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Pappas G, Karantanis W, Ayeni FE, Edirimanne S. Does Prior Breast Irradiation Increase Complications of Subsequent Reduction Surgery in Breast Cancer Patients? A systematic Review and Meta-Analysis. Aesthetic Plast Surg 2024:10.1007/s00266-024-04038-6. [PMID: 38658406 DOI: 10.1007/s00266-024-04038-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 03/28/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Reduction mammoplasty and mastopexy are potentially complicated by prior breast irradiation as part of breast conserving therapy. Associated tissue changes with therapeutic irradiation have led to surgeons deciding the risks may outweigh potential benefit for those patients. A systematic review of the existing literature was performed to explore surgical outcomes of patients undergoing delayed bilateral reduction mammoplasty or mastopexy following unilateral breast irradiation as part of breast conserving therapy. METHODS Medline, PubMed and EMBASE were searched from 1990 to 2023 according to PRISMA guidelines. Studies were combined by the generic inverse variance method on the natural logarithms of rate ratios (RR) using a random effect model in Review manager 5.4.1. RESULTS Fifteen studies reported outcomes in 188 patients who underwent breast reduction (BR) following unilateral breast conserving surgery and radiotherapy. The median age at BR was 51.5 years (range 39-60), and median time since radiotherapy was 48 months (range 11.7-86). We compared outcomes for irradiated breast (IB) versus non-irradiated breast (NIB). Pooled results showed higher rate of major complications in the IB (RR 2.52, 95%CI 0.96-6.63, p=0.06), but not statistically significant. However, rate of minor complications was significantly higher in the IB (RR 3.97 95%CI 1.86-8.50, p<0.0004). Incidence of fat necrosis as a discrete complication was 2× higher in IB (RR 2.14 95%CI 0.85-5.35, p-value 0.10) compared to the NIB, but not significant. CONCLUSION We found breast reduction to be safe with acceptable risk of major complications. However, the overall complication rate remains higher in IB compared to NIB. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- George Pappas
- Department of Surgery, Nepean Hospital, Derby Street, Kingswood, NSW, 2747, Australia
| | - William Karantanis
- Department of Surgery, Nepean Hospital, Derby Street, Kingswood, NSW, 2747, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Femi E Ayeni
- Nepean Institute of Academic Surgery, Nepean Clinical School, The University of Sydney, 62 Derby Street, Kingswood, NSW, 2747, Australia.
| | - Senarath Edirimanne
- Department of Surgery, Nepean Hospital, Derby Street, Kingswood, NSW, 2747, Australia
- Nepean Institute of Academic Surgery, Nepean Clinical School, The University of Sydney, 62 Derby Street, Kingswood, NSW, 2747, Australia
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Prasidha I, Boyages J, Lam TC. Safety of Reduction Mammaplasty and Mastopexy After Breast Conservation Therapy and Radiation Therapy: A Case Series. Ann Plast Surg 2023; 90:27-32. [PMID: 36534097 DOI: 10.1097/sap.0000000000003333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Conservative surgery and radiotherapy (CS + RT) have become the standard of care for early-stage breast cancer as an alternative to mastectomy. With the increasing rate of obesity and incidence of macromastia, surgeons increasingly encounter patients with a history of breast radiation desiring breast reduction. However, elective breast surgery after irradiation remains to be controversial due to known adverse effects of radiation, especially on wound healing, and unknown effects of lumpectomy on traditional pedicle choices. Herein, we present our experiences and outcomes of reduction mammaplasties and mastopexies in patients with breast cancer previously treated with CS + RT. METHODS Between 2009 and 2020, 13 patients undergoing reduction mammaplasty or mastopexy, who have previously underwent CS + RT with or without axillary surgery, were included in this study. Surgical techniques and complications, including delayed wound healing, infection, fat necrosis, and nipple-areolar necrosis, were recorded and analyzed based on the irradiated versus nonirradiated sides. RESULTS Of the 13 patients, delayed wound healing occurred in 7% on the irradiated side and 15% on the nonirradiated sides (P > 0.05). No significant correlation was observed between the number of complications and time of elective breast surgery from the last radiation therapy. Complications between irradiated and nonirradiated breasts did not significantly differ in both the reduction mammaplasty and mastopexy groups. CONCLUSIONS Reduction mammaplasty and mastopexy in patients with a history of lumpectomy and breast irradiation can be safely performed and should be considered in those experiencing macromastia or asymmetry post-CS + RT.
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Affiliation(s)
- Ines Prasidha
- From the Department of Plastic and Reconstructive Surgery, Westmead Hospital
| | - John Boyages
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Tenna S, Morelli Coppola M, Salzillo R, Barone M, Brunetti B, Cagli B, Cogliandro A, Persichetti P. Delayed Mastopexy Following Breast-Conserving Surgery and Radiation Therapy: A Case-Control Study to Evaluate Safety and Versatility of the Central Mound Technique. Aesthetic Plast Surg 2021; 46:2164-2173. [PMID: 34599353 DOI: 10.1007/s00266-021-02615-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/20/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Breast remodeling following breast-conserving surgery (BCS) and radiation therapy (RT) is challenging and often burdened by complications due to irradiated tissue atrophy. The authors present a case-control study to compare the central mound mastopexy (CMM) to more conventional techniques, applying it to different patterns of skin excision. METHODS A variation of the original central mound technique is presented separately addressing glandular and cutaneous deformities. Between 2012 and 2018, 17 consecutive patients presenting defects following unilateral BCS and RT underwent breast remodeling with CMM technique. Immediate and long-term complications together with patient-reported outcomes were evaluated and compared to a matched control group of sixteen patients who underwent superior pedicle mammoplasty. Two independent plastic surgeons reviewed pre- and postoperative photographs and rated the cosmetic outcomes on a visual analog scale from 1 to 5. RESULTS In the study group, different patterns of skin excision, i.e., inverted-T pattern (41.2%), circumareolar (23.5%), skin-sparing type V (17.65%), omega (11.77%), and J (5.88%), were used to correct various breast deformities, and a decisional algorithm was developed. No major complications were registered. Retraction recurrence rate was higher in the control group (p = 0.037). Cosmetic results were considered more satisfying in the CMM group by both patients (4.18 vs 3.00, p<0.001) and surgeons (4.06 vs 2.69, p=0.001). CONCLUSIONS The CMM technique is an advanced approach that addresses breast remodeling after BCS-RT surgery yielding reliable results. Following our algorithm, several patterns of skin excision, tailored to pre-existing scars, can be considered and safely performed. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Stefania Tenna
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Marco Morelli Coppola
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Italy.
| | - Rosa Salzillo
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Mauro Barone
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Beniamino Brunetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Barbara Cagli
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Annalisa Cogliandro
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Rome, Italy
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Lorentzen AK, Lock-Andersen J, Matthiessen LW, Klausen TW, Hölmich LR. Reduction mammoplasty and mastopexy in the previously irradiated breast - a systematic review and meta-analysis. J Plast Surg Hand Surg 2021; 55:330-338. [PMID: 33630696 DOI: 10.1080/2000656x.2021.1888745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Breast cancer is the most common cancer diagnosed in women, and early stages are treated with lumpectomy and irradiation. Irradiation, however, leads to reduced vascularization and fibrosis, which may influence the cosmetic outcome unfavourably and increase complications after subsequent surgery on irradiated breasts. Patients with significant asymmetry after treatment may desire corrective reduction mammoplasty or mastopexy, but this may be associated with increased complication rates. This systematic review and meta-analysis aimed to investigate postoperative complication rates after bilateral reduction mammoplasty or mastopexy in women who had undergone unilateral lumpectomy and irradiation. PubMed, Medline, EMBASE and Cochrane databases were searched for eligible studies. After screening titles and abstracts, 14 full text studies were reviewed, and 7 of these were included in the analysis. The meta-analysis showed a significantly higher complication rate in the irradiated breast compared to the non-irradiated breast, rate ratio 4.82 (95% CI: 1.58, 14.70), p = 0.006. The complication rate was 54% in the irradiated breast (58/107) compared to 8% (9/107) in the non-irradiated breast (p = 0.034). This study suggests that reduction mammoplasty or mastopexy in the previously irradiated breast is associated with a significantly increased risk of complications. Careful patient selection and information are paramount in the treatment of this patient group.
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Affiliation(s)
| | | | | | | | - Lisbet Rosenkrantz Hölmich
- Department of Plastic Surgery, Herlev and Gentofte Hospital, Herlev, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
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Breast Reduction and Mastopexy for Repair of Asymmetry After Breast Conservation Therapy: Lessons Learned. Aesthetic Plast Surg 2019; 43:600-607. [PMID: 30805691 DOI: 10.1007/s00266-019-01338-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Breast conservation therapy (BCT) can cause breast distortion and asymmetry. Repair of this asymmetry by means of breast reduction or mastopexy procedures can be challenging and harbor considerably high rates of complications. METHODS In this retrospective study, we describe our experience in repairing post-BCT breast asymmetry by performing breast reduction or mastopexy. The surgical protocol we followed consisted of stringent patient selection, thorough surgical planning, basic surgical refinements, and patient education for enhancing the likelihood of achieving a good outcome with minimal surgical complications. RESULTS Our search of the departmental database identified 25 patients with breast asymmetry who had undergone breast reduction or mastopexy between 2009 and 2017. Corrective surgery was performed 4 years on average after the completion of radiotherapy, and those patients included eleven who had undergone breast reduction and fourteen who had undergone mastopexy on the radiated side. Two patients (8%) had major complications that required further surgery (major fat necrosis, wound infection, and breast deformation), and five patients (20%) had minor complications (infection, minor fat necrosis, wound dehiscence, and nipple congestion). All complications developed on the radiated breast. There was no correlation between the occurrence of complications and patients' demographics, tumor type, tumor location, and breast tissue resection (p > 0.05). CONCLUSION Only two of our 25 patients had major complications following breast reduction and mastopexy for the repair of asymmetry post-BCT. Following our four-step protocol was instrumental in leading to the successful performance of these procedures. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Dannepond A, Michot A, Pinsolle V, Rousvoal A. Réductions mammaires sur seins irradiés : revue de la littérature. ANN CHIR PLAST ESTH 2019; 64:11-16. [DOI: 10.1016/j.anplas.2018.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/25/2018] [Indexed: 01/14/2023]
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Spear SL, Rao SS, Patel KM, Nahabedian MY. Reduction mammaplasty and mastopexy in previously irradiated breasts. Aesthet Surg J 2014; 34:74-8. [PMID: 24324279 DOI: 10.1177/1090820x13514246] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Little data exist on the safety of elective breast surgery following breast conservation therapy. OBJECTIVES The authors evaluate their experience performing reduction mammaplasties and mastopexies in previously irradiated breasts. METHODS A retrospective chart review was conducted of all reduction mammaplasties and mastopexies in previously irradiated breasts performed by the 2 senior authors (MYN and SLS) from 1995 to 2012 (n = 18). Patient records were analyzed for demographics, perioperative and postoperative details, and complications. RESULTS During the study period, 12 reduction mammaplasties and 6 mastopexies were performed on breasts previously treated with breast conservation therapy. The average study participant age was 49.5 years, and average body mass index was 29. Average preoperative bra cup size was D/DD. One patient was a former smoker; 17 were nonsmokers. Eleven of the 18 patients had been previously treated with chemotherapy; average time between radiation therapy and surgery was 2.5 years. Average specimen weight in the 12 reduction mammaplasties was 623 g. Twenty-two percent (n = 4) of patients experienced a total of 5 minor complications; none required a return to the operating room. One patient (6%) experienced a major complication resulting in approximately 50% loss of breast tissue, which was reconstructed with a latissimus dorsi musculocutaneous flap. Seventeen patients (94%) had successful outcomes with preoperative goals achieved. CONCLUSIONS In the previously irradiated breast, reduction mammaplasty and mastopexy should be approached with extra caution, but the surgeries may still be safely and successfully performed. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Scott L Spear
- Department of Plastic Surgery, Georgetown University Hospital, Washington, DC
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Cin AD, Knight C, Whelan KF, Farrokhyar F. Bilateral reduction mammoplasty following breast cancer: A case-control study. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2012. [DOI: 10.1177/229255031202000105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose Many women undergo a bilateral reduction mammoplasty after lumpectomy and radiation for breast cancer due to breast hypertrophy. The outcomes of these patients, focusing on complications and the need for additional surgery, are reviewed. Methods A matched case-control study with patients serving as their own control (treated breast cancer breasts were ‘cases’, healthy breasts were ‘controls’) was performed. Patients were identified through hospital records between 1980 and 2007. Patients treated by lumpectomy and radiation with subsequent bilateral reduction surgery were included. Data regarding demographics, medical history, and peri- and postoperative complications were collected. Measured outcomes included hematoma or seroma, delayed wound healing, infection, nipple-areolar complex problems, scarring, asymmetry and the need for further surgery. Continuous variables are reported as mean ± SD, and categorical variables are reported as proportions. Results Of the nine patients included in the study, delayed wound healing occurred in 22% of cases. Wound infections occurred in 66.7% of cases, with 22.2% experiencing a second wound infection. One patient experienced partial nipple-areolar complex loss on the radiated breast. There was abnormal scarring in 33.3% of radiated breasts. Postoperative asymmetry occurred in 77.8% of patients. Additional surgery was performed on three patients (33.3%). Conclusions Results of the present study suggest that women with a history of breast cancer treated by lumpectomy and radiation experience higher occurrence of postoperative complications on the radiated breast following bilateral breast reduction. Patients must be informed of these potential risks and require careful postoperative follow-up. An appropriately powered, prospective, multicentred study is required to draw definitive conclusions.
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Affiliation(s)
- Arianna Dal Cin
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario
| | - Casey Knight
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario
| | - Kaitlyn F Whelan
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario
| | - Forough Farrokhyar
- Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario
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Parrett BM, Schook C, Morris D. Breast reduction in the irradiated breast: evidence for the role of breast reduction at the time of lumpectomy. Breast J 2010; 16:498-502. [PMID: 21054644 DOI: 10.1111/j.1524-4741.2010.00965.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Given the high incidence of breast cancer in our society, it is common to encounter patients with macromastia who desire breast reduction after breast-conserving therapy by lumpectomy and radiation. We hypothesize that radiation leads to a significant increase in postoperative complications after breast reduction. All patients with a history of unilateral breast lumpectomy and radiation who subsequently underwent bilateral breast reduction by a single surgeon from 2004 to 2008 were retrospectively reviewed. Outcomes including cellulitis, wound breakdown, seroma, and need for repeat operations were compared between the radiated and nonradiated breast. The Fisher's exact test was used for statistical analysis. Twelve patients (mean age, 57 years) underwent bilateral breast reduction a mean of 86 months after unilateral lumpectomy and radiation. The nonradiated breasts had no complications postoperatively. The radiated breasts had a significant increase in complications with a total of five breasts (42%, p<0.04) having postoperative complications including cellulitis in two breasts, seroma requiring drainage in five breasts, two cases of fat necrosis, and one case of wound dehiscence. This resulted in two admissions for intravenous antibiotics and two repeat operative procedures. Additionally, three patients had significant breast asymmetry or contour deformities after reduction requiring operative revisions. Breast reduction after radiation leads to a significant increase in complications. Given this data, patients with macromastia undergoing breast conservation therapy for cancer should be considered for reduction at the time of lumpectomy and prior to radiation.
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Affiliation(s)
- Brian M Parrett
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Hyperbaric oxygen and reduction mammaplasty in the previously irradiated breast. Plast Reconstr Surg 2010; 125:255e-257e. [PMID: 20517072 DOI: 10.1097/prs.0b013e3181cb67d0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Safety and Aesthetic Improvement Using the Omega Pattern Reduction Mammaplasty after Breast Conservation Surgery and Radiation Therapy. Plast Reconstr Surg 2008; 121:374-380. [DOI: 10.1097/01.prs.0000298315.40074.16] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Breast conservation therapy, consisting of lumpectomy or segmental mastectomy with negative margins followed by breast irradiation, has become a standard and safe alternative to mastectomy in selected patients with early-stage breast cancer. As the inclusion criteria for breast conservation therapy have continued to evolve to include lower quadrant tumors, very large breasts, and central tumors, the potential for significant disfigurement after breast conservation therapy has increased. Bilateral reduction mammaplasty in conjunction with tumor-directed partial mastectomy is a surgical approach that can benefit these patients by creating symmetric, aesthetically pleasing breasts in a single-stage operation.
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Newman LA, Kuerer HM, McNeese MD, Hunt KK, Gurtner GC, Vlastos GS, Robb G, Singletary SE. Reduction mammoplasty improves breast conservation therapy in patients with macromastia. Am J Surg 2001; 181:215-20. [PMID: 11376574 DOI: 10.1016/s0002-9610(01)00563-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Macromastia has been considered a contraindication to breast conservation therapy because of difficulties with radiation therapy. This study evaluates the feasibility of bilateral reduction mammoplasty as a component of breast conservation therapy for breast cancer patients with pendulous breasts. METHODS Of 153 patients undergoing reduction mammoplasty at the University of Texas M. D. Anderson Cancer Center, 28 were identified as breast cancer patients with macromastia receiving breast conservation therapy. Median follow-up was 23.8 months. RESULTS Median patient age was 55 years. Nearly all patients were described as obese. Median weight of the reduction mammoplasty specimen on the cancerous side was 766 g. One patient (4%) required completion mastectomy for inadequate margin control. Major postoperative complications occurred in 2 patients (7%). There were no major postradiation complications. Patient survey revealed a satisfaction rate of 86%. CONCLUSION Bilateral reduction mammoplasty is a reasonable and safe option for breast cancer patients with macromastia who desire breast conservation therapy.
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Affiliation(s)
- L A Newman
- Department of Surgical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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Spear SL, Burke JB, Forman D, Zuurbier RA, Berg CD. Experience with reduction mammaplasty following breast conservation surgery and radiation therapy. Plast Reconstr Surg 1998; 102:1913-6. [PMID: 9810985 DOI: 10.1097/00006534-199811000-00015] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Little is known about the outcome of breast reduction in the previously radiated breast. With the increased popularity of breast conservation in the management of breast cancer, it is inevitable that more women with breast cancer who have had a breast radiated will be seeking breast reduction. Although it would be expected that reduction of the radiated breast would be more challenging and would yield less-pleasing results, it has been unclear whether reduction in the radiated breast could be safely performed without interfering with mammography and cancer surveillance. Our experience using different techniques in three patients demonstrates that such reductions can be effectively and safely done if certain principles are followed. Pedicles should be designed to be broader and shorter than usual, and breast flaps should be undermined or elevated either minimally or not at all.
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Affiliation(s)
- S L Spear
- Division of Plastic Surgery, Georgetown University Medical Center, Washington, DC 20007, USA
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Kurul S, Dinçer M, Kizir A, Uzunismail A, Darendeliler E. Plastic surgery in irradiated areas: analysis of 200 consecutive cases. Eur J Surg Oncol 1997; 23:48-53. [PMID: 9066747 DOI: 10.1016/s0748-7983(97)80142-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Reconstructive surgery in previously irradiated areas is more difficult than in non-irradiated cases. A retrospective analysis of the outcome of 200 previously irradiated patients who had skin graft or flap reconstruction performed by the same surgeon is presented, and the most suitable surgical technique in irradiated areas is discussed. One hundred and fifty-six patients had skin and oral cavity cancer, and were operated on after local recurrence. Twenty patients had breast cancer; 15 were operated on for local recurrence and five for breast reconstruction. Twenty-four patients had soft tissue sarcomas. Eighty-five patients had a skin graft (group 1), 35 had a skin flap (group 2), 10 had a fascia/muscle flap plus skin graft and 70 had a myocutaneous flap (group 3). Analysis of complications revealed statistically significant differences in terms of incomplete graft/flap necrosis between group 1 and 2 (P < 0.001) and groups 1 and 3 (P < 0.001), and in terms of infection between groups 1 and 3 (P < 0.01). We conclude that the method of reconstruction is determined by the characteristics of the defect such as size and localization; the quality, fractionation, total dose, and energy of radiation used; skin and subcutaneous tissue changes due to radiation; and operation time. However, it is reasonable to choose fascia/muscle or myocutaneous flaps for reconstruction in previously irradiated areas. These methods are more resistant to bacterial inoculation, more prone to clean residual infection, and provide better vascularized tissue and volume replacement for contour defects.
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Affiliation(s)
- S Kurul
- Department of Surgical Oncology, Istanbul University, Turkey
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