1
|
Coleman-Belin JC, Barnett J, Khavanin N, Nelson JA, Stern CS, Allen RJ. Imaging in Autologous Breast Reconstruction. Cancers (Basel) 2024; 16:2851. [PMID: 39199622 PMCID: PMC11352801 DOI: 10.3390/cancers16162851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 08/08/2024] [Accepted: 08/12/2024] [Indexed: 09/01/2024] Open
Abstract
The evolution of imaging actively shapes clinical management in the field. Ultrasonography (US), computed tomography angiography (CTA), and magnetic resonance angiography (MRA) stand out as the most extensively researched imaging modalities for ABR. Ongoing advancements include "real-time" angiography and three-dimensional (3D) surface imaging, and future prospects incorporate augmented or virtual reality (AR/VR) and artificial intelligence (AI). These technologies may further enhance perioperative efficiency, reduce donor-site morbidity, and improve surgical outcomes in ABR.
Collapse
Affiliation(s)
| | | | | | | | | | - Robert J. Allen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.C.C.-B.); (N.K.); (J.A.N.); (C.S.S.)
| |
Collapse
|
2
|
Tomita S, Yoshitake T, Matsunaga N, de Kerckhove M, Fujii M, Terao Y. Patient-reported outcomes and quality of life after breast-conserving surgery, mastectomy, and breast reconstruction assessed using the BREAST-Q questionnaire. Breast Cancer Res Treat 2024:10.1007/s10549-024-07396-6. [PMID: 38874689 DOI: 10.1007/s10549-024-07396-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE Breast-conserving surgery is the preferred treatment for breast cancer; however, its associated risk of local recurrence is higher than that of mastectomy. We performed a comparative analysis of four patient-reported outcomes, psychosocial well-being, sexual well-being, breast satisfaction, and physical well-being of the chest, and quality of life after three surgical approaches, breast-conserving therapy (BCT), mastectomy alone, and mastectomy with breast reconstruction, for breast cancer treatment. METHODS A cross-sectional survey using the BREAST-Q questionnaire and including patients who had undergone breast surgery at least 1 year prior to survey completion was performed. The analysis included 1035 patients (mean age, 55.0 ± 9.1 years) who underwent breast reconstruction, 116 patients (mean age, 63.6 ± 12.2 years) who underwent mastectomy, and 64 patients (mean age, 60.8 ± 12.2 years) who underwent BCT. RESULTS Patients who underwent reconstruction had significantly higher psychosocial well-being scores (62.8 ± 18.4) than those who underwent BCT (57.0 ± 23.6) and mastectomy (50.8 ± 16.8) (p < 0.01). However, significant differences in self-acceptance scores among all patients were not observed. Regarding sexual well-being and breast satisfaction, patients who underwent mastectomy had significantly lower scores (29.9 ± 18.7 and 41.8 ± 17.7, respectively) than those who underwent BCT (45.8 ± 26.6 and 58.3 ± 17.5, respectively) and reconstruction (46.4 ± 20.3 and 58.8 ± 15.4, respectively) (p < 0.01). Physical well-being of the chest scores were not significantly different among all patients (p = 0.14). Symptoms after mastectomy included chest muscle pain and arm movement impairment. Breast pain was a notable symptom after BCT. CONCLUSION The study findings provide valuable insights regarding patient-reported outcomes, highlight the potential benefits of breast reconstruction, and emphasize the importance of patients' preferences.
Collapse
Affiliation(s)
- Shoichi Tomita
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
| | - Takashi Yoshitake
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Noriko Matsunaga
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Maiko de Kerckhove
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Miwako Fujii
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Yasunobu Terao
- Department of Plastic and Reconstructive Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| |
Collapse
|
3
|
Schneider J, Lim ST, Yi An Y, Suh YJ. Eosinophilic Dermatoses: Cause of Non-Infectious Erythema after Volume Replacement with Diced Acellular Dermal Matrix in Breast Cancer? Life (Basel) 2024; 14:608. [PMID: 38792629 PMCID: PMC11122398 DOI: 10.3390/life14050608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/21/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Non-infectious erythema, or Red Breast Syndrome (RBS), has been observed on the skin where acellular dermal matrix was implanted, although the exact cause is yet to be determined. PATIENTS AND METHODS A total of 214 female patients underwent breast-conserving surgery (BCS) and volume replacement using diced acellular dermal matrix (dADM) for breast cancer between December 2017 and December 2018. After collecting and evaluating relevant clinical data, inflammation markers, along with NK cell status presented by IFN-γ secretion assay, were measured using ELISA. RESULTS Nineteen patients (8.88%) presented with RBS after BCS and dADM use. A significant increase of platelet-to-lymphocyte ratio was noted in the non-RBS group (p = 0.02). Compared to the RBS group (p = 0.042), the WBC level of the non-RBS group showed significant decrease over time. Eosinophil counts increased significantly at follow-up but went up higher in the RBS group. Multivariate analysis showed preoperative chemotherapy significantly increased the hazard of RBS (OR 3.274, p = 0.047 and OR 17.098, p < 0.001, respectively). DISCUSSION Though no causal relationship between RBS and immune status was proven, the results suggest an association between preoperative chemotherapy and RBS in addition to the possible role of eosinophilia in leading to eosinophilic dermatoses, which warrants further exploration and elucidation.
Collapse
Affiliation(s)
- Jean Schneider
- School of Medicine, Texas Tech University Health Science Center, Lubbock, TX 79430, USA;
| | - Seung Taek Lim
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, The Catholic University of Korea St. Vincent’s Hospital, Suwon 16247, Republic of Korea;
| | - Yeong Yi An
- Department of Radiology, The Catholic University of Korea St. Vincent’s Hospital, Suwon 16247, Republic of Korea;
| | - Young Jin Suh
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, The Catholic University of Korea St. Vincent’s Hospital, Suwon 16247, Republic of Korea;
| |
Collapse
|
4
|
De Lorenzi F, Borelli F, Alessandri-Bonetti M, Marchetti A, Dias LPN, Invento A, Rossi EMC, Loschi P, Veronesi P. A New Level II Oncoplastic Technique for Inferior Pole Defects: The Three-Petal Glandular Reconstruction (3-PR). Aesthetic Plast Surg 2024; 48:887-893. [PMID: 36261743 DOI: 10.1007/s00266-022-03119-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/11/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Oncoplastic surgery (OPS) allows wide excisions and accurate tumor resection and reduces breast deformities by immediate reconstruction of large defects. Superior pedicled mammaplasties allow excellent results in large breasts. Conversely, loco-regional flaps are the standard of care in small-to-medium breasts. However, both techniques show limitations in case of large resections of the lower pole, resulting in skin retraction and downward deviation of nipple and areola. We present a new technique for inferior pole reconstruction to overcome these limitations. It is called "the three-petal reconstruction" (3-PR). METHODS Between September 2016 and May 2019, ten patients with invasive breast cancer of the lower pole underwent breast conservation and 3-PR. RESULTS The 3-PR was uneventful in all patients. No major or minor complications were recorded. Patient and surgeon evaluations scored as good to excellent in all cases. Surveillance examinations in the follow-up did not reveal calcifications nor any findings of suspicion within the reconstructed area. CONCLUSIONS In case of very large defect of lower pole, the 3-PR reveals to be an easy, fast, reproducible method for inferior pole reconstruction. It can represent a niche between therapeutic mammaplasty and perforator flaps, and it could be added to existing available options for tailored reconstruction. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Francesca De Lorenzi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Francesco Borelli
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
| | - Mario Alessandri-Bonetti
- Department of Reconstructive and Aesthetic Plastic Surgery, University of Milan, I.R.C.C.S. Istituto Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
- University of Milan, Milan, Italy
| | - Alberto Marchetti
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Leonardo Pires Novais Dias
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Alessandra Invento
- Department of Breast Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | | | - Pietro Loschi
- Department of Plastic and Reconstructive Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Paolo Veronesi
- Department of Breast Surgery, European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
- University of Milan, Milan, Italy
| |
Collapse
|
5
|
Kilmer LH, Weidman AA, DeGeorge BR, Stranix JT, Campbell CA. Oncoplastic breast reduction surgery decreases rates of reoperation with no increased medical risk. J Plast Reconstr Aesthet Surg 2024; 88:273-280. [PMID: 38016264 DOI: 10.1016/j.bjps.2023.10.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/30/2023]
Abstract
The purpose of this study is to compare the oncologic, medical, and surgical outcomes of lumpectomy versus oncoplastic breast reduction surgery (OBRS) on a national scale. A national insurance-based database was queried for patients who had a lumpectomy with or without a same-day breast reduction by Current Procedural Terminology (CPT) codes. Patients were then matched by obesity, body mass index range, age, region, neoadjuvant chemotherapy, and outcomes were compared. There were 421,455 patients in the lumpectomy group and 15,909 patients in the OBRS group. After matching, 15,134 patients were identified in each group. Repeat lumpectomy or subsequent mastectomy was more common in the lumpectomy group (15.2% vs. 12.2%, p < 0.001). OBRS patients had higher rates of 90-day surgical complications including dehiscence, infection, fat necrosis, breast abscesses, and antibiotic prescription (p < 0.001). Meanwhile, any medical complication was less common in the OBRS group (3.7% vs. 4.5%, p = 0.001). Logistic regression revealed that OBRS was associated with decreased odds of repeat lumpectomy (OR = 0.71, 95% CI 0.66-0.77, p < 0.001) with no significant increased odds of subsequent mastectomy (OR = 1.01, 95% CI 0.91-1.11, p = 0.914). OBRS was found to be associated with decreased risk for reoperation in the form of lumpectomy without increased likelihood of subsequent mastectomy. Although OBRS was associated with increased wound complications, medical complications were found to occur less frequently. This study endorses increased consideration of OBRS when lumpectomy or OBRS is appropriate.
Collapse
Affiliation(s)
- Lee H Kilmer
- Department of Plastic Surgery , Maxillofacial & Oral Health, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
| | - Allan A Weidman
- School of Medicine, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
| | - Brent R DeGeorge
- Department of Plastic Surgery , Maxillofacial & Oral Health, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
| | - John T Stranix
- Department of Plastic Surgery , Maxillofacial & Oral Health, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
| | - Chris A Campbell
- Department of Plastic Surgery , Maxillofacial & Oral Health, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
| |
Collapse
|
6
|
Noguchi M, Morioka E, Yokoi-Noguchi M, Haba Y, Inokuchi M, Hisano M. Oncoplastic breast surgery to prevent "Bird's beak" deformity in the breast: a comparative retrospective study. Surg Today 2024; 54:14-22. [PMID: 37157037 DOI: 10.1007/s00595-023-02690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/06/2023] [Indexed: 05/10/2023]
Abstract
PURPOSES Breast deformity occurring in the lower pole after breast conserving surgery (BCS) is known as bird's beak (BB) deformity. This retrospective study evaluated the outcomes in breasts reconstructed with a conventional closing procedure (CCP) and a downward-moving procedure (DMP), respectively, after BCS. METHODS In CCP, the inferomedial and inferolateral portions of breast tissues were reapproximated toward the midline after wide excision to repair the breast defect. In DMP, the retro-areolar breast tissue was detached from the nipple-areolar complex after wide excision, and the upper pole breast tissue was moved downward to refill the breast defect. RESULTS CCP was performed in 20 patients (Group A), and DMP was performed in 28 patients (Group B). Although retraction of the lower part of the breast was postoperatively observed in 13 (72%) of 18 patients from Group A, it was observed in 7 (28%) of 25 patients in Group B (p < 0.05). The downward pointing of the nipple was observed in 8 (44%) of 18 patients from Group A and in 4 (16%) of 25 patients in Group B (p < 0.05). CONCLUSIONS DMP is more useful for preventing BB deformity than CCP.
Collapse
Affiliation(s)
- Masakuni Noguchi
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, 920-0293, Japan.
- Breast Center, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, Japan.
| | - Emi Morioka
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, 920-0293, Japan
- Breast Center, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, Japan
| | - Miki Yokoi-Noguchi
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, 920-0293, Japan
- Breast Center, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, Japan
| | - Yusuke Haba
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, 920-0293, Japan
- Breast Center, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, Japan
| | - Masafumi Inokuchi
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, 920-0293, Japan
- Breast Center, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, Japan
| | - Machiko Hisano
- Breast Center, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, Japan
| |
Collapse
|
7
|
Businaro Fernandes João T, de Oliveira VM, Bagnoli F, Bastos MCS, Rinaldi JF, Brenelli FP, Mateus EF. How well are Brazilian mastologists (breast surgeons) trained in breast reconstruction and oncoplastic surgery? A study of the impact of a breast reconstruction and oncoplastic surgery improvement course. Front Oncol 2023; 13:1139461. [PMID: 37287926 PMCID: PMC10242663 DOI: 10.3389/fonc.2023.1139461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/24/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction The breasts are a female symbol, impacts self-image and self-esteem. Breast reconstructive and oncoplastic surgeries have an important role in minimizing injuries. In Brazil less than a third of public health system (SUS) users have access to immediate reconstructive surgery. The low rate of breast reconstructions has multiple causes and the deficiency in availability and surgeons' technical qualification play a role. In 2010, the Breast Reconstruction and Oncoplastic Surgery Improvement Course was created by professors of the Mastology Department of Santa Casa de São Paulo and State University of Campinas (UNICAMP). The objectives of this study were to evaluate the impact of the techniques learned on patients' management by the surgeons enrolled in the Course, as well as to characterize their profile. Methods All students enrolled in the Improvement Course between 2010 and 2018 were invited to answer an online questionnaire. Students who did not agree to answer the questionnaire or answered them incompletely were excluded. Results Total students included: 59. The mean age: 48.9 years, male (72%) with more than 5 years of Mastology practice (82.2%), from all regions of Brazil, 1.7% from the North, 33.9% from the Northeast, 44.1% from the Southeast, and 12% from the South. Most of the students considered they had little or no knowledge of breast reconstruction (74.6%) and 91,5% did not consider they had enough aptitude to perform breast reconstructions after finishing residency. After the Course, 96.6% considered themselves apt to perform such surgeries. Over 90% of the students considered the Course had impacted their practice and changed their surgical strategy view. Before the Course, 84.8% of the students stated that less than half of their patients who were operated on for breast cancer had breast reconstruction, compared to 30.5% after the Course. Conclusion The Breast Reconstruction and Oncoplastic Surgery Improvement Course studied here positively impacted the mastologists' management of patients. New training centers worldwide can help a lot of women with breast cancer.
Collapse
Affiliation(s)
- Thais Businaro Fernandes João
- Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP); Faculty of Medical Sciences of Santa Casa de São Paulo (FCMSCSP), São Paulo, Brazil
| | - Vilmar Marques de Oliveira
- Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP); Faculty of Medical Sciences of Santa Casa de São Paulo (FCMSCSP), São Paulo, Brazil
| | - Fábio Bagnoli
- Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP); Faculty of Medical Sciences of Santa Casa de São Paulo (FCMSCSP), São Paulo, Brazil
| | - Maria Carolina Soliani Bastos
- Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP); Faculty of Medical Sciences of Santa Casa de São Paulo (FCMSCSP), São Paulo, Brazil
| | - José Francisco Rinaldi
- Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP); Faculty of Medical Sciences of Santa Casa de São Paulo (FCMSCSP), São Paulo, Brazil
| | - Fabrício Palermo Brenelli
- State University of Campinas (UNICAMP), Campinas, Brazil
- Beneficiência Portuguesa de São Paulo, São Paulo, Brazil
| | - Evandro Fallaci Mateus
- Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP); Faculty of Medical Sciences of Santa Casa de São Paulo (FCMSCSP), São Paulo, Brazil
| |
Collapse
|
8
|
Oncoplastic level II volume displacement surgery for breast cancer: oncological and aesthetic outcomes. Updates Surg 2023:10.1007/s13304-023-01472-0. [PMID: 36862354 PMCID: PMC10359384 DOI: 10.1007/s13304-023-01472-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 02/20/2023] [Indexed: 03/03/2023]
Abstract
Oncoplastic breast-conserving surgery (OBCS) is increasingly used to treat breast cancer with the dual purpose of performing a radical oncological resection while minimizing the risk of post-operative deformities. The aim of the study was to evaluate the patient outcomes after Level II OBCS as regards oncological safety and patient satisfaction. Between 2015 and 2020, a cohort of 109 women consecutively underwent treatment for breast cancer with bilateral oncoplastic breast-conserving volume displacement surgery; patient satisfaction was measured with BREAST-Q questionnaire. The 5-year overall survival and disease-free survival were 97% (95%CI 92, 100) and 94% (95%CI 90, 99), respectively. In two patients (1.8%), mastectomy was finally performed due to margin involvement. The median patient-reported score for "satisfaction with breast" (BREAST-Q) was 74/100. Factors associated with a lower aesthetic satisfaction index included: location of tumour in central quadrant (p = 0.007); triple negative breast cancer (p = 0.045), and re-intervention (p = 0.044). OBCS represents a valid option in terms of oncological outcomes for patients otherwise candidate to more extensive breast conserving surgery; the high satisfaction index also suggests a superiority in terms of aesthetic outcomes.
Collapse
|
9
|
Hing JX, Kang BJ, Keum HJ, Lee J, Jung JH, Kim WW, Yang JD, Lee JS, Park HY. Long-term oncological outcomes of oncoplastic breast-conserving surgery after a 10-year follow-up – a single center experience and systematic literature review. Front Oncol 2022; 12:944589. [PMID: 36016619 PMCID: PMC9396304 DOI: 10.3389/fonc.2022.944589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 07/07/2022] [Indexed: 11/24/2022] Open
Abstract
Aim While many studies reported the oncological outcomes of oncoplastic breast-conserving surgery (OBCS), there were inherent differences in the study population, surgeons’ expertise, and classifications of techniques used. There were also limited studies with long term follow up oncological outcomes beyond 5 years. This current study aimed to compare long-term oncological outcomes of ipsilateral breast tumor recurrence (IBTR) disease-free survival (DFS) and overall survival (OS) following conventional and oncoplastic breast-conserving surgery using volume displacement and replacement techniques. Methods Between 2009 and 2013, 539 consecutive patients who underwent breast conservation surgery including 174 oncoplastic and 376 conventional procedures were analysed. A systematic review of studies with at least five years of median follow up were performed to compare long term oncological outcomes. Results At a median follow-up of 82.4 months, there were 23 (4.2%) locoregional recurrences, 17 (3.2%) metachronous contralateral breast cancer, 26 (4.8%) distant metastases, and 13 (2.4%) deaths. The hazard ratio of OBCS for IBTR, DFS and OS were 0.78 (95% confidence interval [CI] 0.21–2.94, p=0.78), 1.59 (95% CI, 0.88 to 2.87, p=0.12), and 2.1 (95% CI, 0.72 to 5.9, p=0.17) respectively. The 10-year IBTR-free, DFS and OS rate were 97.8%, 86.2%, and 95.7% respectively. Conclusion There remained a dearth in well-balanced comparative studies with sufficient long-term follow-up, and our study reported long-term oncological outcomes for OBCS which were favourable of either VD or replacement techniques.
Collapse
Affiliation(s)
- Jun Xian Hing
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
- Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore, Singapore
- Singhealth Duke-NUS Breast Centre, Singapore Health Services Pte Ltd, Singapore, Singapore
| | - Byeong Ju Kang
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Hee Jung Keum
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Jeeyeon Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Jin Hyang Jung
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Wan Wook Kim
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Jung Dug Yang
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Joon Seok Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ho Yong Park
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
- *Correspondence: Ho Yong Park,
| |
Collapse
|
10
|
Shi W, Wang M, Torres-de la Roche LA, Shi X, Gong Z, Dong J, Chen Z, Zeng J, Jiang Y, Chen Z, Wu K, Zhuo R, De Wilde RL. An Innovative Breast-Conserving Oncoplastic Technique for Treating Small to Medium Volume Breasts With a Tumor in the Lower Quadrant: The Folding Flap Technique. Front Oncol 2022; 12:841682. [PMID: 35311152 PMCID: PMC8931390 DOI: 10.3389/fonc.2022.841682] [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: 12/22/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundHere, we describe an innovative oncoplastic technique for small to medium volume breasts with a tumor in the lower quadrant and this technique could provide sufficient tissue to avoid visible defects after tumor removal and help reshape the natural shape of the breast.MethodsA detailed procedure for the folding flap technique is described step by step. Then, the results of a retrospective analysis of patients treated using this technique, including complications and disease recurrence rate, between January 2017 and November 2021 are reported. Aesthetic outcomes were evaluated on a 5-point scale proposed by the Paris Breast Center.ResultsA total of 52 patients underwent surgery with the folding flap technique, The average operation time was 98.4 min (range, 75–120 min), and the mean bleeding volume was 56.5 mL (range, 20–100 mL). A margin-positive result was confirmed in 1 patient who underwent re-excision. Short-term postoperative complications were observed in 7 patients, including 4 with fat liquefaction, 2 with seroma, and 1 with skin redness and swelling. No flap necrosis was observed. The median follow-up time was 28.6 months (range, 9–58 months), and 2 patients experienced local recurrence. The mean aesthetic score was 4.7 points, with 36 patients scoring 5 points and 26 patients scoring 4 points, respectively.ConclusionsThe folding flap technique, as an innovative and favorable oncoplastic technique for treating small- to medium-volume breasts with a tumor in the lower quadrant, could retain sufficient tissue to fill the residual cavity after the operation while improving the aesthetic outcome of the breast.
Collapse
Affiliation(s)
- Wenjie Shi
- University Hospital for Gynecology, Pius-Hospital, University Medicine Oldenburg, Oldenburg, Germany
| | - Maoli Wang
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | | | - Xuefeng Shi
- Department of Breast Surgery, EUSOMA Certified Breast Center, Guilin TCM Hospital of China, Guilin, China
| | - Zhenyu Gong
- International Center for Aesthetic Medicine, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Jie Dong
- Department of Breast Surgery, EUSOMA Certified Breast Center, Guilin TCM Hospital of China, Guilin, China
| | - Zihao Chen
- University Hospital for Gynecology, Pius-Hospital, University Medicine Oldenburg, Oldenburg, Germany
| | - Jiajia Zeng
- Department of Breast Surgery, EUSOMA Certified Breast Center, Guilin TCM Hospital of China, Guilin, China
| | - Yicheng Jiang
- University Hospital for Gynecology, Pius-Hospital, University Medicine Oldenburg, Oldenburg, Germany
| | - Zhitong Chen
- University Hospital for Gynecology, Pius-Hospital, University Medicine Oldenburg, Oldenburg, Germany
| | - Kejin Wu
- Department of Breast Surgery, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- *Correspondence: Kejin Wu, ; Rui Zhuo, ; Rudy Leon De Wilde,
| | - Rui Zhuo
- Department of Breast Surgery, EUSOMA Certified Breast Center, Guilin TCM Hospital of China, Guilin, China
- *Correspondence: Kejin Wu, ; Rui Zhuo, ; Rudy Leon De Wilde,
| | - Rudy Leon De Wilde
- University Hospital for Gynecology, Pius-Hospital, University Medicine Oldenburg, Oldenburg, Germany
- *Correspondence: Kejin Wu, ; Rui Zhuo, ; Rudy Leon De Wilde,
| |
Collapse
|
11
|
Nanda A, Hu J, Hodgkinson S, Ali S, Rainsbury R, Roy PG. Oncoplastic breast-conserving surgery for women with primary breast cancer. Cochrane Database Syst Rev 2021; 10:CD013658. [PMID: 34713449 PMCID: PMC8554646 DOI: 10.1002/14651858.cd013658.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Oncoplastic breast-conserving surgery (O-BCS) involves removing the tumour in the breast and using plastic surgery techniques to reconstruct the breast. The adequacy of published evidence on the safety and efficacy of O-BCS for the treatment of breast cancer compared to other surgical options for breast cancer is still debatable. It is estimated that the local recurrence rate is similar to standard breast-conserving surgery (S-BCS) and also mastectomy, but the aesthetic and patient-reported outcomes may be improved with oncoplastic techniques. OBJECTIVES Our primary objective was to assess oncological control outcomes following O-BCS compared with other surgical options for women with breast cancer. Our secondary objective was to assess surgical complications, recall rates, need for further surgery to achieve adequate oncological resection, patient satisfaction through patient-reported outcomes, and cosmetic outcomes through objective measures or clinician-reported outcomes. SEARCH METHODS We searched the Cochrane Breast Cancer Group's Specialized Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via OVID), Embase (via OVID), the World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.gov on 7 August 2020. We did not apply any language restrictions. SELECTION CRITERIA We selected randomised controlled trials (RCTs) and non-randomised comparative studies (cohort and case-control studies). Studies evaluated any O-BCS technique, including volume displacement techniques and partial breast volume replacement techniques compared to any other surgical treatment (partial resection or mastectomy) for the treatment of breast cancer. DATA COLLECTION AND ANALYSIS Four review authors performed data extraction and resolved disagreements. We used ROBINS-I to assess the risk of bias by outcome. We performed descriptive data analysis and meta-analysis and evaluated the quality of the evidence using GRADE criteria. The outcomes included local recurrence, breast cancer-specific disease-free survival, re-excision rates, complications, recall rates, and patient-reported outcome measures. MAIN RESULTS We included 78 non-randomised cohort studies evaluating 178,813 women. Overall, we assessed the risk of bias per outcome as being at serious risk of bias due to confounding; where studies adjusted for confounding, we deemed these at moderate risk. Comparison 1: oncoplastic breast-conserving surgery (O-BCS) versus standard-BCS (S-BCS) The evidence in the review found that O-BCS when compared to S-BCS, may make little or no difference to local recurrence; either when measured as local recurrence-free survival (hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.61 to 1.34; 4 studies, 7600 participants; very low-certainty evidence) or local recurrence rate (HR 1.33, 95% CI 0.96 to 1.83; 4 studies, 2433 participants; low-certainty evidence), but the evidence is very uncertain due to most studies not controlling for confounding clinicopathological factors. O-BCS compared to S-BCS may make little to no difference to disease-free survival (HR 1.06, 95% CI 0.89 to 1.26; 7 studies, 5532 participants; low-certainty evidence). O-BCS may reduce the rate of re-excisions needed for oncological resection (risk ratio (RR) 0.76, 95% CI 0.69 to 0.85; 38 studies, 13,341 participants; very low-certainty evidence), but the evidence is very uncertain. O-BCS may increase the number of women who have at least one complication (RR 1.19, 95% CI 1.10 to 1.27; 20 studies, 118,005 participants; very low-certainty evidence) and increase the recall to biopsy rate (RR 2.39, 95% CI 1.67 to 3.42; 6 studies, 715 participants; low-certainty evidence). Meta-analysis was not possible when assessing patient-reported outcomes or cosmetic evaluation; in general, O-BCS reported a similar or more favourable result, however, the evidence is very uncertain due to risk of bias in the measurement methods. Comparison 2: oncoplastic breast-conserving surgery (O-BCS) versus mastectomy alone O-BCS may increase local recurrence-free survival compared to mastectomy but the evidence is very uncertain (HR 0.55, 95% CI 0.34 to 0.91; 2 studies, 4713 participants; very low-certainty evidence). The evidence is very uncertain about the effect of O-BCS on disease-free survival as there were only data from one study. O-BCS may reduce complications compared to mastectomy, but the evidence is very uncertain due to high risk of bias mainly resulting from confounding (RR 0.75, 95% CI 0.67 to 0.83; 4 studies, 4839 participants; very low-certainty evidence). Data on patient-reported outcome measures came from single studies; it was not possible to meta-analyse the data. Comparison 3: oncoplastic breast-conserving surgery (O-BCS) versus mastectomy with reconstruction O-BCS may make little or no difference to local recurrence-free survival (HR 1.37, 95% CI 0.72 to 2.62; 1 study, 3785 participants; very low-certainty evidence) or disease-free survival (HR 0.45, 95% CI 0.09 to 2.22; 1 study, 317 participants; very low-certainty evidence) when compared to mastectomy with reconstruction, but the evidence is very uncertain. O-BCS may reduce the complication rate compared to mastectomy with reconstruction (RR 0.49, 95% CI 0.45 to 0.54; 5 studies, 4973 participants; very low-certainty evidence) but the evidence is very uncertain due to high risk of bias from confounding and inconsistency of results. The evidence is very uncertain for patient-reported outcome measures and cosmetic evaluation. AUTHORS' CONCLUSIONS The evidence is very uncertain regarding oncological outcomes following O-BCS compared to S-BCS, though O-BCS has not been shown to be inferior. O-BCS may result in less need for a second re-excision surgery but may result in more complications and a greater recall rate than S-BCS. It seems that O-BCS may give better patient satisfaction and surgeon rating for the look of the breast, but the evidence for this is of poor quality, and due to lack of numerical data, it was not possible to pool the results of different studies. It seems O-BCS results in fewer complications compared with surgeries involving mastectomy. Based on this review, no certain conclusions can be made to help inform policymakers. The surgical decision for what operation to proceed with should be made jointly between clinician and patient after an appropriate discussion about the risks and benefits of O-BCS personalised to the patient, taking into account clinicopathological factors. This review highlighted the deficiency of well-conducted studies to evaluate efficacy, safety and patient-reported outcomes following O-BCS.
Collapse
Affiliation(s)
- Akriti Nanda
- Department of Breast Surgery, Oxford University Hospitals, Oxford, UK
| | - Jesse Hu
- Division of Breast Surgery, National University Health System, Singapore, Singapore
| | - Sarah Hodgkinson
- Editorial & Methods Department, Cochrane Central Executive, London, UK
| | - Sanah Ali
- Medical School, Oxford University, Oxford, UK
| | | | - Pankaj G Roy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
12
|
Kim MY, Suh YJ, An YY. Imaging surveillance for the detection of ipsilateral local tumor recurrence in patients who underwent oncoplastic breast-conserving surgery with acellular dermal matrix: abbreviated MRI versus conventional mammography and ultrasonography. World J Surg Oncol 2021; 19:290. [PMID: 34579740 PMCID: PMC8477561 DOI: 10.1186/s12957-021-02403-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the usefulness of surveillance-abbreviated magnetic resonance imaging (AB-MRI) for the detection of ipsilateral local tumor recurrence (LTR) in patients who underwent oncoplastic breast-conserving surgery (BCS) with acellular dermal matrix (ADM) by comparing its diagnostic performance with that of mammography (MG) and ultrasonography (US). METHODS The postoperative MG, US, and AB-MRI findings of the ipsilateral breast and pathological results of 324 patients who underwent oncoplastic BCS using ADM were reviewed. The cancer detection rate (CDR), sensitivity, specificity, positive predictive value (PPV) for biopsy, accuracy, and area under the curve (AUC) for each imaging modality were calculated. RESULTS A total of 8 ipsilateral LTRs were diagnosed, and most cancers (87.5%) were stage 0 or 1 (median size of invasive cancer, 1.44 cm; range, 0.7-2 cm). The CDRs of MG, US, MG + US, and AB-MRI were 0.009, 0.012, 0.015, and 0.025 per woman, respectively. Three cancers were detectable on only AB-MRI, and the additional CDR of AB-MRI was 0.010. The sensitivity and specificity of MG, US, MG + US, and AB-MRI were 37.5%, 50%, 62.5%, and 100% and 99.7%, 98.4%, 98.1%, and 97.8%, respectively. The PPVs for biopsy were 75%, 44.4%, 45.5%, and 53.3%, respectively. The AUC was significantly higher for AB-MRI (0.989) than for MG alone (0.686, P = 0.0009), US alone (0.742, P = 0.009), and MG + US (0.803, P = 0.04). A total of 66.7% of cancers visible on only AB-MRI were located at the deep posterior portion of the excision cavity, which might have been missed with MG or MG + US due to masking by the ADM filler. CONCLUSION AB-MRI can improve the detection of ipsilateral LTR despite postoperative changes caused by ADM fillers compared to conventional MG and US. Patients who undergo BCS with ADM can be candidates for AB-MRI surveillance considering improved cancer detection and high sensitivity.
Collapse
Affiliation(s)
- Mi Young Kim
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Young Jin Suh
- Department of Surgery, Division of Breast and Thyroid Surgical Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Yeong Yi An
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea.
| |
Collapse
|
13
|
Alder L, Zaidi M, Zeidan B, Mazari F. Advanced breast conservation and partial breast reconstruction - a review of current available options for oncoplastic breast surgery. Ann R Coll Surg Engl 2021; 104:319-323. [PMID: 34415191 DOI: 10.1308/rcsann.2021.0169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Breast cancer is the most common cancer affecting one in three women with new cancer diagnosis in England. Breast-conserving surgery is the primary surgical option in a vast majority of these patients. Use of oncoplastic techniques in breast conservation surgery has significantly improved the aesthetic outcomes without compromising the oncological safety of cancer resections. Oncoplastic breast-conserving surgery (OPBCS) has transformed the specialty with a paradigm shift in ideology and the recognition that aesthetic and oncological resections are synonymous when planning surgical intervention for patients with breast cancer. The two main options for OPBCS are therapeutic mammoplasty and partial beast reconstruction using pedicle-based flaps. This review aims to highlight key concepts in OPBCS demonstrating an overview of these surgical techniques, their safety, outcomes and the emergence of extreme oncoplastic breast surgery.
Collapse
Affiliation(s)
- L Alder
- University Hospital Southampton NHS Foundation Trust, UK
| | - M Zaidi
- Portsmouth Hospitals NHS Trust, UK
| | - B Zeidan
- University Hospital Southampton NHS Foundation Trust, UK
| | - Fak Mazari
- University Hospital Southampton NHS Foundation Trust, UK
| |
Collapse
|
14
|
Can supine breast magnetic resonance imaging help hit the target in extreme oncoplastic surgery? Eur J Surg Oncol 2021; 47:2788-2796. [PMID: 34412958 DOI: 10.1016/j.ejso.2021.07.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/23/2021] [Accepted: 07/31/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To evaluate the clinical value of supine magnetic resonance imaging (MRI) for tumor localization in breast cancer patients with large or multifocal tumors detected by prone MRI, scheduled for oncoplastic breast conserving surgery (OBCS). Outcomes were compared with those of patients who underwent wide local excision (WLE) or OBCS without MRI guidance. METHODS Over a 2-year period, consecutive patients with large or multifocal disease scheduled for OBCS with MRI-only findings were invited to participate (Group-1). Supplementary supine MRI was performed, and tumor margins were marked in the surgical position. Consecutive patients with early, non-palpable breast cancer who underwent WLE (Group-2) or OBCS (Group-3) were included for comparisons. The primary outcome was reoperation due to an insufficient margin. Secondary outcomes included surgical complications and delayed adjuvant treatment. RESULTS Altogether, 102 breasts (98 patients) were analyzed. All preoperative demographic data were comparable among the three groups. Multifocality, tumor-to-breast volume ratio, and the volume of excised breast tissue were significantly greater in Group-1 than in Groups-2 and 3. Operation time was longer and the need for axillary clearance or surgery for both breasts was more common in Groups-1 and 3 than in Group-2. Adequate margins were achieved in all patients in Groups-1 and 2, and one patient underwent re-excision in Group-3. CONCLUSIONS Supine MRI in the surgical position is a new, promising method to localize multifocal, large tumors visible on MRI. Its short-term outcomes were comparable with those of conventional WLE and OBCS.
Collapse
|
15
|
Orsaria P, Grasso A, Caggiati L, Altomare M, Altomare V. Update on oncoplastic techniques in breast conserving surgery: algorithms for predictable results and custom-made reconstructions. Minerva Surg 2021; 76:512-525. [PMID: 34338466 DOI: 10.23736/s2724-5691.21.08976-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Breast cancer surgery is going to be a relevant specialty involved in the multidisciplinary disease management, finalized to guarantee high performances on mortality reduction together with a quality of life improvement. The intellectual architecture of this field is characterized by its inclination to respect, sharing, empathy and scientific knowledge that can make it a high model of medical culture. In this context, oncoplastic breast conserving surgery is identified by special aesthetic sensitivities, as well as creativity and innovation. Knowing how to reshape the gland and fill the gaps, planning the targeted exeresis design, while anticipating the final outcome, respecting symmetries and ensuring first of all oncological safety, are the new skills that are required to the breast surgeon. Several tecniques could provide a refined surgical treatment but always challenging according to anatomical findings and patient expectations, as a systematic process of self-critical reflection, with the purpose to optimize criteria for improving therapeutic results.
Collapse
Affiliation(s)
- Paolo Orsaria
- Department of Breast Surgery, Campus Bio-Medico University Hospital, Rome, Italy -
| | - Antonella Grasso
- Department of Breast Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Lorenza Caggiati
- Department of Breast Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Michele Altomare
- Department of General Surgery, University of Milan, Milan, Italy
| | - Vittorio Altomare
- Department of Breast Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| |
Collapse
|
16
|
Hussein O, Roshdy S, Hamdy O, Denewer A. Pectoralis major myo-parenchymal flap for local reconstruction of partial mastectomy defects. Description of a new technique. Breast Dis 2021; 41:31-36. [PMID: 34275886 DOI: 10.3233/bd-201042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Breast conservation is the standard of care treatment for early breast cancer. Several oncoplastic approaches have been described for the reconstruction of partial breast defects. The multiplicity of techniques indicates that the ideal reconstructive technique is yet to be identified. There has been a recent emphasis on minimizing the magnitude of surgery. In this report, we describe our experience of using the pectoralis major muscle to fill relatively large post-tumorectomy breast defects. PATIENTS AND TECHNIQUE Nine patients were operated on for malignant breast lesions. Tumorectomy resection with surgical margin rendered a 40-50% breast defect. The parenchymal defect was repaired with an advancement muscle flap of the ipsilateral pectoralis major muscle. RESULTS All patients experienced a non-eventful postoperative course. The early cosmetic outcome was excellent in four patients, good in another four, and fair in one patient. CONCLUSION The pectoralis major flap is useful for local repair of upper half partial breast defects in non-ptosed, cup A-B breasts.
Collapse
Affiliation(s)
- Osama Hussein
- Surgery Department, Mansoura University Oncology Center, Mansoura, Egypt
| | - Sameh Roshdy
- Surgery Department, Mansoura University Oncology Center, Mansoura, Egypt
| | - Omar Hamdy
- Surgery Department, Mansoura University Oncology Center, Mansoura, Egypt
| | - Adel Denewer
- Surgery Department, Mansoura University Oncology Center, Mansoura, Egypt
| |
Collapse
|
17
|
Van Vliet A, Dayicioglu D. A Simple Technique to Correct Lumpectomy Deformities Using Free Nipple Grafting. Ann Plast Surg 2021; 86:S567-S570. [PMID: 34100814 DOI: 10.1097/sap.0000000000002907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lumpectomy followed by radiation can lead to severe breast asymmetry. Many surgeons are hesitant to perform traditional mastopexies on irradiated breasts due to increased complication rates. An alternative approach to achieve breast symmetry is presented. This technique consists of free nipple-areola complex (NAC) grafting of the irradiated breast to a higher position and primary closure of the donor site, in an appropriate fashion without undermining, followed by a formal mastopexy of the nonradiated breast. OBJECTIVE To evaluate the outcomes of free NAC grafting, used as an alternative method to achieve breast symmetry, in patients who underwent lumpectomy with radiation. METHODS A case series of 5 patients who underwent breast revision using this technique, performed by a single surgeon from 2017 to 2019 (n = 5), is presented. PATIENT DEMOGRAPHICS All patients had history of lumpectomy followed by radiation therapy. The average age was 59.2 years, average BMI was 33.0. Three of 5 patients had a significant smoking history. The average time between radiation and surgery was 5.9 years. RESULTS The average operating time was 141.8 minutes. The average follow-up period was 5.8 months. Two (40%) of the free NAC grafts were complicated by hypopigmentation of the reconstructed NAC. No major complications were reported, and no patients required return to the operating room. All patients had successful outcomes with improved breast symmetry. CONCLUSIONS Free NAC grafting of irradiated breasts and contralateral mastopexy may be a reliable alternative to achieve breast symmetry, with a less invasive approach, in patients who underwent lumpectomy and radiation.
Collapse
Affiliation(s)
- Austin Van Vliet
- From the Department of Plastic Surgery, University of South Florida Morsani College of Medicine
| | | |
Collapse
|
18
|
Gulcelik MA, Dogan L. Feasibility of level II oncoplastic techniques in the surgical management of locally advanced breast cancer after neoadjuvant treatment. Int J Clin Pract 2021; 75:e13987. [PMID: 33406297 DOI: 10.1111/ijcp.13987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The study aimed to identify the short- and long-term oncological results and complications of level-II oncoplastic surgery (OPS) techniques applied after neoadjuvant chemotherapy (NAC) for locally advanced breast cancer. METHODS Patients undergoing OPS because of breast cancer (non-NAC) and those undergoing OPS after systemic treatment (NAC) were evaluated. Surgical margin (SM) status, reoperation and re-excision requirements, axillary intervention results, ipsilateral tumour recurrence, axillary recurrence rates and early postoperative complications were recorded. Long-term locoregional recurrence-free survival (LRFS) and overall survival (OS) rates of the patients were analysed. RESULTS There were 1043 patients (893 patients in the non-NAC group and 150 in the NAC group) in the study. There were no significant differences in SM status, re-excision and mastectomy rates between the groups. The 5-year (LRFS) rate was 90.1% in the NAC group and 93.2% in the non-NAC group (P: .09). OS was shorter in the NAC group. Five-year OS rate was 96% in the non-NAC group and 92% in the NAC group (P: .01). There was no significant difference between the groups in terms of delayed wound healing, minor wound infection, fat necrosis, seroma/hematoma, partial nipple necrosisor T-junction necrosis. CONCLUSION It should be noted that the responses to NAC increased with targeted therapies, and breast-conserving became possible in a substantial number of patients who were not eligible for breast-conserving surgery at the first presentation. Notably, oncoplastic surgery increased breast conservation rates without compromising oncological results.
Collapse
Affiliation(s)
- Mehmet Ali Gulcelik
- Department of Surgical Oncology, University of Health Sciences Turkey, Gulhane Training and Research Hospital, Ankara, Turkey
| | - Lutfi Dogan
- Department of Surgical Oncology, University of Health Sciences Turkey, Ankara AY Oncology Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
19
|
Nanda A, Hu J, Hodgkinson S, Rainsbury R, Roy PG. Oncoplastic breast-conserving surgery for women with primary breast cancer. Hippokratia 2020. [DOI: 10.1002/14651858.cd013658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akriti Nanda
- Department of Breast Surgery; Oxford University Hospitals; Oxford UK
| | - Jesse Hu
- General Surgery; Ng Teng Fong General Hospital National University Health System; Singapore Singapore
| | - Sarah Hodgkinson
- Editorial & Methods Department; Cochrane Central Executive; London UK
| | | | - Pankaj G Roy
- Department of Breast Surgery; Oxford University Hospitals; Oxford UK
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Kosasih S, Tayeh S, Mokbel K, Kasem A. Is oncoplastic breast conserving surgery oncologically safe? A meta-analysis of 18,103 patients. Am J Surg 2020; 220:385-392. [PMID: 31926592 DOI: 10.1016/j.amjsurg.2019.12.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 11/10/2019] [Accepted: 12/13/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Oncoplastic Breast Conserving Surgery (OBCS) allows adequate resection margins of tumours unsuitable for standard breast conserving surgery (SBCS) whilst allowing for better cosmesis and reduced morbidity when compared to mastectomy. However, there is limited evidence on its oncological safety. METHODS This study aims to compare oncological safety of OBCS with SBCS and mastectomy by examining the relative risk of cancer recurrence and re-operation rates through meta-analysis. RESULTS 18 studies met the search criteria including 18,103 patients. The primary outcome measure (recurrence) was not significantly different between OBCS and SBCS or mastectomy (RR 0.861; 95% CI 0.640-1.160; p = 0.296). The secondary outcome measure (re-operation) initially achieved significance in favour of OBCS (RR 0.64; 95% CI 0.46-0.89; p = 0.01). However, after adjustment for publication bias this was attenuated to insignificance between the two study groups (RR 0.86; 95% CI 0.56-1.31; p = 0.44). CONCLUSIONS For both cancer recurrence and re-operation rate, there was no significant difference between OBCS and traditional techniques. OBCS is of comparable oncological safety to more established surgical procedures and a useful option in suitable patients.
Collapse
Affiliation(s)
| | - Salim Tayeh
- Homerton University Hospital Foundation Trust, London, UK
| | - Kefah Mokbel
- The London Breast Institute, The Princess Grace Hospital, London, UK
| | - Abdul Kasem
- King's College Hospital NHS Foundation Trust, London, UK.
| |
Collapse
|
22
|
Zhu L, Li S, Tan L, Zhang X, Wu J, Su F, Chen K, Song E. In pursuit of a flawless aphrodite: paving the way to scarless oncoplastic breast surgery. Cancer Commun (Lond) 2019; 39:82. [PMID: 31796126 PMCID: PMC6891967 DOI: 10.1186/s40880-019-0422-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/30/2019] [Indexed: 01/26/2023] Open
Affiliation(s)
- Liling Zhu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, P.R. China
| | - Shunrong Li
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, P.R. China
| | - Luyuan Tan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, P.R. China
| | - Xiaolan Zhang
- Department of Breast Surgery, Guangzhou Concord Cancer Center, Guangzhou, 510045, Guangdong, P.R. China
| | - Jiannan Wu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, P.R. China
| | - Fengxi Su
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P.R. China.,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, P.R. China.,Sufengxi Clinic, Guangzhou, 510000, Guangdong, P.R. China
| | - Kai Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P.R. China. .,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, P.R. China.
| | - Erwei Song
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, Guangdong, P.R. China. .,Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, P.R. China.
| |
Collapse
|
23
|
Lee S, Jung Y, Bae Y. Dermoglandular rotation flap with subaxillary advancement flap as an oncoplastic technique for breast cancer. Breast J 2019; 26:420-426. [PMID: 31502394 DOI: 10.1111/tbj.13503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 11/28/2022]
Abstract
We propose a novel oncoplastic surgical technique, dermoglandular rotation flap with subaxillary advancement flap, as a feasible one-stage operation. Breast conserving surgery, incorporating the dermoglandular rotation flap with subaxillary advancement flap, was performed in 49 female patients with breast cancer, between January and December 2015. After a full-thickness fibroglandular resection including the tumor, an inferior- or a superior-based rotation flap was performed according to the location of the defect. The subaxillary flap consisted of skin, dermis, and subcutaneous fat tissue and was mobilized from the chest wall musculature. Since subaxillary skin has greater redundancy, it can be easily moved to reach the lateral aspect of the breast. Approximation of the subaxillary flap to the lateral side of rotated dermoglandular flap served to relieve skin tension and avoid displacement of the nipple-areola complex (NAC). Consequently, there was wider dermoglandular tissue rotation and efficient filling of defect without any significant postoperative deformity. The mean follow-up period was 46.5 ± 3.1 months (range, 42.4-52.1 months). Mean tumor size, on pathology, was 2.1 cm (range, 0.4-6.0). Mean excised breast tissue weight was 78.4 g (range, 28.6-195.0). More than half of the patients (51%) studied had excised breast tissue weighing more than 80 g. None of the included patients had positive surgical margins in final pathologic reports. Most patients answered excellent or good for self-estimated cosmetic outcomes including symmetry of the breast and NAC, breast shape, scarring, and overall satisfaction. A modified dermoglandular rotation flap technique along with subaxillary advancement flap is a feasible and effective oncoplastic technique for breast cancers.
Collapse
Affiliation(s)
- Seokwon Lee
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Younglae Jung
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Youngtae Bae
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| |
Collapse
|
24
|
Chatterjee A. Author's Response to Reflexion on Consensus Statement on Oncoplastic Surgery, by Zucca-Matthes, Gustavo, et al. Ann Surg Oncol 2019; 26:3007-3008. [PMID: 31144144 DOI: 10.1245/s10434-019-07468-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Indexed: 11/18/2022]
|
25
|
Chatterjee A, Yao M, Sekigami Y, Liang Y, Nardello S. Practical Perspectives Regarding Patient Selection and Technical Considerations in Oncoplastic Surgery. CURRENT BREAST CANCER REPORTS 2019. [DOI: 10.1007/s12609-019-0305-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
26
|
Chatterjee A, Gass J, Patel K, Holmes D, Kopkash K, Peiris L, Peled A, Ryan J, El-Tamer M, Reiland J. A Consensus Definition and Classification System of Oncoplastic Surgery Developed by the American Society of Breast Surgeons. Ann Surg Oncol 2019; 26:3436-3444. [DOI: 10.1245/s10434-019-07345-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Indexed: 01/07/2023]
|
27
|
Agrawal J, Mehta S, Goel A, Selvakumar VP, Kumar K, Pande PK. Reconstruction in Breast Conservation Therapy-Single Tertiary Care Institution Experience with 472 Patients. Indian J Surg Oncol 2018; 9:362-368. [PMID: 30287999 PMCID: PMC6154353 DOI: 10.1007/s13193-017-0663-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 04/24/2017] [Indexed: 11/25/2022] Open
Abstract
Breast conservation therapy (BCT) is now internationally accepted treatment for early breast cancer. Despite of high incidence of carcinoma breast in India, BCT rates are very low as compared to the west. In this article, we wish to share our experience of breast conservation with oncoplasty in Indian women. A retrospective analysis of case records of patients treated with oncoplastic breast conservation from January 2009 to June 2014 in a single surgical oncology unit in a tertiary cancer institute. Demographic patient data, stage of disease, location of primary tumour, use of neo-adjuvant chemotherapy if received, tumour size and breast size ratio, reconstruction method used, post-operative complications and aesthetic score of patients were analysed. Various methods of oncoplasty and partial breast reconstruction used are discussed. Four hundred and seventy-two patient records were found suitable for analysis. Most common stage of presentation was T2N0 in 189 patients (40%). Forty-one patients received neo-adjuvant chemotherapy (NACT). Tumour arising in upper outer quadrant was most common site, seen in 268 (56.7%). The most common method of reconstruction was volume displacement, done in 57.6% patients. Overall surgical complications included wound infection with or without dehiscence, seroma formation, partial flap necrosis and fat necrosis. Cosmesis was found to be excellent in 23.09% and good in 58.47% at 6-month follow-up. Breast conservation with oncoplasty is oncologically safe for early breast cancer treatment and has good cosmetic outcome with high patient satisfaction rates. Its practice should be encouraged in Indian set-up also.
Collapse
Affiliation(s)
- Juhi Agrawal
- Reconstructive Surgery, Department of Surgical Oncology, BLK Super Specialty Hospital, Pusa Road, Delhi, India
| | - Sandeep Mehta
- Reconstructive Surgery, Department of Surgical Oncology, BLK Super Specialty Hospital, Pusa Road, Delhi, India
| | - Ashish Goel
- Department of Surgical Oncology, Pusa Road, Delhi, Delhi 110005 India
| | | | - Kapil Kumar
- Department of Surgical Oncology, Pusa Road, Delhi, Delhi 110005 India
| | | |
Collapse
|
28
|
Hu J, Rainsbury RM, Segaran A, Predescu O, Roy PG. Objective assessment of clinical, oncological and cosmetic outcomes following volume replacement in patients undergoing oncoplastic breast-conserving surgery: protocol for a systematic review. BMJ Open 2018; 8:e020859. [PMID: 30030314 PMCID: PMC6059305 DOI: 10.1136/bmjopen-2017-020859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Oncoplastic breast surgery allows the excision of larger tumours without compromising cosmetic outcome and can be broadly divided into volume displacement and volume replacement techniques. Although oncoplastic surgery has rapidly gained acceptance and is now widely practised, evidence is still lacking especially in patients who underwent volume replacement techniques. As it is a relatively new technique that has been described in the literature in the recent years, a summary of evidence from this literature can help clinicians to understand the clinical, oncologicalandcosmetic outcomes of such procedures. METHODS AND ANALYSIS All original studies including randomised controlled trials, cohort studies, case-control studies and case series involving more than 10 women undergoing partial breast reconstruction using a volume replacement technique will be included. The primary objective is to evaluate the clinical, oncological and cosmetic outcomes following volume replacement in patients undergoing oncoplastic breast-conserving surgery. The secondary objective is to review the patient-reported outcomes (PROMs) associated with oncoplastic breast surgery to help identify any unmet needs and to consider refining the existing PROMs to suit women undergoing volume replacement surgery.A comprehensive literature search, eligibility assessment and extraction of data will be conducted by two trained teams acting independently. Data will be extracted and stored in a database with standardised extraction fields to facilitate easy and consistent data entry. Heterogeneity will be assessed using the Cochrane tests. ETHICS AND DISSEMINATION This systematic review requires no ethical approval. It will be published in a peer-reviewed journal, and it will also be presented at nationalandinternational conferences. PROSPERO REGISTRATION NUMBER CRD42017075700; Pre-results.
Collapse
Affiliation(s)
- Jesse Hu
- Department of Breast Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Richard M Rainsbury
- Department of Breast Surgery, Hampshire Hospitals NHS Foundation Trust, Winchester, UK
| | - Ashvina Segaran
- Department of Breast Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Oana Predescu
- Department of Breast Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Pankaj G Roy
- Department of Breast Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| |
Collapse
|
29
|
Wodzinski M, Skalski A, Ciepiela I, Kuszewski T, Kedzierawski P, Gajda J. Improving oncoplastic breast tumor bed localization for radiotherapy planning using image registration algorithms. Phys Med Biol 2018; 63:035024. [PMID: 29293469 DOI: 10.1088/1361-6560/aaa4b1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Knowledge about tumor bed localization and its shape analysis is a crucial factor for preventing irradiation of healthy tissues during supportive radiotherapy and as a result, cancer recurrence. The localization process is especially hard for tumors placed nearby soft tissues, which undergo complex, nonrigid deformations. Among them, breast cancer can be considered as the most representative example. A natural approach to improving tumor bed localization is the use of image registration algorithms. However, this involves two unusual aspects which are not common in typical medical image registration: the real deformation field is discontinuous, and there is no direct correspondence between the cancer and its bed in the source and the target 3D images respectively. The tumor no longer exists during radiotherapy planning. Therefore, a traditional evaluation approach based on known, smooth deformations and target registration error are not directly applicable. In this work, we propose alternative artificial deformations which model the tumor bed creation process. We perform a comprehensive evaluation of the most commonly used deformable registration algorithms: B-Splines free form deformations (B-Splines FFD), different variants of the Demons and TV-L1 optical flow. The evaluation procedure includes quantitative assessment of the dedicated artificial deformations, target registration error calculation, 3D contour propagation and medical experts visual judgment. The results demonstrate that the currently, practically applied image registration (rigid registration and B-Splines FFD) are not able to correctly reconstruct discontinuous deformation fields. We show that the symmetric Demons provide the most accurate soft tissues alignment in terms of the ability to reconstruct the deformation field, target registration error and relative tumor volume change, while B-Splines FFD and TV-L1 optical flow are not an appropriate choice for the breast tumor bed localization problem, even though the visual alignment seems to be better than for the Demons algorithm. However, no algorithm could recover the deformation field with sufficient accuracy in terms of vector length and rotation angle differences.
Collapse
Affiliation(s)
- Marek Wodzinski
- AGH University of Science and Technology, Department of Measurement and Electronics, al. A.Mickiewicza 30, PL30059, Krakow, Poland. Author to whom any correspondence should be addressed
| | | | | | | | | | | |
Collapse
|
30
|
Internal Mammary Artery Perforator Flap for Immediate Volume Replacement Following Wide Local Excision of Breast Cancer. Arch Plast Surg 2017; 44:502-508. [PMID: 29069885 PMCID: PMC5801778 DOI: 10.5999/aps.2016.00458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/26/2017] [Accepted: 08/02/2017] [Indexed: 11/23/2022] Open
Abstract
Background Breast-conserving therapy is defined as a breast-conserving wide local excision (WLE) of a mammary tumour combined with postoperative radiotherapy. Immediate restoration of the mammary shape by use of breast reduction techniques (volume displacement) or tissue replacement techniques (volume replacement) is gaining popularity to prevent breast malformation. Methods To date, using the internal mammary artery perforator (IMAP) flap has been suggested for immediate volume replacement after WLE, but has never been evaluated in a published study. Results We applied this flap in 12 women (mean age, 56.1 years) after WLE (mean specimen weight, 46.5 g) of the medial aspect of the breast. Over a median follow-up of 35.3 months (standard deviation, 1.2 months), 4 women needed repeated surgery for dog-ear correction of the donor site. Conclusions In our experience, the use of an IMAP flap was a reliable technique with good cosmetic outcomes after oncoplastic reconstruction. In this series, donor site revision often proved necessary initially, but we showed that this may easily be prevented.
Collapse
|
31
|
Noguchi M, Ohno Y, Morioka E, Noguchi M, Nakano Y, Kosaka T, Shimada KI. A novel oncoplastic technique for breast cancer localized in the lower pole of the breast. J Surg Oncol 2017; 117:137-141. [PMID: 28940202 DOI: 10.1002/jso.24824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 08/10/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Masakuni Noguchi
- Breast Center, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan.,Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Yukako Ohno
- Breast Center, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan.,Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Emi Morioka
- Breast Center, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan.,Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Miki Noguchi
- Breast Center, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan.,Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Yasuharu Nakano
- Breast Center, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan.,Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Takeo Kosaka
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Ken-Ichi Shimada
- Department of Plastic Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| |
Collapse
|
32
|
First international consensus conference on standardization of oncoplastic breast conserving surgery. Breast Cancer Res Treat 2017; 165:139-149. [DOI: 10.1007/s10549-017-4314-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 05/23/2017] [Indexed: 12/17/2022]
|
33
|
Abstract
Oncoplastic surgery is integral to all breast cancer surgeries. The use of an aesthetic approach to breast conservation or mastectomy greatly enhances the range of options that can be offered to women with breast cancer and facilitates better outomes from it. It should be the standard of care. However, a structured approach to selecting appropriate techniques is essential, and although many operative procedures are reported, this article sets out to describe a set of principles and an algorithm by which the what, when and for whom for oncoplastic surgery can be defined.
Collapse
|
34
|
Noguchi M, Yokoi-Noguchi M, Ohno Y, Morioka E, Nakano Y, Kosaka T, Kurita T. Oncoplastic breast conserving surgery: Volume replacement vs. volume displacement. Eur J Surg Oncol 2016; 42:926-34. [PMID: 26988623 DOI: 10.1016/j.ejso.2016.02.248] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 02/04/2016] [Accepted: 02/19/2016] [Indexed: 11/30/2022] Open
Abstract
Oncoplastic breast conserving surgery (BCS) has emerged as a third option between conventional BCS and mastectomy. Oncoplastic BCS includes two fundamentally different approaches: volume replacement and volume displacement. The former involves partial mastectomy and immediate reconstruction of the breast with the transposition of autologous tissue from elsewhere, while the latter involves partial mastectomy and using the remaining breast tissue to fill the defect resulting from extirpation of the tumor. There are several benefits associated with oncoplastic BCS. First, it allows partial mastectomy without cosmetic penalties, and can achieve better cosmetic outcomes than total mastectomy with immediate breast reconstruction. Second, it avoids the need for total mastectomy in an increasing number of patients without compromising local control. Third, partial breast reconstruction is less extensive and has fewer complications than conventional procedures. Partial mastectomy and partial breast reconstruction can be carried out either simultaneously as a one-stage procedure, or using a two-stage approach. Although patients prefer a one-stage procedure, it requires intraoperative confirmation of complete tumor excision using frozen-section analysis. Moreover, oncoplastic BCS requires combined skills, knowledge, and understanding of both oncological and plastic surgeries, which may be optimally achieved by an oncoplastic surgeon.
Collapse
Affiliation(s)
- M Noguchi
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-daigaku, Ishikawa, Japan.
| | - M Yokoi-Noguchi
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-daigaku, Ishikawa, Japan
| | - Y Ohno
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-daigaku, Ishikawa, Japan
| | - E Morioka
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-daigaku, Ishikawa, Japan
| | - Y Nakano
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-daigaku, Ishikawa, Japan
| | - T Kosaka
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Uchinada-daigaku, Ishikawa, Japan
| | - T Kurita
- Breast Center, Yale Cancer Center, New Haven, CT, USA
| |
Collapse
|
35
|
De Lorenzi F, Loschi P, Bagnardi V, Rotmensz N, Hubner G, Mazzarol G, Orecchia R, Galimberti V, Veronesi P, Colleoni MA, Toesca A, Peradze N, Mario R. Oncoplastic Breast-Conserving Surgery for Tumors Larger than 2 Centimeters: Is it Oncologically Safe? A Matched-Cohort Analysis. Ann Surg Oncol 2016; 23:1852-9. [DOI: 10.1245/s10434-016-5124-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Indexed: 01/09/2023]
|
36
|
Volumetric breast density is essential for predicting cosmetic outcome at the late stage after breast-conserving surgery. Eur J Surg Oncol 2016; 42:481-8. [PMID: 26852107 DOI: 10.1016/j.ejso.2016.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 12/03/2015] [Accepted: 01/06/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The critical issue related to breast-conserving therapy (BCT) is that cosmetic outcomes deteriorate with long-term follow-up. There is little research for breast density as a predictor of cosmetic outcomes at the late stage after BCT. To improve the long-term quality of life after BCT of breast cancer patients, the correlation of volumetric breast density (VBD) and cosmetic outcome at the late stage after BCT was evaluated. STUDY DESIGN Breast volume, fibroglandular tissue volume, adipose tissue volume, and VBD were calculated on mammography using image analysis software (Volpara(®)) in 151 patients with BCT. Furthermore, the correlation of breast density and the change of breast volume over time was analyzed on mammography in 99 patients who were followed-up long-term after BCT. RESULTS On multivariate analysis, VBD was a predictor of cosmetic outcome after BCT with percent breast volume excised (PBVE). Decreased adipose tissue volume and increased fibrosis were more common in patients with VBD < 15%. Furthermore, remnant breast volume continued to decrease over time in low breast density patients during long-term follow-up. 93% of patients with VBD ≥ 15% and PBVE < 10% had a better cosmetic outcome, while 60% of patients with VBD < 15% and PBVE ≥ 10% had a worse cosmetic outcome after BCT. CONCLUSIONS While PBVE was involved in cosmetic outcome at the early stage after BCT, VBD was associated with cosmetic outcome at the late stage after BCT. Thus, a combination of VBD and PBVE could predict cosmetic outcome after BCT and contribute to the selection for the appropriate BCT.
Collapse
|
37
|
De Lorenzi F, Hubner G, Rotmensz N, Bagnardi V, Loschi P, Maisonneuve P, Venturino M, Orecchia R, Galimberti V, Veronesi P, Rietjens M. Oncological results of oncoplastic breast-conserving surgery: Long term follow-up of a large series at a single institution. Eur J Surg Oncol 2016; 42:71-7. [DOI: 10.1016/j.ejso.2015.08.160] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/24/2015] [Accepted: 08/10/2015] [Indexed: 12/19/2022] Open
|
38
|
Lee S, Lee J, Jung Y, Bae Y. Oncoplastic surgery for inner quadrant breast cancer: fish-hook incision rotation flap. ANZ J Surg 2015; 87:E129-E133. [PMID: 26471108 DOI: 10.1111/ans.13336] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND In oncoplastic breast surgery, the size and location of the defect are two of the major factors affecting the post-operative cosmetic outcome after partial mastectomy. We introduce a modified superior-based dermoglandular rotation flap technique, which can be applied for relatively large tumours and in cases of inner quadrant defects of the breast without surgery of the contralateral breast. METHODS Between January 2007 and December 2012, a total of 34 female patients with breast cancer underwent breast-conserving surgery using the 'fish-hook incision rotational flap'. A fish-hook-shaped skin incision line was designed from an axillary site to the tumour, about 2-3 cm below the skin crease of the inframammary fold. After partial mastectomy, a superior-based dermoglandular tissue flap was mobilized off the pectoralis major muscle and the lower abdominal flap was dissected downward. The dermoglandular flap was then rotated and the lower dissected lower abdominal flap was advanced in the upward direction to fill the defect and restore the breast shape. The cosmetic results were self-estimated 12 months after surgery. RESULTS Mean excised volume of the breast was 23.2 ± 6.1%. The location of the tumours was as follows: upper inner (n = 13, 38.2%) and lower inner quadrant (n = 21, 61.8%). The overall cosmetic satisfaction was self-estimated as follows: excellent (n = 19, 55.9%); good (n = 10, 29.4%); fair (n = 4, 11.8%); poor (n = 1, 2.9%). CONCLUSIONS The 'fish-hook incision rotation flap' is a feasible, effective oncoplastic technique that can be applicable to a relatively large defect located in the inner quadrant of the breast.
Collapse
Affiliation(s)
- Seokwon Lee
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jeeyeon Lee
- Department of Surgery, Kyungpook National University Medical Center, Daegu, Korea
| | - Younglae Jung
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Youngtae Bae
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| |
Collapse
|
39
|
Roshdy S, Hussein O, Khater A, Zuhdy M, El-Hadaad HA, Farouk O, Senbel A, Fathi A, Hamed E, Denewer A. Safety and esthetic outcomes of therapeutic mammoplasty using medial pedicle for early breast cancer. BREAST CANCER-TARGETS AND THERAPY 2015; 7:173-8. [PMID: 26185469 PMCID: PMC4500603 DOI: 10.2147/bctt.s83725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Although therapeutic mammoplasty (TM) was introduced for treatment of localized ductal carcinoma in situ and invasive breast carcinoma (stages I and II) in females with large breast size, the suitability of medial pedicle TM for treatment of breast tumors at different locations has not been established. The objective of this study was to assess the safety and esthetic outcome of medial pedicle TM for breast tumors at different locations. Methods The study was conducted from February 2012 to July 2014. Consecutive patients with early breast carcinoma with medium- and large-sized breasts, with or without ptosis, who were offered medial pedicle TM were included in the study. Patients who were not candidates for breast-conserving surgery or those with tumors located along the medial pedicle were excluded. All patients received immediate postoperative adjuvant chemoradiotherapy. Results Thirty patients with a mean age of 48.5 years received medial pedicle TM in the breast harboring the tumor or, additionally, the other breast (N=14). The tumors were in the upper (60.0%), lower (26.7%), and lateral (13.3%) quadrants. Minor complications occurred in five cases (5/30, 16.7%) in the ipsilateral and in two (2/14, 14.3%) contralateral breasts. No wound dehiscence or areolar necrosis was recorded. A total of 22 (73.3%) patients were scored as excellent cosmesis. After a median follow-up of 20 months, no locoregional recurrence or distant metastases were observed. Conclusion TM using a medial pedicle is a safe and appealing technique among women with tumors at different locations.
Collapse
Affiliation(s)
- Sameh Roshdy
- Department of Surgical Oncology, Mansoura Oncology Center, Mansoura University, Mansoura, Egypt
| | - Osama Hussein
- Department of Surgical Oncology, Mansoura Oncology Center, Mansoura University, Mansoura, Egypt
| | - Ashraf Khater
- Department of Surgical Oncology, Mansoura Oncology Center, Mansoura University, Mansoura, Egypt
| | - Mohammad Zuhdy
- Department of Surgical Oncology, Mansoura Oncology Center, Mansoura University, Mansoura, Egypt
| | - Hend A El-Hadaad
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Omar Farouk
- Department of Surgical Oncology, Mansoura Oncology Center, Mansoura University, Mansoura, Egypt
| | - Ahmad Senbel
- Department of Surgical Oncology, Mansoura Oncology Center, Mansoura University, Mansoura, Egypt
| | - Adel Fathi
- Department of Surgical Oncology, Mansoura Oncology Center, Mansoura University, Mansoura, Egypt
| | - Emadeldeen Hamed
- Department of Surgical Oncology, Mansoura Oncology Center, Mansoura University, Mansoura, Egypt
| | - Adel Denewer
- Department of Surgical Oncology, Mansoura Oncology Center, Mansoura University, Mansoura, Egypt
| |
Collapse
|
40
|
Piper M, Peled AW, Sbitany H, Foster RD, Esserman LJ, Price ER. Comparison of Mammographic Findings Following Oncoplastic Mammoplasty and Lumpectomy Without Reconstruction. Ann Surg Oncol 2015; 23:65-71. [DOI: 10.1245/s10434-015-4611-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Indexed: 11/18/2022]
|
41
|
Therapeutic mammoplasty allows for clear surgical margins in large and multifocal tumours without delaying adjuvant therapy. Breast 2015; 24:171-4. [DOI: 10.1016/j.breast.2015.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 12/22/2014] [Accepted: 01/08/2015] [Indexed: 10/24/2022] Open
|
42
|
Lee J, Jung JH, Kim WW, Hwang SO, Kang JG, Baek J, Yang JD, Lee JW, Park HY. Oncologic outcomes of volume replacement technique after partial mastectomy for breast cancer: A single center analysis. Surg Oncol 2015; 24:35-40. [DOI: 10.1016/j.suronc.2014.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 11/26/2014] [Accepted: 12/13/2014] [Indexed: 11/28/2022]
|
43
|
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.
Collapse
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
| |
Collapse
|
44
|
Yan H, Wang Y, Wang P, Xie Q, Zhao Q. "Scarless" (in the neck) endoscopic thyroidectomy (SET) with ipsilateral levels II, III, and IV dissection via breast approach for papillary thyroid carcinoma: a preliminary report. Surg Endosc 2014; 29:2158-63. [PMID: 25427410 DOI: 10.1007/s00464-014-3911-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 08/15/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Endoscopic thyroidectomy with level II dissection has previously been reported to be performed endoscopically via various approaches. However, very few reports were available regarding level II dissection performed via the breast approach. In this article, we reported a series of 12 papillary thyroid carcinoma (PTC) patients with scarless (in the neck) endoscopic thyroidectomy (SET) via breast approach to level II dissection and evaluated its feasibility and safety. METHODS Between January 2011 and March 2013, 12 PTC female patients with suspected lymph node metastasis at level II, III, or IV were selected for this procedure. After completing thyroidectomy and central compartment dissection, dissection of ipsilateral levels II, III, and IV was performed. The steps of endoscopic lateral neck dissection were similar to those of conventional surgery except that the lateral cervical compartment was exposed by splitting the sternocleidomastoid muscle (SCM) longitudinally and dividing between the strap muscles and the anterior margin of the SCM. RESULTS This procedure was carried out in all of the 12 patients (Table 1). Mean operative time was 243 min (range 165-355 min). Nine patients (75 %) had lymph node metastasis in the lateral compartment confirmed on the final pathological report. Mean lymph node yield (LNY) in the lateral compartment (including ipsilateral level II, III, and IV dissection) was 21.8 (range 5-42). Five patients (41.6 %) had lymph node metastasis in the ipsilateral level II. The mean LNY in the ipsilateral level II was 6.7 (range 1-14). In 1 of the 12 patients, bleeding from injury to the internal jugular vein in level II was encountered intraoperatively, and a 4-cm upper neck transverse incision was made to stop the bleeding. Average postoperative hospital stay was 5.0 days (range 3-7 days). Table 1 Original article on endoscopic lateral neck dissection (including level II) by other authors Author (Ref.) Year Mean age (years) Tumor size (cm) No. of patients M:F Tech. Type of operation Mean LNY in lateral zone Mean operative time (min) Postoperative bleeding Chyle leakage Mean PHS (days) Wu et al. [13] 2013 43.2 1.88 26 6:20 VAT SLND 8.3 137.7 None None 3.6 Lee et al. [8] 2013 40.2 1.39 62 5:57 Robot MRND 32.8 271.8 None None 6.9 Kang et al. [5] 2012 35.8 1.14 56 10:46 Robot MRND 31.1 277.4 1 5 6 Kang et al. [6] 2011 NA NA 36 NA Robot MRND 27.7 280.91 1 3 NA Kang et al. [4] 2009 NA NA 13 NA AP MRND/SLND 18.8 286 NA NA 5.3 Current article 31.2 1.67 12 0:12 SET SLND 21.8 243 None None 5 Ref. references, No. number, M male, F female, Tech. technique, LNY lymph node yield, PHS postoperative hospital stay, VAT video-assisted thyroidectomy, SLND selective lateral neck dissection, MRND modified radical neck dissection, AP axillary approach, NA not available CONCLUSIONS According to the present SET data, level II dissection by SET was a feasible and safe procedure. With reasonable costs and satisfactory cosmetic results, oncoplastic SET via breast approach might gain wider acceptance in the near future.
Collapse
Affiliation(s)
- Haichao Yan
- Department of Thyroid Surgery, Second Affiliated Hospital, Zhejiang University, Hangzhou, 310009, China,
| | | | | | | | | |
Collapse
|
45
|
Vos EL, Koning AHJ, Obdeijn IM, van Verschuer VMT, Verhoef C, van der Spek PJ, Menke-Pluijmers MB, Koppert LB. Preoperative prediction of cosmetic results in breast conserving surgery. J Surg Oncol 2014; 111:178-84. [PMID: 25332158 DOI: 10.1002/jso.23782] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 08/07/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND Preoperative objective predictions of cosmetic result after breast conserving surgery (BCS) has the potential to aid in surgical treatment decision making. Our aim was to investigate the predictive value of tumor volume in relation to breast volume (TV/BV ratio) for cosmetic result. METHODS Sixty-nine invasive breast cancer women with preoperative MRI and treated by BCS and radiotherapy in 2007-2012 were prospectively included. Simple excision or basic oncoplastic techniques were used, but no volume displacement. TV/BV ratio was measured in the MRI while 3D-projected in virtual reality environment (I-Space). Cosmetic result was assessed by patient questionnaire, panel evaluation, and breast retraction assessment (BRA). Quality-of-life was assessed by EORTC QLQ-C30 and BR23. RESULTS Intraobserver and interobserver correlation coefficients for tumor and breast volume were all >0.95. Increasing TV/BV ratio correlated with decreasing cosmetic result as determined by patient, panel, and BRA. TV/BV ratio was a significant independent predictor for the panel evaluation (P=0.028), as was tumor location (P<0.05), and together they constituted a good prediction model (AUC 0.83). CONCLUSIONS TV/BV ratio was a precise and independent predictor for cosmetic result determined by a panel and can be used as preoperative prediction tool to enable more informed surgical treatment decision making.
Collapse
Affiliation(s)
- Elvira L Vos
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
46
|
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]
|
47
|
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.
Collapse
|
48
|
Kim MK, Kim J, Jung SP, Bae SY, Choi MY, Lee SK, Kim S, Kil WH, Kim SW, Kim JH, Kim JS, Nam SJ, Lee JE. Round block technique without cerclage in breast-conserving surgery. Ann Surg Oncol 2013; 20:3341-7. [PMID: 23975305 DOI: 10.1245/s10434-013-3175-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Round block technique is a unique breast resection through periareolar doughnut incision. However, it is more technically challenging and time consuming. We simplified the procedure by exclusion of round block cerclage. The purpose of this study was to introduce our round block technique without cerclage and to evaluate the results of oncological and cosmetic outcomes. METHODS A total of 92 patients with centrally located breast cancer were treated with breast-conserving surgery using round block technique at Samsung Medical Center from July 2009 to May 2012. All patients had a small breast defect with excised breast volume less than 20 % compared to the total breast volume. We minimized the extent of skin removal and used simple interrupted inverted intradermal sutures without cerclage in doughnut closure. Patient's cosmetic satisfaction was assessed by subjective questionnaires at least 6 months after the operation. RESULTS The median size of tumors was 1.7 cm (range 0.5-5.0 cm). The average distance of the tumors from the nipple was 2.0 cm (range 0.0-4.0 cm) on sonogram and most of the tumors were located upper breast (82.6 %). The median operative time was 101.5 min (range 55-180), including axillary surgeries. Median follow-up was 12.0 months (range 2-36), and none of patients have developed local recurrence. Up to the longest 3 years of follow-up, favorable cosmetic results have been found in patients treated with round block technique. CONCLUSIONS Round block without cerclage is technically easy and feasible for centrally located breast tumors with favorable cosmetic results.
Collapse
Affiliation(s)
- Min Kuk Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Modified radical mastectomy: A pilot clinical trial comparing the use of conventional electric scalpel and harmonic scalpel. Int J Surg 2013; 11:496-500. [DOI: 10.1016/j.ijsu.2013.03.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 03/14/2013] [Accepted: 03/29/2013] [Indexed: 11/24/2022]
|
50
|
A new level 1 oncoplastic technique for breast conserving surgery: Rotation glandular flap. Breast 2013; 22:186-189. [DOI: 10.1016/j.breast.2013.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 12/11/2012] [Accepted: 01/06/2013] [Indexed: 11/22/2022] Open
|