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Kijima Y, Hirata M, Higo N, Nakazawa Y, Shinmura K. Nipple reconstruction using spiral-peeling technique during oncoplastic breast-conserving surgery for a patient with small breasts. Surg Today 2024:10.1007/s00595-024-02892-0. [PMID: 38969868 DOI: 10.1007/s00595-024-02892-0] [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: 05/23/2024] [Accepted: 06/18/2024] [Indexed: 07/07/2024]
Abstract
Treatment of early breast cancer using breast-conserving surgery (BCS) commonly leads to local control and acceptable cosmetic results. We report a useful technique to achieve symmetry of the breast shape and nipple-areola, with excellent results. A Japanese patient with early breast cancer located in the inner central area of the breast was enrolled in this study. Intraductal spread of breast cancer to the nipple was suspected; however, no invasion was observed outside the nipple wall. We preserved the cylindrical surface, but resected the inner tissue with the top surface of the nipple. After coring the nipple, the remnant cylindrical surface was cut into a spiral shape. Nipple reconstruction using the spiral-peeling technique during oncoplastic breast-conserving surgery (OPBCS) may be useful for patients who desire nipple preservation.
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Affiliation(s)
- Yuko Kijima
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Munetsugu Hirata
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Naotomo Higo
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yumika Nakazawa
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Kazuya Shinmura
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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Kim JI, Cheun JH, Jung JG, Kim Y, Lim C, Han Y, Jeon S, Hong KY, Lee HB, Han W. Comparison of Quality of Life and Cosmetic Outcome of Latissimus Dorsi Mini-Flap With Breast Conservation Surgery Without Reconstruction. J Breast Cancer 2023; 26:344-352. [PMID: 37565931 PMCID: PMC10475706 DOI: 10.4048/jbc.2023.26.e33] [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: 05/27/2022] [Revised: 12/29/2022] [Accepted: 07/03/2023] [Indexed: 08/12/2023] Open
Abstract
PURPOSE Latissimus dorsi mini-flap (LDMF) reconstruction after breast-conserving surgery (BCS) is a useful volume replacement technique when a large tumor is located in the upper or outer portion of the breast. However, few studies have reported the impact of LDMF on patients' quality of life (QoL) and cosmesis compared with conventional BCS. METHODS We identified patients who underwent BCS with or without LDMF between 2010 and 2020 at a single center. At least 1 year after surgery, we prospectively administered the BREAST-Q to assess QoL and obtained the patients' breast photographs. The cosmetic outcome was assessed using four panels composed of physicians and the BCCT.core software. RESULTS A total of 120 patients were enrolled, of whom 62 and 58 underwent LDMF or BCS only, respectively. The LDMF group had significantly larger tumors, shorter nipple-to-tumor distances in preoperative examinations, and larger resected breast volumes than did the BCS-only group (p < 0.001). The questionnaires revealed that QoL was poorer in the LDMF group, particularly in terms of the physical well-being score (40.9 vs. 20.1, p < 0.001). Notably, the level of patients' cosmetic satisfaction with their breasts was comparable, and the cosmetic evaluation was assessed by panels and the BCCT.core software showed no differences between the groups. CONCLUSION Our results showed that cosmetic outcomes of performing LDMF are comparable to those of BCS alone while having the advantage of resecting larger volumes of breast tissue. Therefore, for those who strongly wish to preserve the cosmesis of their breasts, LDMF can be considered a favorable surgical option after the patient is oriented toward the potential for physical dysfunction after surgery.
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Affiliation(s)
- Jang-Il Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Ho Cheun
- Department of Surgery, Seoul Metropolitan Government Seoul National University, Boramae Medical Center, Seoul, Korea
| | - Ji Gwang Jung
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yumi Kim
- Department of Surgery, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Changjin Lim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yireh Han
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Sookyoung Jeon
- Department of Surgery, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Ki Yong Hong
- Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Byoel Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea.
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Garreffa E, Meattini I, Coles CE, Agrawal A. Use of tumour bed boost radiotherapy in volume replacement oncoplastic breast surgery: A systematic review. Crit Rev Oncol Hematol 2023; 186:103996. [PMID: 37061072 DOI: 10.1016/j.critrevonc.2023.103996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/03/2023] [Accepted: 04/13/2023] [Indexed: 04/17/2023] Open
Abstract
Tumour bed boost radiotherapy (RT) following breast conserving surgery reduces local recurrence in high-risk disease. There is recent debate over challenges to accurately localise tumour bed for RT boost delivery following volume replacement oncoplastic breast surgery (VR-OBS). This review evaluates the reporting of RT boost following VR-OBS in the literature published between January 2010 and December 2021. This review was in line with Preferred Reporting Items for Systematic Reviews and Metaanalysis statement.Nine studies met the inclusion criteria (n=670 patients), and RT boost was used in eight studies. Boost was administered in total to 384 patients (62.5% of irradiated patients). Only two studies reported boost planned target volumes and only one compared these against surgical specimen volumes.RT boost was not reported in most published studies on VR-OBS. Future prospective research are strongly needed to evaluate long-term outcomes of VR-OBS following RT boost, especially on breast cosmesis and patients' satisfaction. DATA AVAILABILITY: Data will be made available upon request.
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Affiliation(s)
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences M Serio, University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
| | | | - Amit Agrawal
- Breast Unit, Cambridge University Hospitals, Biomedical Campus, Cambridge, UK.
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Gao P, Bai P, Kong X, Fang Y, Gao J, Wang J. Patient-Reported Outcomes and Complications Following Breast Reconstruction: A Comparison Between Biological Matrix-Assisted Direct-to-Implant and Latissimus Dorsi Flap. Front Oncol 2022; 12:766076. [PMID: 35155227 PMCID: PMC8828647 DOI: 10.3389/fonc.2022.766076] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background Implant-based breast reconstruction is increasingly becoming the most common method of postmastectomy breast reconstruction in use today. As the traditional autologous reconstruction technique, latissimus dorsi flap (LDF) is employed by surgeons for reconstruction after breast cancer surgery, including partial mastectomy, modified radical mastectomy, and others. The authors aim to compare patient-reported outcomes (PROs) and complications between the SIS matrix-assisted direct-to-implant (DTI) breast reconstruction and the autologous LDF breast reconstruction. Methods Patients undergoing the SIS matrix-assisted DTI reconstruction or mastectomy with LDF reconstruction or partial mastectomy with mini latissimus dorsi flap (MLDF) reconstruction were enrolled in a single institution from August 2010 to April 2019. Patients were included for analysis and divided into three groups: those who underwent LDF reconstruction, those who underwent MLDF reconstruction, and patients who underwent SIS matrix-assisted DTI breast reconstruction. PROs (using the BREAST-Q version 2.0 questionnaire) and complications were evaluated. Results A total of 135 patients met the inclusion criteria: 79 patients (58.5%) underwent SIS matrix-assisted DTI, 29 patients (21.5%) underwent LDF breast reconstruction, and 27 patients (20%) underwent MLDF breast reconstruction. PROs and complication rates between LDF reconstruction group and MLDF reconstruction group showed no statistically significant differences. Furthermore, BREAST-Q responses found that patients in the whole autologous LDF reconstruction group had better psychosocial well-being, showing a mean score of 84.31 ± 17.28 compared with SIS matrix-assisted DTI reconstruction, with a mean score of 73.52 ± 19.96 (p = 0.005), and expressed higher sexual well-being (69.65 ± 24.64 vs. 50.95 ± 26.47; p = 0.016). But there were no statistically significant differences between the two groups for postoperative complications. Conclusion This retrospective study showed no statistically significant differences between LDF breast reconstruction and MLDF breast reconstruction. However, patients in the whole autologous LDF reconstruction group yielded superior PROs than patients in the SIS matrix-assisted DTI reconstruction group in the psychosocial well-being and sexual well-being domains.
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Affiliation(s)
- Peng Gao
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ping Bai
- Department of The Operation Room, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Fang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jidong Gao
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Raufdeen F, Murphy J, Ahluwalia M, Coroneos CJ, Thoma A. Outcomes in volume replacement and volume displacement techniques in oncoplastic breast conserving surgery: A systematic review. J Plast Reconstr Aesthet Surg 2021; 74:2846-2855. [PMID: 34272177 DOI: 10.1016/j.bjps.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 02/09/2021] [Accepted: 06/02/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Volume Replacement (VR-OBCS) and Volume Displacement Oncoplastic Breast Conserving Surgery (VD-OBCS) are commonly used in the management of breast cancer. Many studies summarize the individual postoperative outcomes of these two procedures; however, there is a lack of research that compares outcomes of these approaches. This review summarizes the available VR and VD-OBCS literature in terms of oncological, cosmetic, and clinical outcomes. METHODS An online literature search (MEDLINE, EMBASE, PubMed, and CINAHL) was performed. Studies were included if they were written in English, had more than 10 adult (18+) female patients who underwent VR-OBCS or VD-OBCS, and reported at least one well-described oncological, clinical, or cosmetic outcome RESULTS: Thirty-three studies (26 VR-OBCS and 7 VD-OBCS) were included in this review; VR-OBCS studies were separated based on the use of latissimus dorsi (LD) flaps. Studies utilizing VR-OBCS with LD flaps reported the highest rate of all oncological outcomes; VR-OBCS studies without LD flaps reported the lowest. Rates of hematoma, seroma, and wound dehiscence were highest in VR-OBCS with LD flaps; partial flap loss and fat necrosis were highest in VR-OBCS without LD flaps and infection was highest in VD-OBCS studies. Inconsistencies in methodology (cosmetic outcome measures, outcome definitions, and time horizons) were found in all procedural groups. CONCLUSION Differences in outcomes for both OBCS procedures may be due to the heterogeneity of patient populations. "Doers" and "Users" of breast oncoplastic research should consider tumor size, laterality of tumor, breast size, measurement scales, and defensible time horizons before the application of a study's conclusions.
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Affiliation(s)
- Fasna Raufdeen
- Department of Science, School of Interdisciplinary Science, McMaster University, Hamilton, ON, Canada
| | - Jessica Murphy
- Department of Surgery, Division of Surgery, McMaster University, Hamilton, ON, Canada
| | - Monish Ahluwalia
- Department of Science, School of Interdisciplinary Science, McMaster University, Hamilton, ON, Canada; Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher J Coroneos
- Department of Surgery, Division of Surgery, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Achilles Thoma
- Department of Surgery, Division of Surgery, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada.
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Afsharfard A, Ebrahimibagha H, Zeinalpour A. A Novel Local Transposition Flap for Lateral Breast Reconstruction After Breast Conserving Surgery. Clin Breast Cancer 2021; 21:e448-e453. [PMID: 33612372 DOI: 10.1016/j.clbc.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast conserving surgery (BCS) followed by radiotherapy is used for the management of early-stage breast cancers. There are different techniques to reconstruct the breast after BCS, each has its own advantages and disadvantages. In this study, we aim to present a novel local transposition flap and report the follow-up results of patients who underwent breast reconstruction using this method in the short and long term. MATERIAL AND METHODS We enrolled 100 patients who underwent BCS in the form of upper or lower outer quadrant lumpectomy with or without axillary lymph node dissection. After lumpectomy, the patients underwent breast reconstruction using the local transposition flap technique. We followed the patients for 1 year, and the satisfaction results are assessed and reported postoperation, after radiochemotherapy, and after 1 year. RESULTS The patients' mean age is 47.6 (±11.7) years, and the mean BMI is 32.4 (±2.5). The duration of hospitalization was 1 day in 96 patients and 2 days in 2 patients. There were 2 patients hospitalized for 3 days. Three patients developed seroma and there were no cases of any other complication. The surgeon and patients satisfaction surveys conducted postop, after the radiochemotherapy course, and 1 year after BCS shows that the excellent and good satisfaction rate is 85%, 85%, and 92% respectively. CONCLUSION We believe that the local transposition flap can be an excellent substitution for the existing methods in the reconstruction of the lateral side breast defects.
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Affiliation(s)
- Abolfazl Afsharfard
- Department of general surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Ebrahimibagha
- Department of general surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Adel Zeinalpour
- Department of general surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Kijima Y, Hirata M, Higo N, Toda H. Oncoplastic breast surgery combining partial mastectomy with V-rotation mammoplasty for breast cancer on the upper inner area of the breast. Surg Today 2020; 51:1241-1245. [PMID: 33033958 DOI: 10.1007/s00595-020-02152-x] [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: 05/29/2020] [Accepted: 09/13/2020] [Indexed: 12/01/2022]
Abstract
The treatment of early breast cancer using breast conservation therapy (BCT) commonly ensures local control and acceptable cosmetic results. We herein report a useful technique for obtaining symmetry of the breast shape and a level inframammary line and nipple-areola that achieved excellent results. Four Japanese patients with early breast cancer located on the upper inner area of the breast were enrolled into this study. De-epithelialized skin close to the resected area and skin from the epigastric area with subdermal fatty tissue were moved to repair the defect. Oncoplastic breast surgery (OBS) combining partial mastectomy with the V-rotation mammoplasty technique was useful for patients with breast cancer on the upper inner area of minimal ptotic breasts.
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Affiliation(s)
- Yuko Kijima
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Munetsugu Hirata
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Naotomo Higo
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Hiroko Toda
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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8
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Kijima Y, Hirata M, Higo N, Toda H, Morise Z, Shinden Y, Natsugoe S. Oncoplastic breast surgery combining partial mastectomy with a triangular skin resection and re-centralization of the nipple-areola. Surg Today 2020; 50:1707-1711. [PMID: 32524271 DOI: 10.1007/s00595-020-02041-3] [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: 02/03/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
The treatment of early breast cancer using breast conservation therapy (BCT) commonly ensures local control and acceptable cosmetic results. We herein report a useful technique to obtain symmetry of the breast shape and a level inframammary line and nipple-areola, which achieved excellent results. Six Japanese patients with early breast cancer located on the upper area of the breast were enrolled into this study. A triangle-shaped area of skin was removed together with cancerous and healthy-surrounding breast tissue. Two crescents were designed and de-epithelialized in the directions of 9 o'clock and 3 o'clock. The width of the crescent was decided to be the same as a half or the length of the base of a triangle to be removed. After partial mastectomy, the inner and outer glandular flaps were horizontally sutured. The operations were simple to perform and were not associated with any postoperative complications. Oncoplastic breast surgery combining partial mastectomy with triangular skin resection and re-centralization of the nipple-areola was useful for patients with breast cancer on the upper quadrant area of non-ptotic breasts.
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Affiliation(s)
- Yuko Kijima
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan. .,Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan. .,Department of General Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Munetsugu Hirata
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.,Department of General Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Naotomo Higo
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.,Department of General Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Hiroko Toda
- Department of Breast Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.,Department of General Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Zenichi Morise
- Department of General Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yoshiaki Shinden
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Shoji Natsugoe
- Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
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Ozmen V, Ilgun S, Celet Ozden B, Ozturk A, Aktepe F, Agacayak F, Elbuken F, Alco G, Ordu C, Erdogan Iyigun Z, Emre H, Pilancı K, Soybir G, Ozmen T. Comparison of breast cancer patients who underwent partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (M + I) regarding quality of life (QOL), cosmetic outcome and survival rates. World J Surg Oncol 2020; 18:87. [PMID: 32370753 PMCID: PMC7201547 DOI: 10.1186/s12957-020-01858-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 04/20/2020] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The latissimus dorsi muscle has long been used in breast cancer (BC) patients for reconstruction. This study aimed to compare early stage BC patients who had partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (MI) with respect to quality of life (QoL), cosmetic outcome (CO), and survival rates. PATIENTS AND METHODS The data of patients who underwent PM + MLDF (Group 1) and M + I (Group 2) between January 2010 and January 2018 were evaluated. Both groups were compared in terms of demographics, clinical and pathological characteristics, surgical morbidity, survival, quality of life, and cosmetic results. The EORTC-QLQ C30 and EORTC-QLO BR23 questionnaires and the Japanese Breast Cancer Society (JBCS) Cosmetic Evaluation Scale were used to assess the quality of life and the cosmetic outcome, respectively. RESULTS A total of 317 patients were included in the study, 242 (76.3%) of them in group 1 and 75 (23.6%) of them in group 2. Median follow-up time was 56 (14-116) months. There were no differences identified between the groups in terms of tumor histology, hormonal receptors and HER-2 positivity, surgical morbidity, and 5-year overall and disease-free survival. Group 2 patients were significantly younger than group 1 (p = 0.003). The multifocality/multicentricity rate was higher in group 2 (p ≤ 0.001), whereas tumor size (p = 0.009), body mass index (BMI, p = 0.006), histological grade (p ≤ 0.001), lymph node positivity (p = 0.002), axillary lymph node dissection (ALND) rate (p = 0.005), and presence of lympho-vascular invasion (LVI, p = 0.013) were significantly higher in group 1. When the quality of life was assessed by using the EORTC QLQ C30 and BR23 questionnaires, it was seen that the body image perception (p < 0.001) and nausea/vomiting score (p = 0.024) were significantly better in PM + MLDF group whereas physical function score was significantly better in M + I group (p = 0.012). When both groups were examined in terms of cosmesis with JBCS Cosmetic Evaluation Scale, good cosmetic evaluation score was significantly higher in patients in MLDF group (p = 0.01). DISCUSSION The results of this study indicate that in comparison to M + I procedure, the PM + MLDF procedure provides significantly superior results in terms of body image and cosmetic result with similar morbidity and oncologic outcomes. In selected patients with small breasts and a high tumor/breast ratio, PM + MLDF may be an alternative to subcutaneous mastectomy and implant.
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Affiliation(s)
- Vahit Ozmen
- Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Istanbul, Turkey
| | - Serkan Ilgun
- Department of General Surgery, School of Medicine, Demiroglu Bilim University, Istanbul, Turkey
| | - Burcu Celet Ozden
- Department of Plastic and Reconstructive Surgery, School of Medicine, Altinbas University, Istanbul, Turkey
| | - Alper Ozturk
- Department of General Surgery, School of Medicine, Biruni University, Istanbul, Turkey
| | - Fatma Aktepe
- Department of Pathology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Filiz Agacayak
- Department of Radiology, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Filiz Elbuken
- Department of Radiology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Gul Alco
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Cetin Ordu
- Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
| | - Zeynep Erdogan Iyigun
- Department of Physical Therapy and Rehabilitation, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Hocaoglu Emre
- Department of Plastic & Reconstructive Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
| | - Kezban Pilancı
- Department of Medical Oncology, Bahcesehir Memorial Hospital, Istanbul, Turkey
| | - Gursel Soybir
- Department of General Surgery, Sisli Memorial Hospital, Istanbul, Turkey
| | - Tolga Ozmen
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida, USA
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10
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Fan KL, Yang S, Park S, Park TH, Song SY, Lee N, Lew DH, Kim MJ, Lee DW. Postoperative Cancer Surveillance Following Oncoplastic Surgery with Latissimus Dorsi Flap: a Matched Case-Control Study. Ann Surg Oncol 2019; 26:4681-4691. [PMID: 31605343 DOI: 10.1245/s10434-019-07898-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The latissimus dorsi (LD) myocutaneous flap is a widely used local option in oncoplastic surgery for avoiding breast deformities; however, concerns exist regarding its influence in monitoring recurrence. In this study, we evaluated the impact of this flap on postoperative cancer surveillance. METHODS Each patient receiving oncoplastic surgery with LD flap after partial mastectomy were matched in age, cancer stage, and body mass index with patients receiving partial mastectomy alone. Twenty-nine patients with the oncoplastic LD flap received 99 mammograms and 139 ultrasonograms, while 29 patients with partial mastectomy alone underwent 92 mammograms and 129 ultrasonograms. Mammographic and ultrasonographic findings were classified by Breast Imaging Reporting and Data System (BI-RADS) category and reviewed. Any recommendations for additional evaluation and recurrence were documented. RESULTS During an average follow-up period of 44 months, although the oncoplastic group demonstrated more newly developed benign calcifications (control 14% vs. oncoplastic 41%; p = 0.019) on mammography, the percentage of recall for additional imaging in category 0, and the short-interval follow-up in category 3, was not different between the control and oncoplastic group. Regarding ultrasonography, BI-RADS category was also not different between the two groups; however, the control group showed more fluid collections than the oncoplastic group (control 21% vs. oncoplastic 0%; p = 0.023). One case of local recurrence was observed in the control group. CONCLUSION Although there was an increase in benign calcifications in the oncoplastic group, there were no additional abnormal findings requiring further intervention. We concluded that the LD flap for oncoplastic surgery does not interfere with cancer surveillance, and even decreases the rate of fluid collection.
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Affiliation(s)
- Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Simon Yang
- Department of Plastic and Reconstructive Surgery, and Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Seho Park
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Tae Hwan Park
- Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Seung Yong Song
- Department of Plastic and Reconstructive Surgery, and Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Nara Lee
- Department of Plastic and Reconstructive Surgery, and Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Hyun Lew
- Department of Plastic and Reconstructive Surgery, and Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Radiology, Research Institute of Radiologic Science, Yonsei University College of Medicine, Seoul, Korea.
| | - Dong Won Lee
- Department of Plastic and Reconstructive Surgery, and Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea.
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11
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Duymaz T, İyigün ZE, İlgün AS, Ordu Ç, Üçüncü M, Alço G, Öztürk A, Elbüken F, Aktepe F, Özmen V. The Effect of Mini-Latissimus Dorsi Flap (MLDF) Reconstruction on Shoulder Function in Breast Cancer Patients. Eur J Breast Health 2019; 15:158-162. [PMID: 31312791 DOI: 10.5152/ejbh.2019.4727] [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: 02/05/2019] [Accepted: 04/01/2019] [Indexed: 11/22/2022]
Abstract
Objective The aim of this study is to investigate the effect of mini latissimus dorsi flap (MLDF) reconstruction on ipsilateral shoulder functions. Materials and Methods Those included in the study are the patients aged between 23 and 73, who were operated with the diagnosis of early breast cancer (cT1-3)N0). The first group includes the patients who had sentinel lymph node biopsy (SLNB) with partial mastectomy. The second group consists of the patients who had axillary lymph nodule dissection (ALND) with partial mastectomy. The third group includes the patients who had SLNB and MLDF with partial mastectomy. The fourth group includes the patients who had ALND and MLDF with partial mastectomy. Patients' Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score work model point were recorded. Results 174 patients were included in this study. According to Q-DASH score, no functional change was detected in 69.5% of the patients, whereas slight functional loss was identified in 23.6%, moderate functional loss in 5.7%, severe functional loss 1.1%. In the comparison of Q-DASH scores in surgery groups, while these four groups were being analyzed, a significant difference was determined (p=0.007). When dual analyses were made, it was also established that the difference resulted from the group to which ALND and MLDF were applied together. Conclusion We conclude that MLDF application for reconstruction purposes after breast surgery has a negative impact on shoulder functions of the patients who had both of partial mastectomy and ALND.
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Affiliation(s)
- Tomris Duymaz
- Department of Physiotherapy and Rehabilitation, İstanbul Bilgi University School of Health Sciences, İstanbul, Turkey
| | - Zeynep Erdoğan İyigün
- Department of Physiotherapy and Rehabilitation, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Ahmet Serkan İlgün
- Department of General Surgery, Taksim Training and Research Hospital, İstanbul, Turkey
| | - Çetin Ordu
- Department of Medical Oncology, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Muhammed Üçüncü
- Centre of Breast Health, İstanbul Florence Nightingale Hospital, İstanbul, Turkey
| | - Gül Alço
- Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Alper Öztürk
- Department of General Surgery, Biruni University School of Medicine, İstanbul, Turkey
| | - Filiz Elbüken
- Departmment of Radiology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Fatma Aktepe
- Department of Pathology, Gayrettepe Florence Nightingale Hospital, İstanbul, Turkey
| | - Vahit Özmen
- Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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12
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Zhou L, Wang Y, Cai R, Huang J, Li X, Xie Z, Wang J, Sun Y, Chang EI, Tang J. Pedicled descending branch latissimus dorsi mini‐flap in repairing partial mastectomy defect: Shoulder functional and esthetic outcomes. J Surg Oncol 2019; 120:518-526. [DOI: 10.1002/jso.25524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/10/2019] [Accepted: 05/14/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Lihuan Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer Center Guangzhou People's Republic of China
- Department of Breast OncologySun Yat‐sen University Cancer Center Guangzhou People's Republic of China
| | - Yan Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer Center Guangzhou People's Republic of China
- Department of Breast OncologySun Yat‐sen University Cancer Center Guangzhou People's Republic of China
| | - Ruizhao Cai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer Center Guangzhou People's Republic of China
- Department of Breast OncologySun Yat‐sen University Cancer Center Guangzhou People's Republic of China
| | - Junhao Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer Center Guangzhou People's Republic of China
- Department of Breast OncologySun Yat‐sen University Cancer Center Guangzhou People's Republic of China
| | - Xing Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer Center Guangzhou People's Republic of China
- Department of Breast OncologySun Yat‐sen University Cancer Center Guangzhou People's Republic of China
| | - Zeming Xie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer Center Guangzhou People's Republic of China
- Department of Breast OncologySun Yat‐sen University Cancer Center Guangzhou People's Republic of China
| | - Jin Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer Center Guangzhou People's Republic of China
- Department of Breast OncologySun Yat‐sen University Cancer Center Guangzhou People's Republic of China
| | - Ya Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer Center Guangzhou People's Republic of China
- Department of Breast OncologySun Yat‐sen University Cancer Center Guangzhou People's Republic of China
| | - Edward I. Chang
- Department of Plastic SurgeryMD Anderson Cancer Center Houston Texas
| | - Jun Tang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer Center Guangzhou People's Republic of China
- Department of Breast OncologySun Yat‐sen University Cancer Center Guangzhou People's Republic of China
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13
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The Latissimus Dorsi Myocutaneous Flap Is a Safe and Effective Method of Partial Breast Reconstruction in the Setting of Breast-Conserving Therapy. Plast Reconstr Surg 2019; 143:927e-935e. [PMID: 31033814 DOI: 10.1097/prs.0000000000005577] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reconstruction of partial breast defects in low-volume, nonptotic breasts can be challenging. The authors hypothesized that use of the latissimus dorsi flap in partial breast reconstruction is safe and associated with low complication and high patient satisfaction rates. METHODS All patients who underwent breast-conserving therapy and latissimus dorsi flap reconstruction from January 1, 2006, to December 31, 2016, were identified in a prospectively maintained database. Patient demographics, tumor characteristics, and complications were recorded. Patient-reported outcomes were assessed with the BREAST-Q breast-conserving therapy module. A group of plastic surgeons and laypersons used a five-point Likert scale to evaluate aesthetic outcomes in representative patients. RESULTS Forty-seven patients met the inclusion criteria. Median follow-up was 5.4 years. Most patients (93.6 percent) underwent immediate reconstruction. The mean resection volume was 219.5 cc (range, 70 to 877 cc). The overall complication rate was 8.5 percent. Grade 2 or 3 ptosis (OR, 1.21; 95 percent CI, 1.0 to 1.46; p = 0.03), smoking (OR, 13.1; 95 percent CI, 1.2 to 143.2; p = 0.03), and multicentric tumor (OR, 1.23; 95 percent CI, 1.04 to 1.64; p = 0.02) were associated with a higher complication rate. Ductal carcinoma in situ was associated with reoperation for positive margins (OR, 14.4; 95 percent CI, 2.1 to 100; p = 0.009). Of particular interest, patient-reported outcomes were favorable, with the highest rated domains being Satisfaction with Breasts (61; interquartile range, 37 to 77), Psychosocial Well-being (87; interquartile range, 63 to 100), and Physical Well-being (87; interquartile range, 81 to 100). The median aesthetic score was 4 (of 5). CONCLUSIONS This is the first study to date using the BREAST-Q to assess patient-reported outcomes associated with the latissimus dorsi flap for partial breast reconstruction. The flap is safe and effective for reconstruction in the setting of breast-conserving therapy, providing aesthetically pleasing results with high patient satisfaction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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14
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Bordoni D, Cadenelli P, Ornelli M, Falco G, Accurso A, Gloria A, Maietta S, Rocco N, Magalotti C. The axillary flap in oncoplastic resection of breast cancers located in the upper-outer quadrants: a new surgical technique. BMC Surg 2019; 18:21. [PMID: 31074383 PMCID: PMC7402579 DOI: 10.1186/s12893-018-0467-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/29/2018] [Indexed: 11/19/2022] Open
Abstract
Background The combination of breast conserving surgery (BCS) with plastic surgery techniques has provided a useful surgical tool matching the radicality of the oncological excision with the preservation of breast cosmesis. Even though BCS represents a good option for surgical treatment of tumors located in these quadrants, wide excisions often necessitate breast reshaping in order to avoid nipple areola complex (NAC) displacement and skin retraction. We present a new surgical technique to repair upper-outer quadrants’ defects following breast cancer excision using dermo-glandular flaps and an axillary adipo-fascial flap. Methods During the period from January 2014 to December 2015, 168 patients with an upper-outer quadrant’s breast cancer have been treated in our Department. 83 women have been treated with the described oncoplastic technique and immediate contra-lateral symmetrisation and 85 women underwent standard BCS. We present surgical, oncological and cosmetic outcomes comparing our results with standard BCS. Results At a mean follow-up of 27 months loco-regional recurrences in the two groups were comparable. Short-term complication rates were comparable between the two groups. Re-intervention rates for positive margins were significantly higher in the standard BCS group. The overall satisfaction with cosmetic outcome both assessed by the patient and the surgeon was significantly higher in the oncoplastic group. Conclusions The proposed oncoplastic technique represents a safe and effective solution for reshaping that follows upper-outer breast cancer wide excision, achieving comparable complication rates, lower re-intervention rates for positive margins and better cosmetic results when compared with standard BCS.
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Affiliation(s)
- Daniele Bordoni
- Department of Senology, Ospedale Santa Maria della Misericordia Urbino, Asur marche Area Vasta 1, Urbino, Italy
| | | | - Matteo Ornelli
- Department of Plastic Surgery, Marche Politechnic University, Ancona, Italy
| | - Giuseppe Falco
- Breast Surgery Unit, IRCCS-Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42123, Reggio Emilia, Italy
| | - Antonello Accurso
- Department of Surgery, Breast Unit, University of Naples Federico II, Naples, Italy
| | - Antonio Gloria
- Institute of Polymers, Composites and Biomaterials, National Research Council of Italy, Viale J.F. Kennedy 54, Mostra d'Oltremare Pad. 20, 80125, Naples, Italy
| | - Saverio Maietta
- Department of Industrial Engineering, Fraunhofer JL IDEAS, University of Naples Federico II, P.le Tecchio 80, 80125, Naples, Italy
| | - Nicola Rocco
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S.Pansini, 5, 80131, Naples, Italy.
| | - Cesare Magalotti
- Department of Senology, Ospedale Santa Maria della Misericordia Urbino, Asur marche Area Vasta 1, Urbino, Italy
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15
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Aristokleous I, Saddiq M. Quality of life after oncoplastic breast-conserving surgery: a systematic review. ANZ J Surg 2019; 89:639-646. [PMID: 30977582 DOI: 10.1111/ans.15097] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 12/11/2018] [Accepted: 01/07/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Oncoplastic breast-conserving surgery (OBCS) has gained increasing attention as a treatment option for early breast cancer patients, aiming to achieve the best possible breast symmetry with concomitant oncological safety. This paper aims to systematically review the current literature on patient quality of life (QoL) after OBCS compared with QoL after breast-conserving surgery (BCS) alone. METHODS MEDLINE via Ovid, CINAHL via EBSCO and PsycINFO via OvidSP were searched to retrieve all relevant studies. The reference lists of identified eligible studies were manually examined to search for additional eligible studies. The methodological quality of the included studies was assessed using the Critical Appraisal Skills Programme. RESULTS A total of six articles met the inclusion criteria. Most of the studies used validated patient-reported outcome measures for assessing QoL with good response rates. However, only one study was of sufficiently good quality to provide good evidence (P < 0.05) in favour of OBCS, while the remainder were of low to moderate quality with differences in outcomes that were not statistically significant. CONCLUSION The review found that the current evidence base is limited and not adequate enough to support or to reject the assumption that OBCS is associated with improved QoL when compared with QoL post-BCS. However, the majority of studies show that OBCS is associated with a trend towards better patient QoL. The impact of OBCS on patient QoL needs to be more adequately investigated. Large prospective cohort studies to assess the impact of OBCS on QoL compared with QoL post-BCS are strongly recommended.
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Affiliation(s)
- Iliana Aristokleous
- Department of Surgery, Enköpings Hospital, Enköping, Uppsala County, Sweden.,School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Muhammad Saddiq
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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16
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Papanikolaou IG, Dimitrakakis C, Zagouri F, Marinopoulos S, Giannos A, Zografos E, Zografos CG, Kritikou D, Rodolakis A, Zografos GC, Loutradis D. Paving the way for changing perceptions in breast surgery: a systematic literature review focused on oncological and aesthetic outcomes of oncoplastic surgery for breast cancer. Breast Cancer 2019; 26:416-427. [PMID: 30955172 DOI: 10.1007/s12282-019-00968-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 03/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The emphasis on aesthetic outcomes and quality of life after breast cancer surgery has motivated breast surgeons to develop oncoplastic breast conserving surgery (OPS). Training programs are still rare in most countries, and there is little standardization, which challenges the scientific evaluation of these techniques. This systematic review aims to assess oncological and cosmetic outcomes of OPS. METHODS After a strict selection process with precise inclusion and exclusion criteria, oncologic and aesthetic outcomes of oncoplastic surgery were searched, using the MEDLINE database up to September 30th, 2017. Available published literature was classified in levels of evidence. After a thorough screening process, only studies with the best level of evidence were included on selection. Systematic reviews and meta-analyses were not included for methodological reasons. RESULTS Titles and abstracts of 2.854 citations were identified and after screening 15 prospective studies including 1.391 patients were reviewed and scored in detail. Local relapse was found in 2.8% of cases with a wide range of follow-up (from 6 to 74 months). Close margins were retrieved in 11% of cases and positive margins in 9.4% of cases. Mastectomy was implemented in 6.9% of breast cancer patients to whom OPS was performed. Good cosmetic outcomes were detected in 90.2% of patients undergoing OPS, leaving open issues for who should perform cosmetic evaluation and which method should be used. CONCLUSION Tumor margins, mastectomy rates, and cosmetic outcomes of OPS have to be further improved by standardizing various aspects of OPS. Research efforts should focus on level I evidence assessing both oncological and aesthetic outcomes of OPS and survival rates.
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Affiliation(s)
- I G Papanikolaou
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece.
| | - C Dimitrakakis
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
| | - F Zagouri
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - S Marinopoulos
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
| | - A Giannos
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
| | - E Zografos
- 1st Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - C G Zografos
- 1st Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - D Kritikou
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Rodolakis
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
| | - G C Zografos
- 1st Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - D Loutradis
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
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17
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Pedicled Descending Branch Latissimus Dorsi Mini-flap for Repairing Partial Mastectomy Defect: A New Technique. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1692. [PMID: 29707452 PMCID: PMC5908510 DOI: 10.1097/gox.0000000000001692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/12/2018] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Volume loss is 1 of the major factors influencing cosmetic outcomes of breast after partial mastectomy (PM), especially for smaller breasts, and therefore, volume replacement is critical for optimizing the final aesthetic outcome. We present a novel technique of raising a pedicled descending branch latissimus dorsi (LD) mini-flap for reconstruction of PM defects via an axillary incision. After PM, the LD mini-flap is harvested through the existing axillary incision of the axillary dissection or the sentinel lymph node biopsy. The descending branches of thoracodorsal vessels and nerve are carefully identified and isolated. The transverse branches are protected to maintain muscle innervation and function. The LD muscle is then undermined posteriorly and inferiorly to create a submuscular pocket and a subcutaneous pocket between LD muscle and superficial fascia. Once the submuscular plane is created, the muscle is divided along the muscle fibers from the deep surface including a layer of fat above the muscle. Finally, the LD mini-flap is transferred to the breast defect. Given the limited length and mobility of the LD mini-flap, this approach is best utilized for lateral breast defects. However, for medial defects, the lateral breast tissue is rearranged to reconstruct the medial breast defect, and an LD mini-flap is then used to reconstruct the lateral breast donor site. This technique can therefore be employed to reconstruct all quadrants of the breast and can provide aesthetic outcomes without scars on the back, with minimal dysfunction of LD muscle.
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18
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Abstract
INTRODUCTION Latissimus dorsi (LD) flap has been used for reconstructive purposes in oncoplastic breast surgery. Using large part of the muscle as a flap leads to a residual functional loss. Muscle sparing and mini LD flaps can be used with no functional sequelae. However, the design of such flap presents a challenge. METHODS Twenty cadavers were dissected on both sides to identify the different vascular patterns of the thoracodorsal (TD) pedicle. The vessels were counted, and the following measurements were taken: diameter, length, distance from inferior angel of scapula, and vertebral level. Data were collected and entered into the personal computer. Statistical analysis was done using (SPSS/version 20) software. RESULTS Five vascular patterns of TD pedicle were found. Type 1: a long vertically descending pedicle giving 3 to 4 transverse medial branches to LD in 40%. Type 2: a short pedicle terminating into 1 to 2 serratus anterior collaterals and 1 to 2 transverse lateral branches to LD in 10%. Type 3: a long vertically descending pedicle giving 2 to 3 small lateral branches to upper part of LD and terminating into medial and lateral branches in the lower part of LD in 10%. Type 4: a short pedicle that gives 4 to 5 terminal branches to LD, one of them is a long vertically descending branch to lower part of LD in 20%. Type 5: a short pedicle that terminates into a transverse medial and a long vertical branch to LD in 20%. CONCLUSION The classically described pattern of TD pedicle (type 5) was found in 20% of cases, whereas the most commonly found pattern was type 1. This means that the pattern of TD branching is unpredictable, and a preoperative ultrasound is essential to define the existing pattern and plan the best LD flap design for each patient. In types 1 and 5, the flap can be designed using the transverse medial branch or branches. In type 2, one of the lateral transverse branches can be used. In types 3, 4, and 5, the long descending vertical branch can be used. It has a sizeable diameter (1.80.23 mm), length (12.31.64 cm), and can be located 6.50.96 cm below the inferior angle of scapula.
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19
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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
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20
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Honart JF, Reguesse AS, Struk S, Sarfati B, Rimareix F, Alkhashnam H, Kolb F, Rem K, Leymarie N. Indications and Controversies in Partial Mastectomy Defect Reconstruction. Clin Plast Surg 2017; 45:33-45. [PMID: 29080658 DOI: 10.1016/j.cps.2017.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Breast cancer surgical treatment nowadays includes oncoplastic surgery. It is a reliable oncologic surgical treatment, which also prevents functional and aesthetic sequelae, thus improving the patient's quality of life and satisfaction. Numerous techniques have been described, with different levels of complexity and technicality. Their indications differ depending on the global breast volume and the degree of ptosis, on the tumor volume compared with the breast volume, and on the tumor location. This article describes the authors' many years of experience of breast cancer treatment using oncoplastic surgery. They also established a decision-making guide, whose implementation enables treatment of every patient.
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Affiliation(s)
- Jean-François Honart
- Plastic and Reconstructive Surgery Department, Gustave Roussy, 114, Rue Edouard Vaillant, Villejuif 94800, France.
| | - Anne-Sophie Reguesse
- Plastic and Reconstructive Surgery Department, Gustave Roussy, 114, Rue Edouard Vaillant, Villejuif 94800, France
| | - Samuel Struk
- Plastic and Reconstructive Surgery Department, Gustave Roussy, 114, Rue Edouard Vaillant, Villejuif 94800, France
| | - Benjamin Sarfati
- Plastic and Reconstructive Surgery Department, Gustave Roussy, 114, Rue Edouard Vaillant, Villejuif 94800, France
| | - Françoise Rimareix
- Plastic and Reconstructive Surgery Department, Gustave Roussy, 114, Rue Edouard Vaillant, Villejuif 94800, France
| | - Heba Alkhashnam
- Plastic and Reconstructive Surgery Department, Gustave Roussy, 114, Rue Edouard Vaillant, Villejuif 94800, France
| | - Frédéric Kolb
- Plastic and Reconstructive Surgery Department, Gustave Roussy, 114, Rue Edouard Vaillant, Villejuif 94800, France
| | - Kessara Rem
- Plastic and Reconstructive Surgery Department, Gustave Roussy, 114, Rue Edouard Vaillant, Villejuif 94800, France
| | - Nicolas Leymarie
- Plastic and Reconstructive Surgery Department, Gustave Roussy, 114, Rue Edouard Vaillant, Villejuif 94800, France
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21
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Roy PG, Tenovici AA. Staged approach to partial breast reconstruction to avoid mastectomy in women with breast cancer. Gland Surg 2017; 6:336-342. [PMID: 28861373 DOI: 10.21037/gs.2017.03.08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The lateral chest wall perforator flaps (CWPF) offer an excellent option for partial breast reconstruction (PBR) in women undergoing breast conservation surgery (BCS) for laterally placed tumours in small to moderate non-ptotic breasts. METHODS A total of 20 patients underwent PBR with lateral CWPF over the last 4 years, as two-stage approach. This approach was undertaken for patients with high tumour to breast ratio (>30% predicted resection) in an attempt to avoid mastectomy. The reconstruction was carried out 2-4 weeks after wide local excision in order to ensure clear margins prior to undertaking PBR. RESULTS Twenty-three women were selected for attempt at BCS with 2-stage approach. Three patients had extensive disease so they were then counseled for mastectomy after the first surgery and 20 patients had successful BCS. Out of 20 patients, 13 were symptomatic and 7 were screen-detected with mean age of 49 years. The median tumour size on pre-op imaging was 43 mm (23-75 mm). A percentage of 50% women with unifocal cancers undergoing primary surgery had disease overestimated on pre-op imaging. The complication rate was low. Good to excellent aesthetic outcomes were reported in 90% cases. Patients reported high satisfaction scores. CONCLUSIONS We recommend considering two-stage approach in selected women with high tumour-breast ratio to ensure successful BCS prior to PBR. This approach facilitates BCS and avoids mastectomy in borderline cases, particularly lobular cancers, DCIS, bifocal cancers and post neoadjuvant chemotherapy where pre-operative disease estimation could be challenging. Our small series has shown that this approach results in safe oncological surgery with good aesthetic outcomes in the selected group of women.
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Affiliation(s)
- Pankaj G Roy
- Department of Breast Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS foundation Trust, Oxford, UK
| | - Alexandra A Tenovici
- Department of Breast Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS foundation Trust, Oxford, UK
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Carstensen L. The over-Wise mammoplasty: a modified Wise pattern for large superficial breast tumors. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017. [DOI: 10.1007/s00238-016-1236-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ho W, Stallard S, Doughty J, Mallon E, Romics L. Oncological Outcomes and Complications After Volume Replacement Oncoplastic Breast Conservations-The Glasgow Experience. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2016; 10:223-228. [PMID: 28008267 PMCID: PMC5170883 DOI: 10.4137/bcbcr.s41017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 10/30/2016] [Accepted: 10/31/2016] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Oncoplastic breast conservation surgery (OBCS) combines the principles of surgical oncology and plastic surgery. OBCS has now become a growing option for the treatment of breast cancer and forms a part of breast-conserving therapy (BCT). We sought to investigate and report our experience in two breast units in Glasgow (Victoria Infirmary and Western Infirmary) on volume replacement OBCS. MATERIALS AND METHODS Details of patients treated with volume replacement OBCS were identified from a prospectively recorded database from November 2010 to October 2015. The clinical records included in the oncoplastic dataset were analyzed for demographics, tumor, treatment characteristics, and recurrences. The data were analyzed for follow-up to determine the pattern and timing of recurrence up to April 2016. The primary outcome of this study was tumor-free margin resection rates, and the secondary outcomes were locoregional and distant recurrence rates as these correlate with the overall oncological safety of volume replacement oncoplastic breast surgery (OPBS). RESULTS A total of 30 volume replacement oncoplastic breast conservation procedures have been carried out in this time period. The mean age of the former group was 51 years. Twice as many patients presented symptomatically than had tumors detected on screening. The mean preoperative tumor size on radiology was 25.4 mm. Patients underwent 13 thoracoepigastric flaps, 5 lateral intercostal artery perforator (LICAP) flaps, 2 thoracodorsal artery perforator (TDAP) flaps, 1 lateral thoracic artery perforator (LTAP) flap, 1 crescent flap volume replacement surgery, and 8 matrix rotations. Two patients had neoadjuvant chemotherapy. Fourteen patients had adjuvant chemotherapy, and all patients were treated with adjuvant radiotherapy. Twenty-two patients were treated with hormonal therapy and four patients were treated with Herceptin. The rate of incomplete excision was 10%. Median follow-up time was 48.5 months. Only one regional recurrence was detected. Eight patients encountered some form of complication. CONCLUSION This study continues to show the relative oncological safety of volume replacement oncoplastic conservations as an option for reconstruction in breast cancer patients. Further research is urgently needed to build robust evidence supporting the long-term oncological safety.
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Affiliation(s)
- Weiguang Ho
- The New Victoria Infirmary, Glasgow, Scotland, UK
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Alço G, Igdem S, Okkan S, Dincer M, Sarsenov D, Ilgun AS, Agacayak F, Elbüken F, Ercan T, Selamoglu D, Ozmen V. Replacement of the tumor bed following oncoplastic breast-conserving surgery with immediate latissimus dorsi mini-flap. Mol Clin Oncol 2016; 5:365-371. [PMID: 27699027 PMCID: PMC5038510 DOI: 10.3892/mco.2016.984] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 04/25/2016] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to evaluate the geographic variability of the tumor bed following oncoplastic breast-conserving surgery (OP-BCS), and to assess its relevance for radiotherapy planning. In this prospective study, pre- and postoperative computerized tomography (CT) scans of 22 patients with early-stage breast cancer were fused. The preoperative gross tumor volume or excisional biopsy cavity were contoured under the guidance of preoperative radiological images. Postoperative lumpectomy cavities were contoured under the guidance of surgical clips. The conformity index (CI) was calculated and defined on a scale between 0 and 1, where 0 indicated no overlap and 1 indicated 100% concordance. Associations between CI and the number of clips, time interval between surgery and CT scans, pathological tumor size and age were assessed using independent sample testing. The median CI was 0.07 (in five cases, 1, and in eight cases, 0). The lumpectomy cavity shifted from the primary location in 36.4% of the cases. Median shifts between the isocenters of pre- and postoperative volumes were measured as 1.02 cm (range, 0.4-4.43 cm) in the x, 1.07 cm (range, 0.05-5.67 cm) in the y, and 1.12 cm (range, 0-3.75 cm) in the z directions. Only the clip number was determined to be significantly associated with CI (P=0.017). Pre- and postoperative tumor bed volumes were fully superposed in five of the 22 cases. The present study has shown that the tumor bed is markedly replaced following OP-BCS with latissimus dorsi mini-flap (LDMF) reconstruction. Special care should therefore be taken when defining the lumpectomy cavity following OP-BCS with LDMF reconstruction.
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Affiliation(s)
- Gül Alço
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Istanbul 34349, Turkey
| | - Sefik Igdem
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Istanbul 34349, Turkey
| | - Sait Okkan
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Istanbul 34349, Turkey
| | - Maktav Dincer
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Istanbul 34349, Turkey
| | - Dauren Sarsenov
- Department of Breast Surgery, Florence Nightingale Istanbul Hospital, Istanbul 34387, Turkey
| | - Ahmet Serkan Ilgun
- Department of Breast Surgery, Florence Nightingale Istanbul Hospital, Istanbul 34387, Turkey
| | - Filiz Agacayak
- Department of Radiodiagnostics, Florence Nightingale Istanbul Hospital, Istanbul 34387, Turkey
| | - Filiz Elbüken
- Department of Radiodiagnostics, Florence Nightingale Istanbul Hospital, Istanbul 34387, Turkey
| | - Tulay Ercan
- Department of Radiation Oncology, Florence Nightingale Gayrettepe Hospital, Istanbul 34349, Turkey
| | - Derya Selamoglu
- Department of Breast Surgery, Florence Nightingale Istanbul Hospital, Istanbul 34387, Turkey
| | - Vahit Ozmen
- Department of Breast Surgery, Florence Nightingale Istanbul Hospital, Istanbul 34387, Turkey
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Yiannakopoulou E, Mathelin C. Oncoplastic breast conserving surgery and oncological outcome: Systematic review. Eur J Surg Oncol 2016; 42:625-30. [DOI: 10.1016/j.ejso.2016.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 01/02/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022] Open
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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.
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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
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Trends in Immediate Postmastectomy Breast Reconstruction in the United Kingdom. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e507. [PMID: 26495220 PMCID: PMC4596432 DOI: 10.1097/gox.0000000000000484] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/13/2015] [Indexed: 12/20/2022]
Abstract
Background: The study aimed to evaluate local and national trends in immediate breast reconstruction (IBR) using the national English administrative records, Hospital Episode Statistics. Our prediction was an increase in implant-only and free flap procedures and a decline in latissimus flap reconstructions. Methods: Data from an oncoplastic center were interrogated to derive numbers of implant-only, autologous latissimus dorsi (LD), LD-assisted, and autologous pedicled or free flap IBR procedures performed between 2004 and 2013. Similarly, Hospital Episode Statistics data were used to quantify national trends in these procedures from 1996 to 2012 using a curve fitting analysis. Results: National data suggest an increase in LD procedures between 1996 (n = 250) and 2002 (n = 958), a gradual rise until 2008 (n = 1398) followed by a decline until 2012 (n = 1090). As a percentage of total IBR, trends in LD flap reconstruction better fit a quadratic (R2 = 0.97) than a linear function (R2 = 0.63), confirming a proportional recent decline in LD flap procedures. Conversely, autologous (non-LD) flap reconstructions have increased (1996 = 0.44%; 2012 = 2.76%), whereas implant-only reconstructions have declined (1996 = 95.42%; 2012 = 84.92%). Locally, 70 implant-assisted LD procedures were performed in 2003 -2004, but only 2 were performed in 2012 to 2013. Conclusions: Implants are the most common IBR technique; autologous free flap procedures have increased, and pedicled LD flap procedures are in decline.
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Santos G, Urban C, Edelweiss MI, Zucca-Matthes G, de Oliveira VM, Arana GH, Iera M, Rietjens M, de Lima RS, Spautz C, Kuroda F, Anselmi K, Capp E. Long-Term Comparison of Aesthetical Outcomes After Oncoplastic Surgery and Lumpectomy in Breast Cancer Patients. Ann Surg Oncol 2015; 22:2500-2508. [DOI: 10.1245/s10434-014-4301-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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29
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Clough KB, Benyahi D, Nos C, Charles C, Sarfati I. Oncoplastic Surgery: Pushing the Limits of Breast-Conserving Surgery. Breast J 2015; 21:140-6. [DOI: 10.1111/tbj.12372] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Claude Nos
- L'Institut du Sein - Paris Breast Center; Paris France
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30
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Emiroğlu M, Sert İ, İnal A, Karaali C, Peker K, İlhan E, Gülcelik M, Erol V, Güngör H, Can D, Aydın C. The approach of general surgeons to oncoplastic and reconstructive breast surgery in Turkey: a survey of practice patterns. Balkan Med J 2015; 31:307-12. [PMID: 25667784 DOI: 10.5152/balkanmedj.2014.13230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/23/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Oncoplastic Breast Surgery (OBS), which is a combination of oncological procedures and plastic surgery techniques, has recently gained widespread use. AIMS To assess the experiences, practice patterns and preferred approaches to Oncoplastic and Reconstructive Breast Surgery (ORBS) undertaken by general surgeons specializing in breast surgery in Turkey. STUDY DESIGN Cross-sectional study. METHODS Between December 2013 and February 2014, an eleven-question survey was distributed among 208 general surgeons specializing in breast surgery. The questions focused on the attitudes of general surgeons toward performing oncoplastic breast surgery (OBS), the role of the general surgeon in OBS and their training for it as well as their approaches to evaluating cosmetic outcomes in Breast Conserving Surgery (BCS) and informing patients about ORBS preoperatively. RESULTS Responses from all 208 surgeons indicated that 79.8% evaluated the cosmetic outcomes of BCS, while 94.2% informed their patients preoperatively about ORBS. 52.5% performed BCS (31.3% themselves, 21.1% together with a plastic surgeon). 53.8% emphasized that general surgeons should carry out OBS themselves. 36.1% of respondents suggested that OBS training should be included within mainstream surgical training, whereas 27.4% believed this training should be conducted by specialised centres. CONCLUSION Although OBS procedure rates are low in Turkey, it is encouraging to see general surgeons practicing ORBS themselves. The survey demonstrates that our general surgeons aspire to learn and utilize OBS techniques.
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Affiliation(s)
- Mustafa Emiroğlu
- Department of General Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
| | - İsmail Sert
- Department of General Surgery, Van Regional Training and Research Hospital, Van, Turkey
| | - Abdullah İnal
- Department of General Surgery, Erzincan University, Mengücek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Cem Karaali
- Department of General Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Kemal Peker
- Department of General Surgery, Erzincan University, Mengücek Gazi Training and Research Hospital, Erzincan, Turkey
| | - Enver İlhan
- Department of General Surgery, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Mehmet Gülcelik
- Department of General Surgery, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Varlık Erol
- Department of General Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Hilmi Güngör
- Department of General Surgery, Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Didem Can
- Department of General Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Cengiz Aydın
- Department of General Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
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Tan V, Cornford E, McCulley S, Macmillan R. Qualitative mammographic findings and outcomes of surveillance mammography after partial breast reconstruction with an autologous flap. J Surg Oncol 2014; 111:377-81. [DOI: 10.1002/jso.23838] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 10/18/2014] [Indexed: 11/08/2022]
Affiliation(s)
- V.K. Tan
- Nottingham City Hospital; Nottingham United Kingdom
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Abstract
UNLABELLED When immediate reconstruction is applied to breast conservation therapy (BCT), the benefits extend well beyond the minimization of poor cosmetic results. The purpose of this analysis was to compare literature outcomes between BCT alone and BCT with the oncoplastic approach. METHODS A meta-analysis was performed in PubMed using key words "oncoplastic," "partial breast reconstruction," and "breast conservation therapy." Case reports, series with less than 10 patients, and those with less than 1-year follow-up were excluded from the analysis. The 3 comparative groups included BCT with oncoplastic reduction techniques (Group A), BCT with oncoplastic flap techniques (Group B), and BCT alone (Group C). RESULTS Comparisons were made on 3165 patients in the BCT with oncoplastic group (Groups A and B, 41 papers) and 5494 patients in the BCT alone group (Group C, 20 papers). Demographics were similar, and tumor size was larger in the oncoplastic group (2.7 vs 1.2 cm). The weight of the lumpectomy specimen was 4 times larger in the oncoplastic group. The positive margin rate was significantly lower in the oncoplastic group (12% vs 21%, P < 0.0001). Reexcision was more common in the BCT alone group (14.6% vs 4%, P < 0.0001), however, completion mastectomy was more common in the oncoplastic group (6.5% vs 3.79%, P < 0.0001). The average follow-up was longer in the BCT alone group (64 vs 37 months). Local recurrence was 4% in the oncoplastic group and 7% in the BCT alone group. Satisfaction with the aesthetic outcome was significantly higher in the oncoplastic group (89.5% vs 82.9%, P < 0.001). CONCLUSIONS The oncoplastic approach to BCT allows a generous resection with subsequent reduction in positive margins. The true value on local recurrence remains to be determined. Patients are more satisfied with outcomes when the oncoplastic approach is used.
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Bogusevicius A, Cepuliene D, Sepetauskiene E. The integrated evaluation of the results of oncoplastic surgery for locally advanced breast cancer. Breast J 2013; 20:53-60. [PMID: 24237716 DOI: 10.1111/tbj.12222] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The optimal surgical management of locally advanced breast cancer (LABC) remains undefined. The aim of the study was to obtain long-term results of oncoplastic surgery in terms of overall survival, loco-regional recurrence, and quality of life in case of LABC. Prospective cohort study enrolled 60 patients with stage III breast cancer. Forty-two (70%) patients received neo-adjuvant chemotherapy, 28 patients were considered suitable for surgery as initial treatment option. Type II oncoplastic surgery was performed for all patients: hemimastectomy and breast reconstruction with latissimus dorsi flap - for 29 (48.3%), lumpectomy - 31 (51.7%), and reconstruction with subaxillary flap for four (6.7%), with bilateral reduction mammoplasty - 14 (23.3%) and with J-plastic - 13 (21.7%) patients. Adjuvant chemotherapy and hormonal therapy followed surgery for all, except one, patients. Sequential radiotherapy was administered for all patients. The mean period of follow-up was 86 months. Postoperative morbidity rate was 5%. Local-regional recurrence was detected in six (10%) patients. After reoperation no local relapse was diagnosed. However, three of these patients had systemic dissemination of the disease. Distant metastasis was detected in 23 (38.3%) patients. Distant metastasis-free survival at 5 years was 61.7%. Fourteen patients died (23.3%). A total of 87.2% of the patients had good and excellent esthetic outcome. Oncoplastic breast-conserving surgery can be proposed for selected patients with LABC with acceptable complication, local recurrence rate, and good esthetic results.
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Affiliation(s)
- Algirdas Bogusevicius
- Department of Surgery of Breast Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
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From radical mastectomy to breast-conserving therapy and oncoplastic breast surgery: a narrative review comparing oncological result, cosmetic outcome, quality of life, and health economy. ISRN ONCOLOGY 2013; 2013:742462. [PMID: 24167743 PMCID: PMC3791839 DOI: 10.1155/2013/742462] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 07/30/2013] [Indexed: 11/22/2022]
Abstract
Surgical management of breast cancer has evolved considerably over the last two decades. There has been a major shift toward less-invasive local treatments, from radical mastectomy to breast-conserving therapy (BCT) and oncoplastic breast surgery (OBS). In order to investigate the efficacy of each of the three abovementioned methods, a literature review was conducted for measurable outcomes including local recurrence, survival, cosmetic outcome, quality of life (QOL), and health economy. From the point of view of oncological result, there is no difference between mastectomy and BCT in local recurrence rate and survival. Long-term results for OBS are not available. The items assessed in the QOL sound a better score for OBS in comparison with mastectomy or BCT. OBS is also associated with a better cosmetic outcome. Although having low income seems to be associated with lower BCT and OBS utilization, prognosis of breast cancer is worse in these women as well. Thus, health economy is the matter that should be studied seriously. OBS is an innovative, progressive, and complicated subspeciality that lacks published randomized clinical trials comparing surgical techniques and objective measures of outcome, especially from oncologic and health economy points of view.
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A systematic review of oncoplastic breast-conserving surgery: current weaknesses and future prospects. Ann Surg 2013; 257:609-20. [PMID: 23470508 DOI: 10.1097/sla.0b013e3182888782] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The primary objectives of this systematic review on oncoplastic breast surgery (OPBS) were to evaluate the oncological and cosmetic outcomes of OPBS. The secondary objectives were to assess morbidity, quality of life, and applied algorithms. BACKGROUND Breast-conserving therapy (BCT) has become the standard of care, and survival is now excellent. Consequently, the focus of BCT has increasingly shifted to cosmetic outcome, quality of life, and patient satisfaction. Nonetheless, excision of certain tumors still presents a considerable challenge. Specialized approaches combining oncological surgery and plastic surgery techniques are collectively referred to as OPBS. A summary of OPBS outcomes would facilitate decision-making and best treatment selection by both clinicians and patients. METHODS Using specific inclusion and exclusion criteria to analyze 2090 abstracts on the topic of OPBS published between 2000 and 2011, the authors evaluated each study with respect to design and outcomes. RESULTS A total of 88 articles were identified for potential inclusion and reviewed in detail by the lead authors. No randomized controlled trials were identified. Eleven prospective observational or comparative studies fulfilled inclusion criteria and were selected. In these studies, 80% to 93% of the tumors were invasive. Tumor-free resection margins were observed in 78% to 93%, resulting in a 3% to 16% mastectomy rate. Local recurrence was observed in 0% to 7% of the patients. Good cosmetic outcome was obtained in 84% to 89% of patients. However, most studies showed significant weaknesses including lack of robust design and important methodological shortcomings, negatively influencing generalizability. CONCLUSIONS This systematic review reveals that current evidence supporting the efficacy of OPBS is based on poorly designed and underpowered studies. Given the increasing importance and application of OPBS, there is a pressing need for robust comparative studies, including both randomized controlled trials and well-designed, multicenter prospective longitudinal studies.
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Hamdi M, Rasheed MZ. Advances in autologous breast reconstruction with pedicled perforator flaps. Clin Plast Surg 2013; 39:477-90. [PMID: 23036298 DOI: 10.1016/j.cps.2012.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article presents an overview of pedicled perforator flaps available in breast surgery. The indications, classification, surgical anatomy, and techniques for safe flap elevation are described. Clinical outcomes and complications are discussed, and illustrative case examples are presented.
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Affiliation(s)
- Moustapha Hamdi
- Department of Plastic and Reconstructive Surgery, Brussels University Hospital, Free University of Brussels, UZ Brussel, Laarbeeklaan 101, Brussels B-1090, Belgium.
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38
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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
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39
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Down SK, Jha MBBS MS MSc PK, Burger A, Hussien MI. Oncological Advantages of Oncoplastic Breast-Conserving Surgery in Treatment of Early Breast Cancer. Breast J 2013; 19:56-63. [PMID: 23301761 DOI: 10.1111/tbj.12047] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sue K. Down
- Breast Surgery Unit; Norfolk & Norwich University Hospital; Norwich United Kingdom
| | | | - Amy Burger
- Breast Surgery Unit; Norfolk & Norwich University Hospital; Norwich United Kingdom
| | - Maged I. Hussien
- Breast Surgery Unit; Norfolk & Norwich University Hospital; Norwich United Kingdom
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41
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The Usefulness of Oncoplastic Volume Displacement Techniques in the Superiorly Located Breast Cancers for Korean Patients With Small to Moderate-Sized Breasts. Ann Plast Surg 2011; 67:474-80. [PMID: 21301298 DOI: 10.1097/sap.0b013e318201fdf4] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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42
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White J, Achuthan R, Turton P, Lansdown M. Breast conservation surgery: state of the art. Int J Breast Cancer 2011; 2011:107981. [PMID: 22295209 PMCID: PMC3262560 DOI: 10.4061/2011/107981] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 05/29/2011] [Indexed: 01/03/2023] Open
Abstract
Breast conservation surgery is available to the vast majority of women with breast cancer. The combination of neoadjuvant therapies and oncoplastic surgical techniques allows even large tumours to be managed with a breast-conserving approach. The relationship between breast size and the volume of tissue to be excised determines the need for volume displacement or replacement. Such an approach can also be used in the management of carefully selected cases of multifocal or multicentric breast cancer. The role of novel techniques, such as endoscopic breast surgery and radiofrequency ablation, is yet to be precisely defined.
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Affiliation(s)
- Jonathan White
- The Breast Care Unit, Leeds General Infirmary, Leeds, West Yorkshire LS1 3EX, UK
| | - Raj Achuthan
- The Breast Care Unit, Leeds General Infirmary, Leeds, West Yorkshire LS1 3EX, UK
| | - Philip Turton
- The Breast Care Unit, Leeds General Infirmary, Leeds, West Yorkshire LS1 3EX, UK
| | - Mark Lansdown
- The Breast Care Unit, Leeds General Infirmary, Leeds, West Yorkshire LS1 3EX, UK
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Parmar V, Hawaldar R, Badwe RA. Safety of partial breast reconstruction in extended indications for conservative surgery in breast cancer. Indian J Surg Oncol 2011; 1:256-62. [PMID: 22693374 DOI: 10.1007/s13193-011-0052-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 04/05/2010] [Indexed: 11/24/2022] Open
Abstract
Breast conservation surgery after large volume excisions for women with relatively larger or multicentric operable breast cancer (OBC) and in some locally advanced breast cancers (LABC) post neo-adjuvant chemotherapy (NACT), is known to be a feasible option using a latissimus dorsi flap. However, the oncological safety of such a procedure is not well reported in literature. Two hundred and twenty one women with breast cancer (148-OBC, 73-LABC) underwent BCT plus LD during March 1998 to August 2009. One hundred and forty six women (72-LABC, 66-OBC) received prior NACT for downstaging, followed by completion of adjuvant therapy in all, including postoperative radiotherapy and hormone therapy where indicated. Women aged 20-62 years, with tumors 1.5-15 cm (median 5.0 cm), underwent volume replacement surgery with LD flap. All positive cut margins (total-4.9%, gross positive-1.3%) were re-excised to ensure negative margins. The mean surgical time for excision of primary with axillary clearance followed by volume replacement by LD was 5 h and mean hospital stay 6 days. Donor site morbidity was seen in 11 patients and 3 had minor recipient site infection. At a median follow up of 36 months, ten of 221 patients (4.5%) had failed locally (7-OBC, 3-LABC). The determinants of local recurrence were presence of lymphatic vascular invasion (p = 0.016) and axillary metastasis (p = 0.003). BCT plus LD flap is an oncologically safe, technically quick procedure with minimal morbidity, and should be offered to all eligible women as an extended breast conservation procedure.
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Oncoplastic surgery for Japanese patients with ptotic breasts. Breast Cancer 2010; 18:273-81. [DOI: 10.1007/s12282-009-0190-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 11/02/2009] [Indexed: 10/20/2022]
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Intramammarian flap reconstruction (IFR) technique in breast conserving surgery. Breast 2009; 18:387-92. [DOI: 10.1016/j.breast.2009.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Revised: 07/30/2009] [Accepted: 10/06/2009] [Indexed: 11/23/2022] Open
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Santanelli F, Paolini G, Campanale A, Longo B, Amanti C. Modified Wise-Pattern Reduction Mammaplasty, a New Tool for Upper Quadrantectomies: A Preliminary Report. Ann Surg Oncol 2009; 16:1122-7. [DOI: 10.1245/s10434-009-0358-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Indexed: 11/18/2022]
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Bae YT. Oncoplastic Breast Surgery. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2009. [DOI: 10.5124/jkma.2009.52.10.981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Young-tae Bae
- Division of Breast Surgery, Pusan National University College of Medicine, Korea.
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Rusby JE, Paramanathan N, Laws SA, Rainsbury RM. Immediate latissimus dorsi miniflap volume replacement for partial mastectomy: use of intra-operative frozen sections to confirm negative margins. Am J Surg 2008; 196:512-8. [DOI: 10.1016/j.amjsurg.2008.06.026] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Revised: 06/01/2008] [Accepted: 06/01/2008] [Indexed: 01/28/2023]
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Almasad JK, Salah B. Breast Reconstruction by Local flaps after Conserving Surgery for Breast Cancer: An Added Asset to Oncoplastic Techniques. Breast J 2008; 14:340-4. [DOI: 10.1111/j.1524-4741.2008.00595.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Oncoplastic Breast Surgery: A Global Perspective on Practice, Availability, and Training. World J Surg 2008; 32:2570-7. [DOI: 10.1007/s00268-008-9635-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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