studies reported the number of patients where the tumour bed could not be localised. CONCLUSIONS The use of local boost radiotherapy and tumour bed marking was not reported in the majority of studies of oncoplastic BCS. Future studies need to provide detailed information regarding the use of boost radiotherapy and difficulties determining the target volume so that current radiotherapy approaches can be reviewed and improved for these advanced techniques.
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Affiliation(s)
- M V Schaverien
- Department of Surgery, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, Scotland, UK; Canniesburn Plastic Surgery Unit Jubilee Building, Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK.
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Comparing reduction mammaplasty specimens between superior and central pedicle techniques: a retrospective study. Eur J Cancer Prev 2012; 22:348-51. [PMID: 23222410 DOI: 10.1097/cej.0b013e32835b382e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED The aim of this study was to evaluate the histologic diagnoses of the reduction mammaplasty specimens in two retrospective series of patients operated using superior and central pedicle mammaplasties. Between November 2000 and December 2011, 60 consecutive patients (120 breasts) underwent breast reduction using the superior pedicle technique with a vertical scar (Lejour's technique). These patients were compared with another series of 80 patients (150 breasts) who underwent breast reduction using a vertical scar mammaplasty with a central pedicle (Copcu's technique). The characteristics of the patients were statistically similar between the two groups. Therefore, 140 patients who had undergone reduction mammaplasty were analyzed with respect to their histologic diagnoses, age, and specimen's weight. In the superior pedicle technique, we found that 30% of these women had pathologic alterations in at least one of their breasts, whereas the pathologic changes in patients who underwent Copcu's technique were 35%. In terms of tumor diagnosis, the upper quadrant excision technique (e.g. Copcu's method) may be safer. If there is no other special condition, it is better to use the pedicle technique in which the upper lateral and upper medial pole is removed. LEVEL OF EVIDENCE Level I, therapeutic study.
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25
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Optimizing surgical margins in breast conservation. Int J Surg Oncol 2012; 2012:585670. [PMID: 23304479 PMCID: PMC3523540 DOI: 10.1155/2012/585670] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 10/31/2012] [Indexed: 11/18/2022] Open
Abstract
Adequate surgical margins in breast-conserving surgery for breast cancer have traditionally been viewed as a predictor of local recurrence rates. There is still no consensus on what constitutes an adequate surgical margin, however it is clear that there is a trade-off between widely clear margins and acceptable cosmesis. Preoperative approaches to plan extent of resection with appropriate margins (in the setting of surgery first as well as after neoadjuvant chemotherapy,) include mammography, US, and MRI. Improvements have been made in preoperative lesion localization strategies for surgery, as well as intraoperative specimen assessment, in order to ensure complete removal of imaging findings and facilitate margin clearance. Intraoperative strategies to accurately assess tumor and cavity margins include cavity shave techniques, as well as novel technologies for margin probes. Ablative techniques, including radiofrequency ablation as well as intraoperative radiation, may be used to extend tumor-free margins without resecting additional tissue. Oncoplastic techniques allow for wider resections while maintaining cosmesis and have acceptable local recurrence rates, however often involve surgery on the contralateral breast. As systemic therapy for breast cancer continues to improve, it is unclear what the importance of surgical margins on local control rates will be in the future.
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Kim J, Yoo J, Lee J, Chang E, Suh K. Oncoplastic reconstruction with superior based lateral breast rotation flap after lower quadrant tumor resection. J Breast Cancer 2012; 15:350-5. [PMID: 23091549 PMCID: PMC3468790 DOI: 10.4048/jbc.2012.15.3.350] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 05/16/2012] [Indexed: 11/30/2022] Open
Abstract
Purpose Poor cosmetic outcome have been reported as a result of breast cancer operation due to lower quadrant breast tumors; this is particularly true for women with small, firm breasts. Herein, we report here on the use of superior based lateral breast rotation flap reconstruction to improve cosmetic outcome in patients with lower quadrant breast cancer. Methods We enrolled 33 patients with invasive breast cancer located in the lower quadrant of the breast, which were located more than 2 cm apart from the nipple. After completing a quadrantectomy, a single S-shaped or reverse S-shaped incision was made from axilla to tumor site. Two triangular skin islands, one on the axilla and one overlying the tumor were marked for excision. Once the fibroglandular tissues and the additional fatty tissue of the lateral chest wall were appropriately mobilized, the breast defect was closed at the mid-point of the parenchymal thickness in order to keep the natural position of the infra mammary fold. Results Median tumor size was 2.3 cm (range, 0.7-3.5 cm) and median resected volume was 35.5 g (range, 27.0-51.0 g). With a mean follow-up of 24.5 months (range, 9.0-33.5 months), cosmetic outcomes were good (94.0%) to fair (6.0%) at 6 months after the procedure, and there was no local or systemic recurrence during the short term follow-up period. Conclusion Clearly, this type of rotation flap reconstruction is an oncologically safe and a cosmetically sound procedure. Hopefully this rotation flap reconstruction technique will become more widely available and perhaps a standard procedure for lower quadrant breast tumors, especially for cosmetic treatment of small to medium-sized breasts.
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Affiliation(s)
- Jeryong Kim
- Department of Surgery, Research Institute for Medical Science, Chungnam National University College of Medicine, Daejeon, Korea
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27
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Evaluating the Feasibility of Extended Partial Mastectomy and Immediate Reduction Mammoplasty Reconstruction as an Alternative to Mastectomy. Ann Surg 2012; 255:1151-7. [DOI: 10.1097/sla.0b013e31824f9769] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McIntosh J, O'Donoghue J. Therapeutic mammaplasty – A systematic review of the evidence. Eur J Surg Oncol 2012; 38:196-202. [DOI: 10.1016/j.ejso.2011.12.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 11/15/2011] [Accepted: 12/12/2011] [Indexed: 10/14/2022] Open
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The role of oncoplastic therapeutic mammoplasty in breast cancer surgery--a review. Surg Oncol 2011; 21:133-41. [PMID: 21411311 DOI: 10.1016/j.suronc.2011.01.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 09/22/2010] [Accepted: 01/17/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Reduction mammoplasty is an established technique for symptom relief in women with breast hypertrophy. Therapeutic mammoplasty and radiotherapy may allow cancers to be surgically treated whilst maintaining oncological safety and improving cosmetic outcome. This article aims to review the evidence upon which therapeutic mammoplasty is based and to outline an approach for surgical planning and selection. METHODS A systematic PubMed and Medline literature search was carried out. All abstracts were studied and papers that dealt primarily with breast conservation using plastic surgery techniques were reviewed. RESULTS AND CONCLUSION Therapeutic mammoplasty is a useful procedure for breast conserving cancer surgery in women with large breasts, conferring a good cosmetic and functional outcome. This article proposes that breast surgeons experienced in oncological surgery can safely resect tumours from all aspects of the breast with a minimal number of variations in standard mammoplasty technique.
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30
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Parmar V, Hawaldar R, Badwe RA. Safety of partial breast reconstruction in extended indications for conservative surgery in breast cancer. Indian J Surg Oncol 2011; 1:256-62. [PMID: 22693374 DOI: 10.1007/s13193-011-0052-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 04/05/2010] [Indexed: 11/24/2022] Open
Abstract
Breast conservation surgery after large volume excisions for women with relatively larger or multicentric operable breast cancer (OBC) and in some locally advanced breast cancers (LABC) post neo-adjuvant chemotherapy (NACT), is known to be a feasible option using a latissimus dorsi flap. However, the oncological safety of such a procedure is not well reported in literature. Two hundred and twenty one women with breast cancer (148-OBC, 73-LABC) underwent BCT plus LD during March 1998 to August 2009. One hundred and forty six women (72-LABC, 66-OBC) received prior NACT for downstaging, followed by completion of adjuvant therapy in all, including postoperative radiotherapy and hormone therapy where indicated. Women aged 20-62 years, with tumors 1.5-15 cm (median 5.0 cm), underwent volume replacement surgery with LD flap. All positive cut margins (total-4.9%, gross positive-1.3%) were re-excised to ensure negative margins. The mean surgical time for excision of primary with axillary clearance followed by volume replacement by LD was 5 h and mean hospital stay 6 days. Donor site morbidity was seen in 11 patients and 3 had minor recipient site infection. At a median follow up of 36 months, ten of 221 patients (4.5%) had failed locally (7-OBC, 3-LABC). The determinants of local recurrence were presence of lymphatic vascular invasion (p = 0.016) and axillary metastasis (p = 0.003). BCT plus LD flap is an oncologically safe, technically quick procedure with minimal morbidity, and should be offered to all eligible women as an extended breast conservation procedure.
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Hernanz F, Regaño S, Vega A, Gómez Fleitas M. Reduction mammaplasty: an advantageous option for breast conserving surgery in large-breasted patients. Surg Oncol 2009; 19:e95-e102. [PMID: 19716288 DOI: 10.1016/j.suronc.2009.08.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Revised: 04/19/2009] [Accepted: 08/03/2009] [Indexed: 12/25/2022]
Abstract
Oncoplastic breast conserving surgery is a good approach for large-breasted women with breast cancer, as it increases the rate of breast conserving surgery, improves cosmetic results and prevents both cosmetic sequelae and the symptoms associated with macromastia. We reviewed ten publications in which 276 patients had been treated with bilateral reduction mammaplasty. All showed the same conclusion: women with breast cancer and macromastia candidates for breast conserving surgery could obtain clear oncological and cosmetic advantages and an improvement in quality of life if they were treated using bilateral reduction onco-therapeutic mammaplasty.
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Affiliation(s)
- Fernando Hernanz
- Department of Surgery, University of Cantabria, Santander, Spain.
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32
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Hernanz De La Fuente F, Gómez Fleitas M, Martínez García F. [Reduction mammaplasty in breast cancer surgery]. Cir Esp 2009; 85:140-6. [PMID: 19264296 DOI: 10.1016/j.ciresp.2008.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 07/08/2008] [Indexed: 11/26/2022]
Abstract
Reduction mammaplasty techniques enable the breast cancer surgeon to provide an integral surgical treatment, thus significantly increasing and improving surgical options. These techniques are used to correct problems after the conservative treatment of type 1 breast cancer and to achieve symmetry between the breasts after mastectomy. They are also the basis of cosmetic reconstruction techniques in conservative oncoplastic surgery.
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Munhoz AM, Montag E, Arruda E, Aldrighi CM, Filassi JR, Piato JR, Prado LC, Aldrighi JM, Gemperli R, Ferreira MC. Immediate reconstruction following breast-conserving surgery: management of the positive surgical margins and influence on secondary reconstruction. Breast 2008; 18:47-54. [PMID: 19110425 DOI: 10.1016/j.breast.2008.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2008] [Revised: 09/17/2008] [Accepted: 10/21/2008] [Indexed: 10/21/2022] Open
Abstract
The efficacy of breast-conserving surgery for the local control of early breast cancer has been repeatedly evidenced. Although immediate reconstruction following breast-conserving surgery has been described, little information is available regarding surgical management in reoperative settings due to positive margins. We studied the influence of intraoperatively assessed and postoperatively controlled surgical margin status on the type of breast-conserving surgery and report our results regarding complications in a reoperative breast reconstruction scenario. All patients were seen by a multidisciplinary team who recommended breast-conserving surgery. According to the breast volume, ptosis and tumor size/location, the patients were also evaluated by a plastic surgeon, who recommended reconstruction with the appropriate technique. Intraoperative assessment of surgical margins was determined by histological examination of frozen sections. The mean follow-up time was 48 months. Two hundred and eighteen patients (88.5%) underwent breast-conserving surgery and immediate reconstruction. Twelve (5.5%) patients had a positive tumor margin after review of the permanent section. All patients underwent re-exploration. In 1.3%, a second reconstructive technique was indicated and in 2.2% a skin-sparing mastectomy with total reconstruction was performed. Our findings support the important role of the intraoperative assessment of surgical margins and its interference in the selection of reconstruction techniques and negative margins; however, it will not guarantee complete excision of the tumor. Success depends on coordinated planning with the oncologic surgeon and careful intraoperative management.
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Assessment of immediate conservative breast surgery reconstruction: a classification system of defects revisited and an algorithm for selecting the appropriate technique. Plast Reconstr Surg 2008; 121:716-727. [PMID: 18317121 DOI: 10.1097/01.prs.0000299295.74100.fa] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Although various techniques have been used for breast conservation surgery reconstruction, there are few studies describing a logical approach to reconstruction of these defects. The objectives of this study were to establish a classification system for partial breast defects and to develop a reconstructive algorithm. METHODS The authors reviewed a 7-year experience with 209 immediate breast conservation surgery reconstructions. Mean follow-up was 31 months. Type I defects include tissue resection in smaller breasts (bra size A/B), including type IA, which involves minimal defects that do not cause distortion; type IB, which involves moderate defects that cause moderate distortion; and type IC, which involves large defects that cause significant deformities. Type II includes tissue resection in medium-sized breasts with or without ptosis (bra size C), and type III includes tissue resection in large breasts with ptosis (bra size D). RESULTS Eighteen percent of patients presented type I, where a lateral thoracodorsal flap and a latissimus dorsi flap were performed in 68 percent. Forty-five percent presented type II defects, where bilateral mastopexy was performed in 52 percent. Thirty-seven percent of patients presented type III distortion, where bilateral reduction mammaplasty was performed in 67 percent. Thirty-five percent of patients presented complications, and most were minor. CONCLUSIONS An algorithm based on breast size in relation to tumor location and extension of resection can be followed to determine the best approach to reconstruction. The authors' results have demonstrated that the complications were similar to those in other clinical series. Success depends on patient selection, coordinated planning with the oncologic surgeon, and careful intraoperative management.
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35
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Lee SJ, Bae YT, Seo HI, Kang TW. Immediate Breast Reconstruction with Contralateral Pectoralis Major Myomammary Flap for Breast Conserving Surgery. J Breast Cancer 2008. [DOI: 10.4048/jbc.2008.11.4.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Seung Ju Lee
- Department of Surgery, College of Medicine, Pusan National University, Busan, Korea
| | - Young Tae Bae
- Department of Surgery, College of Medicine, Pusan National University, Busan, Korea
| | - Hyong Il Seo
- Department of Surgery, College of Medicine, Pusan National University, Busan, Korea
| | - Tae Woo Kang
- Department of Surgery, Maryknoll General Hospital, Busan, Korea
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Rainsbury RM. Surgery Insight: oncoplastic breast-conserving reconstruction—indications, benefits, choices and outcomes. ACTA ACUST UNITED AC 2007; 4:657-64. [DOI: 10.1038/ncponc0957] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 06/14/2007] [Indexed: 11/09/2022]
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37
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Hernanz de la Fuente F, Gómez Fleitas M. Mamoplastia oncoterapéutica. Una opción adecuada en la paciente con cáncer de mama y gigantomastia. Cir Esp 2007; 82:46-9. [PMID: 17580033 DOI: 10.1016/s0009-739x(07)71662-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Bilateral reduction mammaplasty in women with breast cancer and macromastia allows appropriate oncological surgical treatment with functional and cosmetic benefits and facilitates postoperative radiation therapy. The surgical approach carried out in three patients with breast cancer and macromastia is discussed.
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Affiliation(s)
- Fernando Hernanz de la Fuente
- Unidad de Patología Mamaria, Servicio de Cirugía General II, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain.
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Munhoz AM, Montag E, Arruda E, Aldrighi C, Filassi JR, de Barros AC, Piato JR, Prado L, Petti D, Baracat E, Ferreira MC. Reliability of inferior dermoglandular pedicle reduction mammaplasty in reconstruction of partial mastectomy defects: surgical planning and outcome. Breast 2007; 16:577-89. [PMID: 17566738 DOI: 10.1016/j.breast.2007.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Revised: 02/25/2007] [Accepted: 04/25/2007] [Indexed: 10/23/2022] Open
Abstract
The objective of this study is to describe the surgical planning of the inferior dermoglandular pedicle (IDP) technique and its outcome following partial mastectomy reconstruction. A total of 26 patients with breast cancer underwent immediate IDP reconstruction. IDP was indicated to reconstruct superior/central breast defects. Postoperative complications were evaluated and information on esthetic result and satisfaction were collected. About 57.6 percent had tumors measuring 2cm or less (T1). Immediate complications occurred in 34.2 percent with skin necrosis in 11.4 and dehiscence in 7.6 percent. Late complications were observed in 11.4 percent. The cosmetic result was considered to be good or very good in 88.4 percent and the majority of patients were satisfied. All complications were treated by conservative approach. IDP is a reliable technique and should be given consideration in cases of superior/central quadrant reconstruction. The success of the procedure depends on patient selection and careful intra-operative management.
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Affiliation(s)
- Alexandre Mendonça Munhoz
- Division of Plastic Surgery and Breast Surgery Group, University of São Paulo School of Medicine, Rua da Consolação 3605 ap 91 ZIP 01416-001 Sao Paulo, SP, Brazil.
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Demirkan B, Alacacioglu A, Yilmaz U. Relation of Body Mass Index (BMI) to Disease Free (DFS) and Distant Disease Free Survivals (DDFS) Among Turkish Women with Operable Breast Carcinoma. Jpn J Clin Oncol 2007; 37:256-65. [PMID: 17553816 DOI: 10.1093/jjco/hym023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND The correlation between body mass index (BMI) and patient and tumor characteristics related to prognosis has not been well explored and may help to elucidate the mechanisms involved in the carcinogenesis. Because of the equivocal, inconsistent and uncertain research results as well as racial and ethnic differences, we aimed to evaluate the prognostic significance of high BMI in Turkish women with operable breast carcinoma. METHODS Two hundred and sixty-six patients who had operable invasive breast carcinoma diagnosed from 2000 through 2004 in a single institution were evaluated for their demographic features, BMI, histopathological/immunohistochemical examinations and treatments. Quetelet BMI [weight (kg)/height (m)2] categories were selected according to the World Health Organization definition. Disease free survival (DSF) as well as distant disease free survival (DDSF) analyses were performed to identify independent prognostic factors. RESULTS Post-menopausal patients were significantly in the higher quartile of BMI than pre-menopausal patients (P = 0.003). While post-menopausal obese patients had worse DSF and DDFS (P = 0.001), vascular invasion was the independent prognostic factor for both survival indices (P = 0.031). CONCLUSIONS Post-menopausal obese Turkish women are at increased risk of developing breast tumors with aggressive phenotype and obesity is a strong predictor of poor DSF and DDFS. Preventive strategies to reduce not only the prevalence of obesity and breast cancer but also the mortality must be recognized as the cost-effective public-health policy for Turkey.
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Affiliation(s)
- Binnaz Demirkan
- Dokuz Eylül University Institute of Oncology, Department of Clinical Oncology, Division of Medical Oncology, Izmir, Turkey.
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40
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Ricci MD, Munhoz AM, Pinotti M, Geribela AH, Teixeira LC, Aldrighi C, Ferreira MC, Filassi JR, Pinotti JA. The influence of reduction mammaplasty techniques in synchronous breast cancer diagnosis and metachronous breast cancer prevention. Ann Plast Surg 2007; 57:125-32; discussion 133. [PMID: 16861988 DOI: 10.1097/01.sap.0000216245.16475.b9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although reduction mammaplasty (RM) is a well-described technique for cosmetic objectives, there are few reports regarding its bilateral application combined with oncologic breast surgery in patients with breast cancer. The purpose of this study is to analyze the role of RM in the contralateral breast (CB) synchronous cancer (SBC) incidence, the impact in risk reduction for metachronous breast cancer (MBC), the disease-free period, and overall survival METHODS Patients were divided into 2 groups; group I: 114 pts submitted to oncologic surgery associated with immediate CB RM. Group II: 135 pts without CB RM. Mean time of follow-up was 51.5 months for both groups. Data regarding age, tumor size, histologic type and grade, clinical stage, and adjuvant therapy were collected RESULTS Except for the CB RM, no differences were observed between the groups. In group I, the diagnosis of an occult, synchronic, and invasive carcinoma was noted in 1.8%, in situ in 2.6%, and MBC in 1.8%. In group II, MBC was observed in 6.7%. No difference was observed between the 2 groups (P = 0.062). The initiation of adjuvant therapy, the disease-free period, and overall survival were not influenced by the CB RM. CONCLUSION CB RM is a reliable technique providing an opportunity for diagnosis of an occult SBC. There is evidence of reduction of MBC; however, a larger number of patients are necessary for significant conclusions. The technique should be considered in combination with immediate breast reconstruction. Success depends on patient selection and careful intraoperative management.
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Affiliation(s)
- Marcos Desidério Ricci
- Department of Gynecology and Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil
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Munhoz AM, Montag E, Arruda EG, Aldrighi C, Gemperli R, Aldrighi JM, Ferreira MC. Superior-medial dermoglandular pedicle reduction mammaplasty for immediate conservative breast surgery reconstruction: technical aspects and outcome. Ann Plast Surg 2007; 57:502-8. [PMID: 17060729 DOI: 10.1097/01.sap.0000233969.25031.cb] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Reduction mammaplasty procedures and especially the superior-medial dermoglandular pedicle (SMDP) technique are frequently used for esthetic objectives; however, few reports have been available regarding its application following conservative breast surgery reconstruction. The purpose of this study is to analyze the feasibility of the technique and describe the surgical planning and its outcome following oncologic surgery. METHODS Thirty-nine patients underwent immediate bilateral SMDP breast reconstructions. Mean time of follow-up was 20 months. SMDP was indicated to reconstruct inferior breast defects in patients with enough remaining breast tissue. Reconstructed (RB) and opposite (OB) breast complications were evaluated and information on esthetic result and patient satisfaction was collected. RESULTS Tumors (51.2%) measured 2 cm or less (T1) and 66.6% were located in the lower outer quadrants. Mean change in nipple position was 12.5 cm. Immediate RB complications occurred in 8 patients (20.5%), with skin necrosis in 3 (7.6%), infection in 2 (5.1%), dehiscence in 2 (5.1%), and partial areola necrosis in 1 (2.5%) patient. Late complications were observed in 7.6%. All late complications were observed after adjuvant radiotherapy. The cosmetic result was considered to be good or very good in 84.6%, and the majority of patients were either very satisfied or satisfied. All complications were treated by conservative approach. CONCLUSION SMDP is a reliable technique and should be given primary consideration in cases of lower quadrant reconstruction. The success of the procedure depends on patient selection, coordinated planning, and careful intraoperative management.
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Munhoz AM, Filassi JR, Aldrighi C, Ricci MD, Martella E, de Barros AC, Gemperli R, Ferreira MC. Bilateral reduction mammaplasty for immediate breast conservation surgery reconstruction and intraoperative radiotherapy: a preliminary report. Aesthetic Plast Surg 2007; 31:94-100. [PMID: 17205249 DOI: 10.1007/s00266-006-0200-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breast conservation surgery and postoperative radiotherapy are widely accepted as the treatment of choice for patients with early breast cancer. Despite its oncologic benefits, the radiotherapy may cause unpredictable outcomes in soft tissues, especially in patients undergoing breast reconstruction. Described recently, intraoperative irradiation (IORT) has been indicated for selected patients as an alternative to radiotherapy with fewer adverse local effects. Clinical use of reduction mammaplasty (RM) techniques in oncologic breast surgery has been described previously. However, no previous studies have mentioned its application after breast conservation surgery and IORT. METHODS The authors used RM to reconstruct a partial breast tissue defect secondary to breast conservation surgery followed by IORT treatment in a 46-year-old patient with an 11-mm invasive ductal carcinoma between the superior internal quadrants of the right breast. RESULTS Satisfactory breast volume and shape were achieved, and no immediate or late complications were observed. After 2 postoperative years, no evidence of fat necrosis, tumor recurrence, or tissue volume loss was observed. CONCLUSION The initial data indicate that RM in the setting of breast conservation surgery reconstruction and IORT is feasible. With appropriate patient selection, respecting indications and limitations, RM has its place among the various reconstructive techniques. Additional studies with larger clinical series and longer follow-up periods are necessary to analyze the precise IORT effects in patients submitted to immediate breast conservation surgery reconstruction.
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Affiliation(s)
- Alexandre Mendonça Munhoz
- Department of Plastic Surgery, University of São Paulo and Hospital Sírio-Libanês, São Paulo, Rua da Consolação 3605 ap 91, 01416-001, Sao Paulo, SP, Brazil.
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Koh SH, Seo HI, Bae YT. Immediate Conservative Breast Reconstruction Technique using Lateral Thoracodorsal Fasciocutaneous Flap. J Breast Cancer 2007. [DOI: 10.4048/jbc.2007.10.3.217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sang-Hwa Koh
- Department of Surgery, College of Medicine, Pusan National University, Busan, Korea
| | - Hyung-Il Seo
- Department of Surgery, College of Medicine, Pusan National University, Busan, Korea
| | - Young-Tae Bae
- Department of Surgery, College of Medicine, Pusan National University, Busan, Korea
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Abstract
The evidence that obesity adversely affects women's health is overwhelming and indisputable. The risk of postmenopausal breast cancer increases with obesity; measured as weight gain, body mass index, waist-hip ratio or percent body fat. It is also established that obesity is associated with poor prognosis of breast cancer. This review examines in detail the possible mechanisms by which obesity causes poor prognosis of breast cancer such as estrogenic activity, advanced or more aggressive disease at diagnosis and high likelihood of both local and systemic treatment failure. After careful consideration of the available evidence, the author concludes that obesity contributes towards development and poor prognosis of breast cancer; therefore, weight management should be an integral part of any strategy to prevent and improve the outcome of breast cancer.
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Affiliation(s)
- A R Carmichael
- Department of Surgery, Russells Hall Hospital, Dudley, UK.
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Schrenk P, Wölfl S, Bogner S, Huemer GM, Huemer G, Wayand W. Symmetrization reduction mammaplasty combined with sentinel node biopsy in patients operated for contralateral breast cancer. J Surg Oncol 2006; 94:9-15. [PMID: 16788937 DOI: 10.1002/jso.20542] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Occult invasive cancer found in reduction mammaplasty specimen in the contralateral breast in breast cancer patients requires axillary lymph node dissection (ALND) to assess the lymph node status. Routine Sentinel node (SN) biopsy in these patients may avoid secondary ALND when an occult cancer is found and the SN is negative in the permanent histological examination. METHODS One hundred sixty-nine breast cancer patients underwent contralateral reduction mammaplasty for symmetrization and with SN biopsy of the non-cancer breast. SN mapping was done using a vital blue dye alone (n = 136) or in combination with a radiocolloid (n = 33). RESULTS A mean number of 1.4 SNs (range 1-3 SNs) was identified in 158 of 169 patients (identification rate 93.5%). One of 158 patients revealed a positive SN but no tumor was found in the reduction mammaplasty/mastectomy specimen, whereas the SN was negative in 157 patients. Histological examination of the 169 reduction mammaplasty specimen revealed 5 occult invasive cancers and 4 patients with high grade DCIS but due to a negative SN biopsy the patients were spared a secondary ALND. CONCLUSION The small number of patients with occult contralateral cancers may not warrant routine SN mapping in patients scheduled for contralateral reduction mammaplasty.
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MESH Headings
- Adult
- Aged
- Axilla
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma in Situ/pathology
- Carcinoma in Situ/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/secondary
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Female
- Humans
- Lymph Node Excision
- Lymph Nodes/pathology
- Lymphatic Metastasis
- Mammaplasty/methods
- Middle Aged
- Sentinel Lymph Node Biopsy/economics
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Affiliation(s)
- Peter Schrenk
- Second Department of Surgery-Ludwig Boltzmann Institute for Surgical Endoscopy, AKH Linz, Linz, Austria.
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Munhoz AM, Montag E, Arruda EG, Aldrighi C, Gemperli R, Aldrighi JM, Ferreira MC. The role of the lateral thoracodorsal fasciocutaneous flap in immediate conservative breast surgery reconstruction. Plast Reconstr Surg 2006; 117:1699-710. [PMID: 16651939 DOI: 10.1097/01.prs.0000209943.13682.42] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although the lateral thoracodorsal fasciocutaneous flap is a well-studied procedure for late breast reconstruction following radical surgery, there are few previous reports regarding its indication, flap design, and clinical outcome following conservative breast surgery. METHODS Thirty-four patients underwent immediate unilateral lateral thoracodorsal fasciocutaneous flap breast reconstructions. Mean time of follow-up was 23 months. The lateral thoracodorsal fasciocutaneous flap was indicated to reconstruct moderate lateral breast defects where there was not enough breast tissue to perform the reconstruction. Flap and donor-site complications were evaluated. Information on aesthetic results and patient satisfaction was collected. RESULTS All tumors were located in lateral breast regions, and 64.7 percent measured 2 cm or less (T1). Flap complications occurred in four patients (11.8 percent), with partial flap necrosis in three (8.8 percent). Donor-site complications occurred in eight (23.5 percent), with seroma in five (14.7 percent) and wound dehiscence in three (8.8 percent). The cosmetic result was considered to be good or very good in 88.2 percent, and the majority of patients were either very satisfied or satisfied. Surgical intervention was necessary in two cases of wound dehiscence. Serial dorsal puncture in cases of seroma were performed with satisfactory results. CONCLUSIONS The lateral thoracodorsal fasciocutaneous flap is a simple and reliable technique for conservative breast surgery reconstruction. Success depends on patient selection, coordinated planning with the oncologic surgeon, and careful intraoperative management.
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Munhoz AM, Montag E, Arruda EG, Aldrighi C, Gemperli R, Aldrighi JM, Ferreira MC. Critical analysis of reduction mammaplasty techniques in combination with conservative breast surgery for early breast cancer treatment. Plast Reconstr Surg 2006; 117:1091-103; discussion 1104-7. [PMID: 16582770 DOI: 10.1097/01.prs.0000202121.84583.0d] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although reduction mammaplasty is a well-described technique for aesthetic purposes, there are few previous reports regarding its application and clinical outcome following conservative breast surgery reconstruction. The purpose of this study was to analyze the feasibility of the technique and its outcome following conservative breast surgery. METHODS Oncologic data and information on age, body mass index, smoking history, and comorbid conditions were collected. Reconstructed and opposite breast complications were evaluated. Reduction mammaplasty was indicated to reconstruct moderate breast defects in patients with enough remaining breast tissue. Mean follow-up was 22 months. RESULTS Seventy-four patients underwent immediate reduction mammaplasty following breast-conserving surgery. In 55.4 percent of patients, tumors measured 2 cm or less (T1) and in 47.2 percent they were located in the upper outer quadrants. Breast complications occurred in 13 patients (17.6 percent), with skin necrosis in six (8.1 percent), infection in two (2.7 percent), partial areola necrosis in two (2.7 percent), dehiscence in two, and total areola necrosis in one (1.35 percent). Late complications represented by skin lesions and fat necrosis were observed in five patients (6.8 percent). Obese patients and smokers had a significantly higher rate of reconstructed breast complications compared with the normal/overweight patients (p = 0.002) and nonsmokers (p = 0.043). No significant association between complications and age, hypertension, diabetes, axillary lymph node dissection, or chemotherapy was found. CONCLUSIONS Reduction mammaplasty is a consistent technique for reconstruction following breast-conserving surgery. Complications are more often observed in the reconstructed breast, and obese patients and smokers are higher risk patients.
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Thornton BP, Stewart DH, McGrath PC, Pu LLQ. Breast reduction as an alternative treatment option for early breast cancer in women with macromastia. Ann Plast Surg 2006; 56:26-30. [PMID: 16374091 DOI: 10.1097/01.sap.0000183791.51843.40] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Macromastia has been considered a relative contraindication to breast conservation therapy because of difficulties with postoperative radiation therapy and cosmesis. This study evaluates the feasibility of the inferior pedicle reduction mammaplasty as a component of breast conservation therapy for patients with early breast cancer. A retrospective review identified 6 patients with macromastia receiving oncologic treatment of breast cancer and simultaneous breast reduction. Mean age was 43.5 +/- 8.7 (mean +/- SD) years, and all breast cancers were stage I or II, averaging 2.3 +/- 1.5 cm in size. All patients underwent a Wise-pattern inferior pedicle breast reduction after cancer extirpation and received postoperative radiation as part of their treatment. They were evaluated for postoperative complications, esthetic outcome of the breasts, and local recurrence. Patients in this series were followed for an average of 30.3 months, with no significant postoperative complications and recurrences. Breast reduction incisions healed primarily and adjuvant radiation was completed without a delay. All patients were pleased with the esthetic result and had improvement of their symptoms related to macromastia. Thus, we believe that breast reduction is a reasonable and safe option for early breast cancer patients with macromastia who desire breast conservation therapy. Our combined oncologic and reconstructive approach may improve the outcome of this group of patients with early breast cancers.
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Affiliation(s)
- Brian P Thornton
- Division of Plastic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, KY 40536-0284, USA
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Giacalone PL, Roger P, Dubon O, El Gareh N, Daurés JP, Laffargue F. Traitement conservateur des cancers du sein : zonectomie vs oncoplastie. Étude prospective à propos de 99 patientes. ACTA ACUST UNITED AC 2006; 131:256-61. [PMID: 16530156 DOI: 10.1016/j.anchir.2005.12.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Accepted: 12/20/2005] [Indexed: 11/29/2022]
Abstract
UNLABELLED The integration of oncoplastic techniques with a concomitant contralateral symmetrization procedure is a novel surgical approach that allows wide excisions and prevents breast deformities. AIM OF THE STUDY This prospective study was undertaken to compare the accuracy of breast resection, between standard narrow lumpectomy and oncoplastic surgery. PATIENTS AND METHODS Ninety-nine consecutive women undergoing breast cancer resection were enrolled in a prospective study comparing oncoplastic surgery (42 women) and standard lumpectomy (57 women). The size of the glandular resection, the width of the nearest margins, the ratio of clear margins and the need for further surgery were recorded. RESULTS The oncoplastic approach resulted in significantly greater glandular resection and wider free histological margins than did standard lumpectomy. The need for re-exicsional surgery was significantly lower in the oncoplastic group than in the lumpectomy group. Furthermore, a trend towards fewer secondary mastectomies was seen for the oncoplastic approach versus standard lumpectomy. CONCLUSIONS The use of oncoplastic techniques and concomitant symmetrization of the contralateral breast allows extensive resections for conservative treatment of breast carcinoma achieves accurate tumour resection and reduces the need for further surgery.
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Affiliation(s)
- P-L Giacalone
- Service de Gynécologie-Obstétrique, Unité de Chirurgie Oncologique et Mammaire, Hôpital Arnaud-de-Villeneuve, Montpellier, France.
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