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Binks M, Boyages J, Suami H, Ngui N, Meybodi F, Hughes TM, Edirimanne S. Oncoplastic breast surgery - a pictorial classification system for surgeons and radiation oncologists (OPSURGE). ANZ J Surg 2024. [PMID: 39254174 DOI: 10.1111/ans.19212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 06/10/2024] [Accepted: 08/06/2024] [Indexed: 09/11/2024]
Abstract
INTRODUCTION Changes to the tumour bed following oncoplastic breast surgery complicate the administration of adjuvant radiotherapy. Consensus guidelines have called for improved interdisciplinary communication to aid adjuvant boost radiotherapy. We propose a framework of tumour bed classification following oncoplastic surgery to enhance understanding and communication between the multidisciplinary breast cancer team and facilitate effective and more precise delivery of adjuvant boost radiotherapy. METHODS A classification system was devised by grouping oncoplastic procedures based on skin incision, tissue mobilization, tumour bed distortion, seroma formation and flap reconstruction. The system is supplemented by a colour-coded pictorial guide to tumour bed rearrangement with common oncoplastic procedures. RESULTS A 5-tier framework was developed. Representative images were produced to describe tumour bed alterations. CONCLUSION The proposed framework (OPSURGE) improves the identification of the primary tumour bed after initial breast-conserving surgery, which is imperative to both the surgeon in planning re-excision and the radiation oncologist in planning boost radiotherapy.
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Affiliation(s)
- Matthew Binks
- Division of Surgery, Gosford Hospital, Gosford, New South Wales, Australia
| | - John Boyages
- School of Medicine and Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
- Radiation Oncology, Icon Cancer Centre, Sydney, New South Wales, Australia
| | - Hiroo Suami
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Nicholas Ngui
- School of Medicine and Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
- Division of Surgery, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Farid Meybodi
- Division of Surgery, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - T Michael Hughes
- School of Medicine and Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
- Division of Surgery, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Senarath Edirimanne
- Division of Surgery, Sydney Adventist Hospital, Sydney, New South Wales, Australia
- Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Ockerman KM, Bryan J, Wiesemann G, Neal D, Marji FP, Heath F, Kanchwala S, Oladeru O, Spiguel L, Sorice-Virk S. Closed Incision Negative Pressure Therapy in Oncoplastic Surgery Prevents Delays to Adjuvant Therapy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5028. [PMID: 37250834 PMCID: PMC10219713 DOI: 10.1097/gox.0000000000005028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 03/31/2023] [Indexed: 05/31/2023]
Abstract
Breast reductions, including oncoplastic breast surgery (OBS), have high postoperative wound healing complication (WHC) rates, ranging from 17% to 63%, thus posing a potential delay in the onset of adjuvant therapy. Incision management with closed incision negative pressure therapy (ciNPT) effectively reduces postoperative complications in other indications. This retrospective analysis compares postoperative outcomes and delays in adjuvant therapy in patients who received ciNPT on the cancer breast versus standard of care (SOC) after oncoplastic breast reduction and mastopexy post lumpectomy. Methods Patient demographics, ciNPT use, postoperative complication rates, and time to adjuvant therapy were analyzed from the records of 150 patients (ciNPT = 29, SOC = 121). Propensity score matching was used to match patients based on age, body mass index, diabetes, tobacco use, and prior breast surgery. Results In the matched cohort, the overall complication rate of ciNPT-treated cancerous breasts was 10.3% (3/29) compared with 31% (9/29) in SOC-treated cancerous breasts (P = 0.096). Compared with the SOC-treated cancerous breasts, the ciNPT breasts had lower skin necrosis rates [1/29 (3.4%) versus 6/29 (20.7%); P = 0.091] and dehiscence rates [0/29 (0%) versus 8/29 (27.6%); P = 0.004]. In the unmatched cohort, the total number of ciNPT patients who had a delay in adjuvant therapy was lower compared to the SOC group (0% versus 22.5%, respectively; P = 0.007). Conclusion Use of ciNPT following oncoplastic breast reduction effectively lowered postoperative wound healing complication rates and, most importantly, decreased delays to adjuvant therapy.
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Affiliation(s)
- Kyle M. Ockerman
- From the College of Medicine, University of Florida, Gainesville, Fla
| | - Jaimie Bryan
- From the College of Medicine, University of Florida, Gainesville, Fla
| | - Gayle Wiesemann
- From the College of Medicine, University of Florida, Gainesville, Fla
| | - Dan Neal
- From the College of Medicine, University of Florida, Gainesville, Fla
| | - Fady P. Marji
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, Fla
| | | | - Suhail Kanchwala
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Pennsylvania
| | | | - Lisa Spiguel
- Division of Surgical Oncology, Department of Surgery, University of Florida, Gainesville, Fla
| | - Sarah Sorice-Virk
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, Fla
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Kang MJ, Hong HK, Eo PS, Lee JS, Lee JW, Lee J, Park HY, Yang JD. Surgical Strategies for Partial Breast Reconstruction in Medial-Located Breast Cancer: A 12-Year Experience. J Breast Cancer 2023; 26:35-45. [PMID: 36852966 PMCID: PMC9981984 DOI: 10.4048/jbc.2023.26.e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 11/01/2022] [Accepted: 01/08/2023] [Indexed: 02/18/2023] Open
Abstract
PURPOSE Partial breast reconstruction is challenging in medially located breast cancer, particularly in terms of achieving satisfactory aesthetic coverage. Thus, we aimed to investigate surgical strategies for filling medial defects resulting from breast-conserving surgery to improve patient satisfaction and aesthetic outcomes. METHODS We retrospectively evaluated 113 patients (114 cases) with medially located breast cancer between 2007 and 2018. We analysed the patient data, such as breast size, specimen weight, complications, and aesthetic results obtained using a questionnaire. RESULTS The mean body mass index and specimen weight were 23.43 kg/m² (range, 18.5-26.8) and 83.29 g (range, 15-290 g), respectively. The tennis racket and round-block techniques were chosen for small defects (< 10%-15%) in small- and medium-sized breasts. The rotational and perforator flap techniques were used for medium-sized defects. The latissimus dorsi (LD) flap technique was used for large defects (> 30%). Hematoma was found in 1 case (0.96%), linear skin necrosis was found in 1 case (0.96%), seroma in the LD flaps was found in 8 cases (7.69%); fat necrosis in the rotational flaps was found in 2 cases (1.92%); and fat necrosis in an anterior intercostal artery perforator flap was found in 1 case (0.96%). 91 patients (87.5%) were satisfied with the aesthetic results. CONCLUSION The techniques used in this study for medially located breast cancer can produce fine aesthetic outcomes with regard to breast size and resection volume, with few complications.
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Affiliation(s)
- Myeong Jae Kang
- Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyun Ki Hong
- Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Pil Seon Eo
- Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Joon Seok Lee
- Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jeong Woo Lee
- Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jeeyeon Lee
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Ho Yong Park
- Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jung Dug Yang
- Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Korea.
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Aesthetic, Quality-of-Life, and Clinical Outcomes after Inferior Pedicle Oncoplastic Reduction Mammoplasty. Aesthetic Plast Surg 2023; 47:905-911. [PMID: 36735002 DOI: 10.1007/s00266-023-03257-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/26/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Oncoplastic breast surgery is more likely to achieve superior aesthetic outcomes compared to lumpectomy alone. Oncoplastic reduction mammoplasty (ORM) is a volume displacement oncoplastic technique that combines lumpectomy and reduction mammoplasty. Data on aesthetic and quality-of-life (QoL) outcomes after ORM are scarce in the literature. Based on a literature review, this present study reports outcomes on the largest group of ORM patients to date. METHODS A retrospective review was conducted of all patients who underwent ORM between 2011 and 2018 at a tertiary care centre. Patients were excluded if no pedicle information was available or did not undergo post-operative radiotherapy. All patients with available post-operative photographs were aesthetically evaluated by four blinded, independent investigators blinded based on breast symmetry, nipple symmetry, and overall appearance. The BREAST-Q (breast conserving module) was used to assess QoL outcomes. RESULTS Two-hundred-and-sixteen consecutive patients (223 breasts) were included. Macromastia (cup size D or higher) was present in 173 patients (80.1%). Inferior pedicle ORM was utilized in 179 (80.3%) breasts. Eighty-eight patients (40.7%) were aesthetically evaluated, of whom 69 patients (78.4%) had "good", "very good", or "excellent" grades in all aesthetic categories. Seventy-five patients (85.2%) had "good" or better grades in overall appearance. Preoperative ptosis grade, cup size, presence of post-operative complications, and breast specimen weight had no significant correlations with aesthetic grades. Inferior pedicle ORM was associated with a higher "satisfaction with breast" Q-score (p=0.017) compared to other pedicle approaches. CONCLUSION Inferior pedicle ORM achieves objectively excellent aesthetic outcomes and high patient satisfaction with the reconstruction. 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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Franca FC, de Oliveira-Junior I, Morgan AM, Haikel RL, da Costa Vieira RA. Breast-conserving surgery with the geometric compensation/split reduction technique. Indications, oncologic safety and cosmesis. A cohort series and systematic review of the literature. Surg Oncol 2022; 44:101839. [PMID: 35994978 DOI: 10.1016/j.suronc.2022.101839] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Geometric Compensation Technique (GCT) and the Split Reduction Technique (SRT) enables breast conserving surgery (BCS) in selected patients with breast cancer initially candidates to mastectomy. METHODS Observational study of patients with breast cancer who underwent GCT consecutively treated. Evaluated retrospectively: indications, clinical characteristics, surgical features and recurrences. Cosmesis were evaluated prospectively by the BCCT.core software, Harris/Harvard and Garbay scales. Descriptive statistics were performed, chi-square test was used to compare aesthetic outcomes; Kappa and Weighted Kappa test was used to assess agreement between the postoperative evaluations; Kaplan-Meier model for follow-up and recurrence. A systematic review was carried out using PRISMA methodology. RESULTS Thirty-six patients were evaluated, 26 (72.2%) with medium/large breasts with or without ptosis, seven (19.4%) with small breasts with or without ptosis, a profile undergoing GCT not previously identified in the literature. The mean tumor clinical size was 3.65 ± 1.59 cm. 34 (94.4%) patients underwent GCT. Mean follow-up time was 36.6 ± 16.8 months, with no local recurrences. According to BCCT.core, the postoperative aesthetic was good in 17 (51.5%) patients and 11 (33.3%) was reasonable. In the systematic review, 3.584 articles were evaluated, 20 articles were selected, 243 patients undergoing GCT were found, with several indications for BCS instead of mastectomy, with high rates of free margins, low recurrence and good aesthetic outcomes. CONCLUSION GCT, an oncologically safe and aesthetically satisfactory option, has been extended to patients with small and medium breasts with ptosis, large tumors to breast volume or in unfavorable resection sites, initially candidates for mastectomy.
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Affiliation(s)
- Flávia Cardoso Franca
- Postgraduate Program of Tocoginecology, Botucatu Medical School, São Paulo State University - UNESP, Av. Prof. Montenegro. Distrito de Botucatu, Botucatu, SP, CEP: 18618-687, Brazil; Postgraduate Program of Oncology, Barretos Cancer Hospital, R. Antenor Duarte Viléla, 1331 - Dr. Paulo Prata, Barretos, SP, CEP: 14784-400, Brazil
| | - Idam de Oliveira-Junior
- Postgraduate Program of Tocoginecology, Botucatu Medical School, São Paulo State University - UNESP, Av. Prof. Montenegro. Distrito de Botucatu, Botucatu, SP, CEP: 18618-687, Brazil; Postgraduate Program of Oncology, Barretos Cancer Hospital, R. Antenor Duarte Viléla, 1331 - Dr. Paulo Prata, Barretos, SP, CEP: 14784-400, Brazil; Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, R. Antenor Duarte Viléla, 1331 - Dr. Paulo Prata, Barretos, SP, CEP: 14784-400, Brazil
| | - Andréa Moreno Morgan
- Postgraduate Program of Oncology, Barretos Cancer Hospital, R. Antenor Duarte Viléla, 1331 - Dr. Paulo Prata, Barretos, SP, CEP: 14784-400, Brazil
| | - Raphael Luiz Haikel
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, R. Antenor Duarte Viléla, 1331 - Dr. Paulo Prata, Barretos, SP, CEP: 14784-400, Brazil
| | - René Aloisio da Costa Vieira
- Postgraduate Program of Tocoginecology, Botucatu Medical School, São Paulo State University - UNESP, Av. Prof. Montenegro. Distrito de Botucatu, Botucatu, SP, CEP: 18618-687, Brazil; Postgraduate Program of Oncology, Barretos Cancer Hospital, R. Antenor Duarte Viléla, 1331 - Dr. Paulo Prata, Barretos, SP, CEP: 14784-400, Brazil; Departament of Surgery, Division of Mastology, Muriaé Cancer Hospital, Av. Cristiano Ferreira Varella, 555 - Universitário, Muriaé, MG, CEP: 36888-233, Brazil.
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Salibian AA, Olson B, Shauly O, Patel KM. Oncoplastic breast reconstruction: Principles, current techniques, and future directions. J Surg Oncol 2022; 126:450-459. [PMID: 35452129 DOI: 10.1002/jso.26897] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 11/06/2022]
Abstract
Oncoplastic breast reconstruction has improved esthetic results after breast-conserving surgery with low complication rates and stable oncologic outcomes. Basic principles can be applied across different volume displacement and replacement techniques including restoration of breast shape and symmetry through esthetic incisions while eliminating dead space. Technique selection is guided by several factors including breast size, resection-to-breast ratio, and patient desires. A surgeon familiar with all techniques will allow individualization of treatment and optimization of outcomes.
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Affiliation(s)
- Ara A Salibian
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA
| | - Blade Olson
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA
| | - Orr Shauly
- Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA
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Orabi A, Youssef MMG, Manie TM, Shaalan M, Hashem T. Lateral chest wall perforator flaps in partial breast reconstruction. J Egypt Natl Canc Inst 2022; 34:2. [PMID: 35001182 PMCID: PMC8743083 DOI: 10.1186/s43046-021-00100-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast conserving surgery (BCS) has been a standard procedure for the treatment of breast cancer instead of mastectomy whenever possible. Lateral chest wall perforator flaps are one of the volume replacement techniques that participate in increasing the rate of BCS especially in small- to moderate-sized breasts with good cosmetic outcome. In this study, we tried to evaluate the outcome of those flaps as an oncoplastic procedure instead of the conventional flaps. METHODS This study included 26 patients who underwent partial mastectomy with immediate reconstruction using lateral chest wall perforator flaps in the period from October 2019 to November 2020. The operative time, techniques, and complications were recorded. The cosmetic outcome was assessed 3 months post-radiation therapy through a questionnaire and photographic assessment. RESULTS Lateral intercostal artery perforator (LICAP), lateral thoracic artery perforator (LTAP) and combined flaps were performed in 24, 1, and 1 patients, respectively. The mean operative time was 129.6 ± 13.2 min. The flap length ranged from 10 to 20 cm and its width from 5 to 9 cm. Overall patients' satisfaction was observed to be 88.5% as either excellent or good and the photographic assessment was 96.2% as either excellent or good. CONCLUSIONS Lateral chest wall perforator flaps are reliable and safe option for partial breast reconstruction with an acceptable aesthetic outcome. In the era of oncoplastic breast surgery, they deserve to gain attention especially with the advantages of some modifications added to the classic technique.
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Affiliation(s)
- Ahmed Orabi
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
| | - Mina M G Youssef
- Norfolk and Norwich University Hospital, Norwich, UK.,Breast Surgery Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Tamer M Manie
- Breast Surgery Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed Shaalan
- Breast Surgery Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Tarek Hashem
- Breast Surgery Department, National Cancer Institute, Cairo University, Cairo, Egypt
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Alder L, Zaidi M, Zeidan B, Mazari F. Advanced breast conservation and partial breast reconstruction - a review of current available options for oncoplastic breast surgery. Ann R Coll Surg Engl 2021; 104:319-323. [PMID: 34415191 DOI: 10.1308/rcsann.2021.0169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Breast cancer is the most common cancer affecting one in three women with new cancer diagnosis in England. Breast-conserving surgery is the primary surgical option in a vast majority of these patients. Use of oncoplastic techniques in breast conservation surgery has significantly improved the aesthetic outcomes without compromising the oncological safety of cancer resections. Oncoplastic breast-conserving surgery (OPBCS) has transformed the specialty with a paradigm shift in ideology and the recognition that aesthetic and oncological resections are synonymous when planning surgical intervention for patients with breast cancer. The two main options for OPBCS are therapeutic mammoplasty and partial beast reconstruction using pedicle-based flaps. This review aims to highlight key concepts in OPBCS demonstrating an overview of these surgical techniques, their safety, outcomes and the emergence of extreme oncoplastic breast surgery.
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Affiliation(s)
- L Alder
- University Hospital Southampton NHS Foundation Trust, UK
| | - M Zaidi
- Portsmouth Hospitals NHS Trust, UK
| | - B Zeidan
- University Hospital Southampton NHS Foundation Trust, UK
| | - Fak Mazari
- University Hospital Southampton NHS Foundation Trust, UK
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Meattini I, Becherini C, Bernini M, Bonzano E, Criscitiello C, De Rose F, De Santis MC, Fontana A, Franco P, Gentilini OD, Livi L, Meduri B, Parisi S, Pasinetti N, Prisco A, Rocco N. Breast reconstruction and radiation therapy: An Italian expert Delphi consensus statements and critical review. Cancer Treat Rev 2021; 99:102236. [PMID: 34126314 DOI: 10.1016/j.ctrv.2021.102236] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023]
Abstract
Breast conserving surgery (BCS) plus radiation therapy (RT) or mastectomy have shown comparable oncological outcomes in early-stage breast cancer and are considered standard of care treatments. Postmastectomy radiation therapy (PMRT) targeted to both the chest wall and regional lymph nodes is recommended in high-risk patients. Oncoplastic breast conserving surgery (OBCS) represents a significant recent improvement in breast surgery. Nevertheless, it represents a challenge for radiation oncologists as it triggers different decision-making strategies related to treatment volume definition and target delineation. Hence, the choice of the best combination and timing when offering RT to breast cancer patients who underwent or are planned to undergo reconstruction procedures should be carefully evaluated and based on individual considerations. We present an Italian expert Delphi Consensus statements and critical review, led by a core group of all the professional profiles involved in the management of breast cancer patients undergoing reconstructive procedures and RT. The report was structured as to consider the main recommendations on breast reconstruction and RT and analyse the current open issues deserving investigation and consensus. We used a three key-phases and a Delphi process. The final expert panel of 40 colleagues selected key topics as identified by the core group of the project. A final consensus on 26 key statements on RT and breast reconstruction after three rounds of the Delphi voting process and harmonisation was reached. An accompanying critical review of available literature was summarized. A clear communication and cooperation between surgeon and radiation oncologist is of paramount relevance both in the setting of breast reconstruction following mastectomy when PMRT is planned and when extensive glandular rearrangements as OBCS is performed. A shared-decision making, relying on outcome-based and patient-centred considerations, is essential, while waiting for higher level-of-evidence data.
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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; Italian Association of Radiotherapy and Clinical Oncology (AIRO) Breast Cancer Group, Italy; Clinical Oncology Breast Cancer Group (COBCG), Italy.
| | - Carlotta Becherini
- 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; Italian Association of Radiotherapy and Clinical Oncology (AIRO) Breast Cancer Group, Italy
| | - Marco Bernini
- Breast Surgery Unit - Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Elisabetta Bonzano
- Department of Radiation Oncology, IRCCS San Matteo Polyclinic Foundation & PhD School in Experimental Medicine, University of Pavia, Pavia, Italy; Italian Association of Radiotherapy and Clinical Oncology (AIRO) Breast Cancer Group, Italy; Clinical Oncology Breast Cancer Group (COBCG), Italy
| | - Carmen Criscitiello
- Department of Oncology and Haematology (DIPO), University of Milan & Division of Early Drug Development for Innovative Therapy, European Institute of Oncology, IRCCS, Milan, Italy
| | - Fiorenza De Rose
- Division of Radiation Oncology, Santa Chiara Hospital, Trento, Italy; Italian Association of Radiotherapy and Clinical Oncology (AIRO) Breast Cancer Group, Italy; Clinical Oncology Breast Cancer Group (COBCG), Italy
| | - Maria Carmen De Santis
- Radiation Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Italian Association of Radiotherapy and Clinical Oncology (AIRO) Breast Cancer Group, Italy; Clinical Oncology Breast Cancer Group (COBCG), Italy
| | - Antonella Fontana
- Radiation Oncology Unit, Ospedale Santa Maria Goretti, Latina, Italy; Italian Association of Radiotherapy and Clinical Oncology (AIRO) Breast Cancer Group, Italy
| | - Pierfrancesco Franco
- Department of Translational Medicine, University of Eastern Piedmont & Radiation Oncology Unit, AOU "Maggiore della Carità", Novara, Italy; Italian Association of Radiotherapy and Clinical Oncology (AIRO) Breast Cancer Group, Italy; Clinical Oncology Breast Cancer Group (COBCG), Italy
| | | | - Lorenzo Livi
- 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; Italian Association of Radiotherapy and Clinical Oncology (AIRO) Breast Cancer Group, Italy
| | - Bruno Meduri
- Radiation Oncology Unit, University Hospital of Modena, Modena, Italy; Italian Association of Radiotherapy and Clinical Oncology (AIRO) Breast Cancer Group, Italy; Clinical Oncology Breast Cancer Group (COBCG), Italy
| | - Silvana Parisi
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy; Italian Association of Radiotherapy and Clinical Oncology (AIRO) Breast Cancer Group, Italy
| | - Nadia Pasinetti
- Radiation Oncology Service, ASST Valcamonica, Esine, Italy; Italian Association of Radiotherapy and Clinical Oncology (AIRO) Breast Cancer Group, Italy; Clinical Oncology Breast Cancer Group (COBCG), Italy
| | - Agnese Prisco
- Department of Radiation Oncology, University Hospital of Udine, ASUFC, Udine, Italy; Italian Association of Radiotherapy and Clinical Oncology (AIRO) Breast Cancer Group, Italy
| | - Nicola Rocco
- Group for Reconstructive and Therapeutic Advancements (G.RE.T.A.), Milan, Naples, Catania, Italy
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Wan N, Liu D, Lu L, He X, Song D, Li Z, Zhou X, Peng W, Liu Z. [Application of pedicled omentum flap in breast reconstruction of breast cancer patients]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1006-1010. [PMID: 31407561 PMCID: PMC8337907 DOI: 10.7507/1002-1892.201901007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/06/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the clinical application of the pedicled omentum flap in breast reconstruction of breast cancer patients. METHODS Between May 2013 and October 2017, 205 patients with breast cancer received modified mastectomy. The pedicled omentum flap was used to reconstruct breast at the same time. All patients were female with an average age of 34.9 years (mean, 26-58 years). The tumor located at left breast in 127 cases and right side in 78 cases. The diameter of the tumor was 2-5 cm (mean, 2.9 cm). The 120 cases of breast cancer were at stage Ⅰ and 85 cases were at stage Ⅱ; and 126 cases were invasive ductal carcinoma and 79 cases were invasive lobular carcinoma. The course of disease ranged from 10 to 92 days (mean, 38.5 days). The size of defect after tumor ablation ranged from 9 cm× 6 cm to 18 cm×12 cm; the size of pedicled omentum flap ranged from 18 cm×10 cm to 22 cm×16 cm. RESULTS According to the anatomical basis, the omentum was divided into 4 types, including thin type (42 cases, 20.5%), medium type (133 cases, 64.9%), hypertrophy type (24 cases, 11.7%), and absence type (6 cases, 2.9%). All omentum flaps survived successfully and the incisions healed by first intention. All patients were followed up 6-74 months (mean, 24.5 months); 83 cases were followed up more than 5 years. The shape, texture, and elasticity of the reconstructed breast were good and no flap contracture deformation happened. Only linear scar left at the donor sites, and the function of abdomen was not affected. No local recurrence happened. CONCLUSION The pedicled omentum flap can be harvested safely and reliable, which is the one of ideal option for breast reconstruction in breast cancer patients.
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Affiliation(s)
- Nengbin Wan
- Department of Breast Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008,
| | - Dequan Liu
- The First Department of Breast Surgery, Yunnan Province Cancer Hospital, the Third Affiliated Hospital of Kunming School of Medicine, Kunming Yunnan, 650000, P.R.China
| | - Lingli Lu
- Department of Breast Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Xiao He
- Department of Breast Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Dajiang Song
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Zan Li
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Xiao Zhou
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Wen Peng
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
| | - Zeyang Liu
- Department of Oncology Plastic Surgery, Hunan Cancer Hospital, Changsha Hunan, 410008, P.R.China
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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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The Impact of Breast Clinic on the Mastectomy and Axillary Clearance Rates at a Tertiary Hospital in an Eastern Caribbean Nation: A Comparative Study. Int J Breast Cancer 2019; 2019:8018242. [PMID: 30984428 PMCID: PMC6431495 DOI: 10.1155/2019/8018242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 12/17/2018] [Accepted: 01/10/2019] [Indexed: 11/18/2022] Open
Abstract
Background Breast cancer is the leading form of cancer in women in Trinidad and Tobago. Traditionally the practice of mastectomy or wide local excision with or without axillary clearance was applied to most of these patients. This is often associated with significant morbidity and a poor cosmetic outcome with both negatively impacting the patients quality of life. The aim of our study was to assess the mastectomy and axillary clearance rate before and after the introduction of a specialty breast clinic in September 2012. Design and Methods This is a retrospective comparative study of all female patients who underwent breast cancer surgery at our tertiary hospital 3 years prior to and 3 years after starting of breast clinic (between January 2010 and December 2015). Patients were identified from the surgical log books of our hospital. There are 5 surgical units at our hospital and in one of those units the lead surgeon had a special interest in surgical oncoplastic breast surgery. That unit formed the breast clinic in August 2012. Results There were 532 women (256 before breast clinic and 276 after breast clinic era) with histologically verified breast cancer operated on between January 2010 and December 2015. The overall mastectomy rate was reduced from 62% to 51% (0.7 to 0.4) and the axillary clearance rate from 66.79% versus 37.31% (0.6 to 0.4) after the introduction of the clinic with p values of 0.007 and 0.009, respectively. Conclusions The introduction of breast clinic has significantly reduced the mastectomy and axillary clearance rate at our teaching hospital.
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Murugappan K, Saboo A, Kuo L, Ung O. Paradigm shift in the local treatment of breast cancer: mastectomy to breast conservation surgery. Gland Surg 2018; 7:506-519. [PMID: 30687624 PMCID: PMC6323252 DOI: 10.21037/gs.2018.09.01] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/03/2018] [Indexed: 01/16/2023]
Abstract
There have been fundamental changes in the approach to breast cancer management over the last century but the primary objective of achieving oncological safety remains unchanged. This evolution is highlighted with a summary of the key evidences in support of the oncological safety of breast conserving surgery (BCS) in early breast cancer (EBC) management. We will also discuss the increasingly pivotal role that neoadjuvant chemotherapy (NACT) may play, in the local treatment of EBC and locally advanced breast cancer (LABC) and the long-term surgical and oncological outcomes.
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Affiliation(s)
- Kowsi Murugappan
- Royal Brisbane Breast Surgery Unit, Department of General Surgery, RBWH, Brisbane, Australia
- University of Queensland, Brisbane, Australia
| | - Apoorva Saboo
- Royal Brisbane Breast Surgery Unit, Department of General Surgery, RBWH, Brisbane, Australia
| | - Lu Kuo
- University of Queensland, Brisbane, Australia
| | - Owen Ung
- Royal Brisbane Breast Surgery Unit, Department of General Surgery, RBWH, Brisbane, Australia
- University of Queensland, Brisbane, Australia
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14
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de Freitas TB, Lopes de Barros Lima KM, de Andrade Carvalho H, de Azevedo Marques P, Belfort Mattos FT, Franco Fonseca AS, Munhoz AM, Filassi JR, Stuart SR, Marta GN. What a difference a clip makes! Analysis of boost volume definition in radiation therapy for conservative breast surgery. Eur J Surg Oncol 2018; 44:1312-1317. [PMID: 30041975 DOI: 10.1016/j.ejso.2018.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 05/04/2018] [Accepted: 06/11/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE/OBJECTIVE(S) To evaluate the role of surgical clips placement in the definition of boost treatment volume. MATERIALS/METHODS Clinical Target Volumes (CTV) were defined as: CTV Breast, CTV Quadrant (based on physical exam and pre-surgical images), CTV Boost, defined by clip plus margin (1 cm for 2 or more clips and 2 cm for 1 clip only) plus radiological changes, CTV NT (normal tissue), defined by CTV Quadrant minus CTV Boost and CTV MISS (CTV that would be outside the treatment volume), defined by CTV Boost minus CTV Quadrant. RESULTS A total of 247 patients were included. Upper lateral quadrant was the most common clinical location (47.3%). The median number of clips used was three. The mean volumes were: CTV Breast:982.52 cc, CTV Boost:36.59 cc, CTV Quadrant:285.07 cc, CTV NT:210.1 cc and CTV MISS:13.57 cc. Only 50.6% (125) of the patients presented the CTV Boost completely inside the CTV Quadrant and in 47.3% (117), partially inside. Among patients with any CTV MISS, 80.3% (98) had 10% or more of CTV Boost outside the treatment volume. Regarding CTV MISS, there were no statistically significant differences between the groups with 1 clip versus 2 or more clips, nor between patients with or without reconstructive surgery. In average, the CTV Boost was 87% smaller than the CTV Quadrant. The whole quadrant irradiation would lead to unnecessary irradiation of 26% of normal breast tissue. CONCLUSION Surgical bed clipping is up most important in the definition of the boost volume irradiation to ensure precision minimizing geographical miss and optimizing surrounding normal tissue sparing.
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Affiliation(s)
- Thiago Brasileiro de Freitas
- Department of Radiology and Oncology, Division of Radiation Oncology, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
| | | | - Heloísa de Andrade Carvalho
- Department of Radiology and Oncology, Division of Radiation Oncology, Instituto de Radiologia (INRAD), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil.
| | - Patricia de Azevedo Marques
- Department of Plastic Surgery, Division of Breast Reconstruction, Cancer Institute of São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Fabio Teixeira Belfort Mattos
- Department of Plastic Surgery, Division of Breast Reconstruction, Cancer Institute of São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Alexandre Siqueira Franco Fonseca
- Department of Plastic Surgery, Division of Breast Reconstruction, Cancer Institute of São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Alexandre Mendonça Munhoz
- Department of Plastic Surgery, Division of Breast Reconstruction, Cancer Institute of São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Division of Plastic Surgery, Hospital Sírio-Libanês, São Paulo, Brazil.
| | - José Roberto Filassi
- Department of Obstetrics and Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Silvia R Stuart
- Department of Radiology and Oncology, Division of Radiation Oncology, Instituto de Radiologia (INRAD), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Gustavo Nader Marta
- Department of Radiology and Oncology, Division of Radiation Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil; Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil.
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Matsumoto WK, Munhoz AM, Okada A, Montag E, Arruda EG, Fonseca A, Ferrari O, Brasil JA, Pretti L, Filassi JR, Gemperli R. Influence of advanced age on postoperative outcomes and total loss following breast reconstruction: a critical assessment of 560 cases. ACTA ACUST UNITED AC 2018; 45:e1616. [PMID: 29617492 DOI: 10.1590/0100-6991e-20181616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/04/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE to evaluate the role of age in the risk of postoperative complications in patients submitted to unilateral breast reconstruction after mastectomy, with emphasis on total reconstruction loss. METHODS we conducted a retrospective study of patients submitted to breast reconstruction, whose variables included: oncological and reconstruction data, postoperative complications, including loss of reconstruction and complications of surgical wound. We divided the patients into two groups, according to the classification of the Brazilian National Elderly Policy and the Statute of the Elderly: young (age <60 years) and elderly (60 years or more). We also grouped them according to the World Health Organization classification: young people (age <44 years), middle age (45-59 years); elderly (age 60-89 years) and extreme advanced age (90 years or older). We applied the surgical risk classification of the American Society of Anesthesiologists to investigate the role of the preoperative physical state as a possible predictor of complications. RESULTS of the 560 patients operated on, 94 (16.8%) were 60 years of age or older. We observed a local complication rate of 49.8%, the majority being self-limited. The incidences of necrosis, infection and dehiscence were 15.5%, 10.9% and 9.3%, respectively. Patients older than 60 years presented a chance of complication 1.606 times greater than the younger ones. Forty-five (8%) patients had loss of the reconstruction; there was no statistically significant difference in the mean age of the patients who presented this result or not (p=0.321). CONCLUSION in selected patients, breast reconstruction can be considered safe; most documented complications were limited and could be treated conservatively.
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Affiliation(s)
| | - Alexandre Mendonça Munhoz
- - Sírio-Libanês Hospital, Plastic Surgery, São Paulo, SP, Brazil.,- Faculty of Medicine, University of São Paulo, Mammary Reconstruction Group, São Paulo, SP, Brazil.,- University of São Paulo, Cancer Institute of the State of São Paulo, São Paulo, SP, Brazil
| | - Alberto Okada
- - University of São Paulo, Cancer Institute of the State of São Paulo, São Paulo, SP, Brazil.,- Faculty of Medicine, University of São Paulo, Division of Plastic Surgery, São Paulo, SP, Brazil
| | - Eduardo Montag
- - University of São Paulo, Cancer Institute of the State of São Paulo, São Paulo, SP, Brazil.,- Faculty of Medicine, University of São Paulo, Division of Plastic Surgery, São Paulo, SP, Brazil
| | - Eduardo Gustavo Arruda
- - University of São Paulo, Cancer Institute of the State of São Paulo, São Paulo, SP, Brazil.,- Faculty of Medicine, University of São Paulo, Division of Plastic Surgery, São Paulo, SP, Brazil
| | - Alexandre Fonseca
- - University of São Paulo, Cancer Institute of the State of São Paulo, São Paulo, SP, Brazil.,- Faculty of Medicine, University of São Paulo, Division of Plastic Surgery, São Paulo, SP, Brazil
| | - Orlando Ferrari
- - Faculty of Medicine, University of São Paulo, Division of Plastic Surgery, São Paulo, SP, Brazil
| | | | - Lia Pretti
- - Faculty of Medicine, University of São Paulo, Division of Plastic Surgery, São Paulo, SP, Brazil
| | - José Roberto Filassi
- - Faculty of Medicine, University of São Paulo, Mammary Reconstruction Group, São Paulo, SP, Brazil.,- University of São Paulo, Cancer Institute of the State of São Paulo, São Paulo, SP, Brazil.,- Sírio-Libanês Hospital, Mastology, São Paulo, SP, Brazil
| | - Rolf Gemperli
- - Faculty of Medicine, University of São Paulo, Division of Plastic Surgery, São Paulo, SP, Brazil
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Amin AA, Rifaat M, Farahat A, Hashem T. The role of thoracodorsal artery perforator flap in oncoplastic breast surgery. J Egypt Natl Canc Inst 2017; 29:83-87. [DOI: 10.1016/j.jnci.2017.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/12/2017] [Accepted: 01/15/2017] [Indexed: 10/20/2022] Open
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Munhoz AM, Gemperli R, Filassi JR. Oncoplastic surgery with omental flap reconstruction: a study of 200 cases. Breast Cancer Res Treat 2017; 163:407-409. [PMID: 28299477 DOI: 10.1007/s10549-017-4193-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 03/08/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Alexandre Mendonça Munhoz
- Department of Plastic Surgery, Hospital Sírio-Libanês and Cancer Institute University of São Paulo, Rua Mato Grosso, 306 cj.1706/1705 Higienópolis, São Paulo, 01239-040, Brazil.
| | - Rolf Gemperli
- Department of Plastic Surgery, University of São Paulo, São Paulo, Brazil
| | - José Roberto Filassi
- Department of Breast Surgery, Cancer Institute University of São Paulo, São Paulo, Brazil
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Hashem T, Farahat A. Batwing versus Wise pattern mammoplasty for upper pole breast tumours: a detailed comparison of cosmetic outcome. World J Surg Oncol 2017; 15:60. [PMID: 28292293 PMCID: PMC5351177 DOI: 10.1186/s12957-017-1124-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 03/06/2017] [Indexed: 12/29/2022] Open
Abstract
Background The aim of this study is to compare the results of batwing mammoplasty and Wise pattern mammoplasty in the surgical management of upper pole breast tumours. Methods This is a retrospective observational study including 126 breast cancer patients who presented between 2009 and 2015 to the National Cancer Institute of Cairo University in Egypt. All patients were candidates for breast conservation, with upper pole tumours, which was defined as tumours between 3 and 9 o’clock. Patients were categorized into two groups. Group A (64) included patients who underwent inferiorly based therapeutic mammoplasty, while group B (62) was designated for patients who had batwing mammoplasty. The results of both groups were compared and analyzed. Results Wise pattern mammoplasty group had statistically significant higher complication rate. The overall aesthetic result of Wise pattern technique was superior to batwing mammoplasty. However, batwing mammoplasty showed a statistically significant higher rate of patient satisfaction. Conclusions Both techniques are valid options for upper pole breast tumours. Wise pattern therapeutic mammoplasty remains aesthetically superior; however, batwing mammoplasty is an easy, simple technique with acceptable results to patients.
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Affiliation(s)
- Tarek Hashem
- Breast Surgery Department, National Cancer Institute, Cairo University, Cairo, Egypt. .,Department of Surgical Oncology, National Cancer Institute, Nr 1, Fom El Khalig, Kasr El Aini Street, Cairo, Egypt.
| | - Ahmed Farahat
- Breast Surgery Department, National Cancer Institute, Cairo University, Cairo, Egypt
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19
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The horseshoe flap. An “emergency” oncoplastic breast surgery technique. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-016-1186-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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20
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Catanuto G, Pappalardo F, Rocco N, Leotta M, Ursino V, Chiodini P, Buggi F, Folli S, Catalano F, Nava MB. Formal analysis of the surgical pathway and development of a new software tool to assist surgeons in the decision making in primary breast surgery. Breast 2016; 29:74-81. [DOI: 10.1016/j.breast.2016.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/15/2016] [Accepted: 06/05/2016] [Indexed: 11/30/2022] Open
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Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: long term aesthetic, functional and satisfaction outcomes. Contemp Oncol (Pozn) 2016; 20:256-60. [PMID: 27647991 PMCID: PMC5013678 DOI: 10.5114/wo.2015.55272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 07/13/2015] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY Despite the increase in studies concerning oncoplastic reduction mammoplasty (ORM), data showing long-term aesthetic and patient satisfaction for ORM in patients with macromastia remain limited. Therefore, this study evaluated the long-term results of tumorectomy and concomitant bilateral ORM for early-stage breast cancer patients with macromastia in terms of cosmesis, patient satisfaction, and functional outcomes. MATERIAL AND METHODS Retrospective data of patients with macromastia undergoing ORM for breast cancer between 1996 and 2011 were examined and evaluated regarding the aesthetic results, patient satisfaction, and functional outcomes. RESULTS The median age of the 82 patients was 50 years. The median follow-up was 120 months (range: 28-212 months). The median breast volume was 1402 cm(3), and the median weight of the excised breast material was 679 g. A good or excellent evaluation of the cosmetic outcome was as follows: self-evaluation: 84.1% at the early-stage, 80.3% at the later stage; panel evaluation: 75.4% at the late-stage. Median patient satisfaction rates were 9.1% for early-stage disease and 8.8% for late-stage disease. Reduced mobility and intertrigo improved by three-fold during the post-operative period. CONCLUSIONS ORM for early-stage breast cancer in women with macromastia results in good cosmesis in both the early-stage and long-term, and is quite acceptable for use in patients. Patients reacted favorably to the prospect of having their breast cancer and macromastia treated in a single session, and positive results continued over the long-term.
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Hernanz F, González-Noriega M, Pérez RV, Gómez-Fleitas M. Versatility of therapeutic reduction mammoplasty in oncoplastic breast conserving surgery. World J Surg Proced 2015; 5:217-222. [DOI: 10.5412/wjsp.v5.i3.217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 06/09/2015] [Accepted: 07/23/2015] [Indexed: 02/06/2023] Open
Abstract
Oncoplastic breast conserving surgery is the gold standard approach for the surgical treatment of early breast cancer. There is a well defined technique named “therapeutic mammoplasty” which is characterized for using a reduction mammaplasty technique to treat breast cancer conservatively. In our current practice, “therapeutic mammoplasty” or therapeutic reduction mammaplasty is our favorite oncoplastic breast conserving approach which it used in almost half of our patients. This technique is very versatile allows us the resection of tumors located in all breast quadrants of patients with moderate-to large-sized breasts. We describe a series of 57 patients who were treated using a therapeutic reduction mammaplasty. All surgical procedures were carried out by one comprehensive breast surgeon who planned and designed the surgery performing both oncologic and reconstructive procedures. Surgical margins were insufficient in eight patients (14%). Nine patients (15.8%) had a complication in early postoperative period and in one of them adjuvant radiotherapy was delayed four months due to a wound dehiscence. The rate of synchronous contralateral symmetrization was 31.6%. Our conclusion is that reduction mammaplasty is a useful and safe skill to treat breast cancer conservatively playing a very important role therefore it must be situated in the priority of learning objectives.
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Holt R, Murphy J. PICO™ incision closure in oncoplastic breast surgery: a case series. Br J Hosp Med (Lond) 2015; 76:217-23. [PMID: 25853353 DOI: 10.12968/hmed.2015.76.4.217] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Single-use negative pressure wound therapy (PICO™) has been used on high-risk surgically incised wounds with encouraging results, but there is no evidence for its use in oncoplastic breast surgery. This article reports a case series with closed incisions in oncoplastic breast procedures following the introduction of PICO™.
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Affiliation(s)
- Rachel Holt
- ST8 Trainee in Plastic Surgery, University Hospital South Manchester NHS Foundation Trust, Manchester M23 9LT
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24
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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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Atiyeh B, Dibo S, Zgheib E, Abbas J. Skin sparing/skin reducing mastectomy (SSM/SRM) and the concept of oncoplastic breast surgery. Int J Surg 2014; 12:1115-22. [PMID: 25178261 DOI: 10.1016/j.ijsu.2014.08.401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/24/2014] [Accepted: 08/28/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION With the better understanding of breast cancer history and biology, improved diagnostic modalities and the shift towards minimally invasive surgeries, indications for prophylactic mastectomy, skin sparing or skin reducing mastectomies (SSM/SRM) with nipple areolar complex (NAC) preservation coupled with immediate breast reconstruction are gaining popularity. The authors share their experience and conception with mastectomy and immediate alloplastic breast reconstruction with the esthetic circumvertical mammoplasty pattern combined with the dermal barrier buttress flap. MATERIAL AND METHODS The described technique was performed for 28 patients presenting for mastectomy and immediate alloplastic breast reconstruction. With close collaboration between the oncologic and plastic surgeons, mastectomy was performed in all cases with the esthetic circumvertical mammoplasty pattern. To achieve safe excision and optimal reconstruction, the standard incisions could be custom designed to fit oncologic requirements and allow the creation of a dermal barrier flap used as a buttress separating the implant from the suture line. CONCLUSION The circumvertical mastectomy pattern combined with the dermal barrier buttress flap is a versatile option allowing safe reconstruction regardless of the tumor and necessary skin excision location.
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Affiliation(s)
- Bishara Atiyeh
- Euro-Mediterranean Council for Burns and Fire Disasters, Beirut, Lebanon; Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Saad Dibo
- Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Elias Zgheib
- Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Jaber Abbas
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Munhoz AM, Montag E, Gemperli R. Oncoplastic breast surgery: indications, techniques and perspectives. Gland Surg 2014; 2:143-57. [PMID: 25083476 DOI: 10.3978/j.issn.2227-684x.2013.08.02] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 08/20/2013] [Indexed: 11/14/2022]
Abstract
Breast-conservation surgery (BCS) is established as a safe option for most women with early breast cancer. Recently, advances in oncoplastic techniques have reduced surgical trauma and thus are capable of preserving the breast form and quality of life. In spite of the most BCS defects can be managed with primary closure, the aesthetic outcome may be unpredictable. Oncoplastic reconstruction may begin at the time of BCS (immediate), weeks (delayed-immediate) or months to years afterwards (delayed). With immediate reconstruction, the surgical process is smooth, since both procedures can be associated in one operative setting. Additionally, it permits wider excision of the tumor, with a superior mean volume of the specimen and potentially reducing the incidence of margin involvement. The oncoplastic techniques are related to volume displacement or replacement procedures including local flaps, latissimus dorsi myocutaneous flap and reduction mammaplasty/masthopexy. Regardless of the fact that there is no consensus concerning the best approach, the criteria are determined by the surgeon's experience and the size of the defect in relation to the size of the remaining breast. On the basis of our 15-year experience, it is possible to identify trends in types of breast defects and to develop an algorithm for immediate BCS reconstruction on the basis of the initial breast volume, the extent/location of glandular tissue ressection and the remaining available breast tissue. The main advantages of the technique utilized should include reproducibility, low interference with the oncologic treatment and long-term results. Surgical planning should include the patients's preferences, and chiefly addressing individual reconstructive requirements, enabling each patient to receive an individual "custom-made" reconstruction.
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Affiliation(s)
- Alexandre Mendonça Munhoz
- 1 Plastic Surgery Division, Hospital Sírio-Libanês, São Paulo/ Brazil ; 2 Breast Reconstruction Group, University of São Paulo School of Medicine, Brazil ; 3 Division of Plastic Surgery, University of São Paulo School of Medicine, Brazil
| | - Eduardo Montag
- 1 Plastic Surgery Division, Hospital Sírio-Libanês, São Paulo/ Brazil ; 2 Breast Reconstruction Group, University of São Paulo School of Medicine, Brazil ; 3 Division of Plastic Surgery, University of São Paulo School of Medicine, Brazil
| | - Rolf Gemperli
- 1 Plastic Surgery Division, Hospital Sírio-Libanês, São Paulo/ Brazil ; 2 Breast Reconstruction Group, University of São Paulo School of Medicine, Brazil ; 3 Division of Plastic Surgery, University of São Paulo School of Medicine, Brazil
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Lee S, Lee J, Lee S, Bae Y. Oncoplastic breast surgery with latissimus dorsi myocutaneous flap for large defect in patients with ptotic breasts: is it feasible when combined with local flaps? World J Surg Oncol 2014; 12:65. [PMID: 24669908 PMCID: PMC3974747 DOI: 10.1186/1477-7819-12-65] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 03/16/2014] [Indexed: 12/04/2022] Open
Abstract
Background The latissimus dorsi myocutaneous flap (LDMCF) is frequently applied to breast cancer patients for breast reconstruction. However, the LDMCF is considered inappropriate for patients with ptotic breast. The authors investigated combining LDMCF and two local flaps for large defects of the breast after partial mastectomy in patients with ptosis. Methods Nineteen patients with breast cancer underwent a partial mastectomy with immediate reconstruction. Reconstruction methods consisted of LDMCF, thoraco-epigastric flap, and inferior pedicled rotational local flap, referred to as a combined pedicle flap. The cosmetic results were self-assessed after chemotherapy and radiotherapy by a four-point scoring system. Results Ptosis was graded as follows: two patients with grade 1, 10 patients with grade 2, and seven patients with grade 3. The mean tumor size was 2.7 cm and multifocality was identified in 11 patients (57.9%). The mean excised volume was 468.5 cm3 and the percentage of excised volume was 46.2%. The cosmetic results were excellent in five patients, good in seven patients, fair in six patients, and poor in one patient. Conclusion The combined pedicle flap, consisting of LDMCF, thoraco-epigastric flap, and inferior pedicled rotational local flap, allows good cosmesis in breast cancer patients with large breasts or ptosis despite a wide excision.
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Affiliation(s)
| | | | | | - Youngtae Bae
- Department of Surgery, Medical Research Institute, Pusan National University, Ami-dong 1-ga, Seo-gu, Busan 602-739, Republic of Korea.
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Munhoz AM, Montag E, Gemperli R. Current aspects of therapeutic reduction mammaplasty for immediate early breast cancer management: An update. World J Clin Oncol 2014; 5:1-18. [PMID: 24527398 PMCID: PMC3920176 DOI: 10.5306/wjco.v5.i1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 11/02/2013] [Accepted: 11/16/2013] [Indexed: 02/06/2023] Open
Abstract
Breast-conservation surgery (BCS) is established as a safe surgical treatment for most patients with early breast cancer. Recently, advances in oncoplastic techniques are capable of preserving the breast form and quality of life. Although most BCS defects can be managed with primary closure, the aesthetic outcome may be unpredictable. Among technical options, therapeutic reduction mammaplasty (TRM) remains a useful procedure since the BCS defect can be repaired and the preoperative appearance can be improved, resulting in more proportional breasts. As a consequence of rich breast tissue vascularization, the greater part of reduction techniques have based their planning on preserving the pedicle of the nipple-areola complex after tumor removal. Reliable circulation and improvement of a conical shape to the breast are commonly described in TRM reconstructions. With an immediate approach, the surgical process is smooth since both procedures can be carried out in one operative setting. Additionally, it permits wider excision of the tumor, with a superior mean volume of the specimen and potentially reduces the incidence of margin involvement. Regardless of the fact that there is no consensus concerning the best TRM technique, the criteria is determined by the surgeon’s experience, the extent/location of glandular tissue resection and the size of the defect in relation to the size of the remaining breast. The main advantages of the technique utilized should include reproducibility, low interference with the oncological treatment and long-term results. The success of the procedure depends on patient selection, coordinated planning and careful intra-operative management.
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Semprini G, Cattin F, Vaienti L, Brizzolari M, Cedolini C, Parodi P. Oncoplastic surgery and cancer relapses: Cosmetic and oncological results in 489 patients. Breast 2013; 22:946-51. [DOI: 10.1016/j.breast.2013.05.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 11/18/2012] [Accepted: 05/05/2013] [Indexed: 12/22/2022] Open
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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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Oncoplastic breast reduction: maximizing aesthetics and surgical margins. Int J Surg Oncol 2012; 2012:907576. [PMID: 23209890 PMCID: PMC3504375 DOI: 10.1155/2012/907576] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 10/03/2012] [Accepted: 10/22/2012] [Indexed: 12/02/2022] Open
Abstract
Oncoplastic breast reduction combines oncologically sound concepts of cancer removal with aesthetically maximized approaches for breast reduction. Numerous incision patterns and types of pedicles can be used for purposes of oncoplastic reduction, each tailored for size and location of tumor. A team approach between reconstructive and breast surgeons produces positive long-term oncologic results as well as satisfactory cosmetic and functional outcomes, rendering oncoplastic breast reduction a favorable treatment option for certain patients with breast cancer.
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Pompei S, Marcasciano F, Frascino LF, Cesarini C, Labardi L, Caravelli G, Abate O, Arelli F. The inferior pedicle flap used as “filler” in breast conservative therapy. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-012-0760-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hoffmann J, Wallwiener D. Breast cancer surgery and financial reimbursement in Germany. Breast Care (Basel) 2012; 7:384-8. [PMID: 24647777 DOI: 10.1159/000343294] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The reimbursement for breast cancer-specific operative interventions in Germany is regulated by the diagnosis-related group (DRG) system. The essential elements of the German DRG system, which was developed as a per-case lump-sum payment system, are presented, including the participating institutions. The actual treatment situation in breast cancer surgery is now aptly reflected in the introduction of the OPS (operation and treatment procedure classification) 2012. This is oriented on the classification model of Hoffmann and Wallwiener, with its complexity-based differentiation that reflects the basic idea of different resource usage. Despite the actual potential of the appropriately differentiated encryption of surgical procedures, which illustrates their differences in resource costs and consumption, appropriate reimbursement has still not been achieved. Hopefully, in the future the calculation of the DRGs in the field of breast cancer surgery will be based on data feedback from the hospitals and treatment institutions, and will be more suited to the main purpose of the DRG system, i.e. that reimbursement reflects resource expenditure. A necessary basic tool for differentiated, complexity-oriented encryption has been achieved with the OPS 2012, which mirrors our classification model for oncological, oncoplastic and reconstructive breast surgery.
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Urban C, Lima R, Schunemann E, Spautz C, Rabinovich I, Anselmi K. Oncoplastic principles in breast conserving surgery. Breast 2012; 20 Suppl 3:S92-5. [PMID: 22015301 DOI: 10.1016/s0960-9776(11)70302-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Oncoplastic surgery (OP) represents a major advance in breast cancer surgery. It is based on three principles: ideal oncology surgery with free margins and adequate local control of disease, immediate breast reconstruction and symmetry, with the transposition of plastic surgery techniques into breast cancer surgery. Its original focus was to improve the quality of life of patients undergoing oncological treatments that can be more effective from the aesthetic-functional point of view than the traditional breast conserving techniques. As it happens with all changes of paradigms, it brings new challenges for the traversal formation of all involved in the treatment of breast cancer. Besides that, it opens to new perspectives of surgical research related to the aesthetic results, quality of life and local control, as well as optimization of operative timing and reduction of both adverse effects and costs. The aim of this review was to present the principles of this approach and the main techniques applied, evaluating its indications and limits in conservative breast cancer surgery.
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Affiliation(s)
- Cicero Urban
- Breast Unit, Hospital Nossa Senhora das Gragas, Curitiba, Brazil.
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Outcome analysis of immediate and delayed conservative breast surgery reconstruction with mastopexy and reduction mammaplasty techniques. Ann Plast Surg 2012; 67:220-5. [PMID: 21301307 DOI: 10.1097/sap.0b013e3181f77bba] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bilateral mammaplasty or mastopexy is frequently used for oncoplastic objectives. However, little information has been available regarding outcome following immediate and delayed reconstruction. METHOD Patients were divided into Group I (immediate reconstruction) and Group II (delayed reconstruction). Retrospective review was performed to compare complications, length of hospital stay, revision surgeries, and satisfaction. The associations between the complications with potential risk factors (timing, age, body mass index, smoking, and comorbid medical conditions) were analyzed. RESULTS There were a total of 144 patients with a mean follow-up of 47 months. Of the 106 patients in Group I, complications occurred in 24 (22.6%), skin necrosis was observed in 7.5%, fat necrosis in 5.6%, and 6.6% patients developed local recurrence. Mean period of hospitalization was 1.89 days. Of the 38 patients of the Group II, complications occurred in 12 (31.5%), skin necrosis was observed in 7 (18.4%), fat necrosis in 4 (10.5%), and 5.2% patients developed local recurrence. Mean period of hospitalization was 1.35 days. Increased length of hospital stay greater than 1 day (P < 0.001) and the number of revision surgeries (P = 0.043) were associated with the timing of the reconstruction. In univariate analysis, no difference between groups was found with respect to complication incidence (P = 0.275); however, after adjusting for other risk factors, the probability of complications tend to be higher for Group II (OR = 2.65; 95% confidence interval = 1.01-7.00; P = 0.049). CONCLUSIONS On the basis of the results of our study, the probability of complications tends to be higher for delayed reconstructions, and it is demonstrated that obesity and smoking are risk factors for complications. Ultimately, these data may facilitate the provision of individualized risk information for shared medical decision-making.
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Hernanz F, Sánchez S, Cerdeira MP, Figuero CR. Long-term results of breast conservation and immediate volume replacement with myocutaneous latissimus dorsi flap. World J Surg Oncol 2011; 9:159. [PMID: 22142459 PMCID: PMC3286394 DOI: 10.1186/1477-7819-9-159] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 12/05/2011] [Indexed: 11/23/2022] Open
Abstract
Background Published long-term outcomes of oncoplastic breast-conserving surgery are scarce and, specifically, aesthetic outcomes assessed with an objective method have not previously been published. Methods A cohort of 41 patients treated with a quadrantectomny and immediate reconstruction using a myocutaneous latissimus dorsi flap were analyzed and their aesthetic outcomes were evaluated objectively by BCCT.core software. Results At the end of a 58-month follow-up from the date of initial diagnosis, one patient (2.4%) developed an ipsilateral recurrence, six patients developed distant metastases and three patients died (7.3%) without ipsilateral recurrence, one of them presenting hepatic metastases at the time of the initial diagnosis. We were able to evaluate aesthetic results in 23 patients, 3 assessed as excellent, 12 good and 8 fair. Conclusion This oncoplastic volume replacement technique obtained a good local control and satisfactory and stable aesthetic results which have maintained unchanged after a long period of time.
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Affiliation(s)
- Fernando Hernanz
- Breast Unit, Hospital, University of Cantabria, Marqués de Valdecilla (Avda Valdecilla s/n), Santander, (39008), Cantabria, Spain.
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Breast-volume displacement using an extended glandular flap for small dense breasts. PLASTIC SURGERY INTERNATIONAL 2011; 2011:359842. [PMID: 22567239 PMCID: PMC3335467 DOI: 10.1155/2011/359842] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 06/21/2011] [Accepted: 06/21/2011] [Indexed: 11/17/2022]
Abstract
We defined the glandular flap including fat in the subclavicular area as an extended glandular flap, which has been used for breast-conserving reconstruction in the upper portion of the breast. Indication. The excision volume was 20% to 40% of the breast volume, and the breast density was dense. Surgical Technique. The upper edge of the breast at the subclavicular area was drawn in the standing position before surgery. After partial mastectomy, an extended glandular flap was made by freeing the breast from both the skin and the pectoralis fascia up to the preoperative marking in the subclavicular area. It is important to keep the perforators of the internal mammary artery and/or the branches of the lateral thoracic artery intact while making the flap. Results. Seventeen patients underwent remodeling using an extended glandular flap. The cosmetic results at 1 year after the operation: excellent in 11, good in 1, fair in 3, and poor in 2. All cases of unacceptable outcome except one were cases with complications, and more than 30% resection of moderate or large size breasts did not obtain an excellent result for long-term followup. Conclusion. This technique is useful for performing the breast-conserving reconstruction of small dense breasts.
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Munhoz AM, Montag E, Arruda E, Brasil JA, Aldrighi JM, Gemperli R, Filassi JR, Ferreira MC. Immediate conservative breast surgery reconstruction with perforator flaps: New challenges in the era of partial mastectomy reconstruction? Breast 2011; 20:233-40. [DOI: 10.1016/j.breast.2011.01.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 10/08/2010] [Accepted: 01/03/2011] [Indexed: 10/18/2022] Open
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The role of oncoplastic therapeutic mammoplasty in breast cancer surgery--a review. Surg Oncol 2011; 21:133-41. [PMID: 21411311 DOI: 10.1016/j.suronc.2011.01.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 09/22/2010] [Accepted: 01/17/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Reduction mammoplasty is an established technique for symptom relief in women with breast hypertrophy. Therapeutic mammoplasty and radiotherapy may allow cancers to be surgically treated whilst maintaining oncological safety and improving cosmetic outcome. This article aims to review the evidence upon which therapeutic mammoplasty is based and to outline an approach for surgical planning and selection. METHODS A systematic PubMed and Medline literature search was carried out. All abstracts were studied and papers that dealt primarily with breast conservation using plastic surgery techniques were reviewed. RESULTS AND CONCLUSION Therapeutic mammoplasty is a useful procedure for breast conserving cancer surgery in women with large breasts, conferring a good cosmetic and functional outcome. This article proposes that breast surgeons experienced in oncological surgery can safely resect tumours from all aspects of the breast with a minimal number of variations in standard mammoplasty technique.
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Patani N, Carpenter R. Oncological and aesthetic considerations of conservational surgery for multifocal/multicentric breast cancer. Breast J 2010; 16:222-32. [PMID: 20565467 DOI: 10.1111/j.1524-4741.2010.00917.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Conventional indications for mastectomy (MX) reflect circumstances where breast conserving therapy (BCT) could compromise oncological or cosmetic outcome. MX continues to be recommended for the majority of women with multiple lesions within the same breast. In this article, we review the oncological safety and aesthetic considerations of BCT in the context of multifocal (MF) or multicentric (MC) breast cancer. Literature review facilitated by Medline and PubMed databases. Published studies have reported divergent results regarding the oncological adequacy of BCT in the management of MF or MC disease. Earlier studies demonstrated high rates of local recurrence (LR) for BCT. More recent series have found BCT to be comparable to MX in terms of LR, distant failure, disease free and overall survival. Few studies have adequately evaluated cosmetic outcomes following BCT for MF or MC breast cancer. Contemporary oncoplastic techniques have extended the clinical utility of BCT and are of particular relevance to breast conservation in the context of MF or MC lesions. Appropriate case selection, preoperative oncological and aesthetic planning, satisfactory clearance of the surgical margins and adjuvant radiotherapy are of paramount importance. In the absence of level-1 guidance concerning the management of women with MF or MC disease, each case requires discussion with regard to tumor and patient related factors in the context of the multidisciplinary team. In selected patients with MF or MC disease, BCT is oncologically safe and cosmetically acceptable. Uniformity of practice and the establishment of a standard of care will require an evidence-base from prospective studies.
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Affiliation(s)
- Neill Patani
- The Breast Unit, Elizabeth Garrett Anderson Wing, University College Hospital, London, United Kingdom
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Partial Breast Reconstruction With Mini Superficial Inferior Epigastric Artery and Mini Deep Inferior Epigastric Perforator Flaps. Ann Plast Surg 2010; 65:147-54. [DOI: 10.1097/sap.0b013e3181c9dcb2] [Citation(s) in RCA: 12] [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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How does ptosis affect satisfaction after immediate reconstruction plus contralateral mammaplasty? Ann Plast Surg 2010; 65:294-9. [PMID: 20661128 DOI: 10.1097/sap.0b013e3181cc2a0a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Breast reconstruction can reduce psychologic distress without interfering with adjuvant treatment. The study was conducted to determine how ptosis affects satisfaction after immediate partial breast reconstruction with local flaps and symmetrization of the contralateral breast. Twenty patients, with estimated breast volume between 300 and 600 mL and tumor size until T2 by TNM classification, were included in a retrospective cohort study based on a prospective database. The breast was reconstructed using local flaps based on the perforating vessels of the intercostal and pectoralis major muscles. The donor site was located at the intersection of the lower quadrants of the breast. Contralateral mammaplasty using the vertical technique was used to maintain balanced breast volume and shape. A satisfaction score on a scale of 0 to 10 was used, and its correlation with the degree of breast ptosis (1-3) was evaluated. Despite good overall satisfaction scores, significant differences between the ptosis groups 1 (<1 cm) and 3 (>3 cm) were observed (P = 0.010). Breast reconstruction using local flaps plus contralateral mammaplasty performed at the time of surgical resection produced satisfaction scores considered good (8/10). This combined technique seems to be of greatest benefit when the degree of breast ptosis is marked.
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Use of Pectoralis Major With or Without Pectoralis Minor Muscle Flap to Fill Lumpectomy in the Breast. Ann Plast Surg 2010; 65:23-7. [DOI: 10.1097/sap.0b013e3181bba07c] [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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Quality-of-life and self-esteem outcomes after oncoplastic breast-conserving surgery. Plast Reconstr Surg 2010; 125:811-7. [PMID: 20195109 DOI: 10.1097/prs.0b013e3181ccdac5] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This prospective trial was designed to assess the impact of oncoplastic surgery on quality of life and self-esteem of breast cancer patients undergoing breast-conserving treatment. METHODS Forty-five patients with primary breast cancer to be treated with breast-conserving surgery and immediate partial breast reconstruction were assessed with regard to quality-of-life and self-esteem outcomes preoperatively and 6 and 12 months postoperatively. Another 42 breast cancer patients, treated by conservative surgery without breast reconstruction at least 1 year previously, were assessed for the control group. Validated questionnaires (Short Form-36, Brazilian version, and the Rosenberg-EPM Self-Esteem Scale) were used. Data were analyzed by using the Mann-Whitney and Friedman tests. RESULTS Participation rates at the follow-up assessments were 95.5 percent at the 6-month follow-up and 88.9 percent at the 12-month follow-up. Control and reconstruction groups were matched for age, body mass index, and demographic and oncologic aspects. At postoperative month 12, the breast reconstruction group had significantly better health status than the control group with regard to physical functioning (p < 0.000), health perception (p < 0.002), vitality (p < 0.007), social functioning (p < 0.02), role emotional (p < 0.02), mental health (p < 0.000), and self-esteem (p < 0.02). Compared with preoperatively, breast reconstruction group scores were significantly higher at 12 months postoperatively for seven of the eight dimensions of the Short Form-36: physical functioning (p < 0.01), role physical (p < 0.02), health perception (p < 0.02), vitality (p < 0.01), social functioning (p < 0.02), role emotional (p < 0.05), and mental health (p < 0.02). Self-esteem was also significantly better at 12 months (p < 0.02). CONCLUSION Oncoplastic surgery had a positive impact on quality of life and self-esteem of patients undergoing breast-conserving treatment.
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Zaha H, Sunagawa H, Kawakami K, Touyama T, Yonaha T, Ohshiro N. Partial Breast Reconstruction for an Inferomedial Breast Carcinoma Using an Omental Flap. World J Surg 2010; 34:1782-7. [DOI: 10.1007/s00268-010-0535-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Oncoplastic breast surgery for cancer: analysis of 540 consecutive cases [outcomes article]. Plast Reconstr Surg 2010; 125:454-462. [PMID: 20124831 DOI: 10.1097/prs.0b013e3181c82d3e] [Citation(s) in RCA: 176] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Synchronous plastic and oncological surgery is undertaken to improve the security of excision margins and yield high-quality aesthetic outcomes when conventional breast-conserving therapy either anticipates poor results or is not possible. METHODS A total of 540 consecutive patients underwent primary oncoplastic breast surgery for cancer with high tumor-to-breast volume ratios and locations precluding a good aesthetic result with simple tumor excision. A variety of techniques were employed at the Institut Curie between 1986 and 2007, and aesthetic outcomes were assessed on a five-point scale from 1 (excellent) to 5 (poor). RESULTS The median age was 52 years (range, 28 to 90 years), and median follow-up was 49 months (6 to 262 months). Median tumor size was 29.1 mm (range, 4 to 100 mm), with most patients (72.3 percent) having a brassiere cup size of B or C. Close or involved margins occurred in 18.9 percent, with mastectomy being necessary in 9.4 percent. A satisfactory aesthetic outcome (ratings of 1 to 3) at 5 years was obtained in 90.3 percent. Five-year overall and distant disease-free survival rates were 92.9 and 87.9 percent, respectively, with local recurrence in 6.8 percent. CONCLUSIONS With local recurrence and survival rates similar to those for breast-conserving therapy, this series confirms the safety of oncoplastic breast surgery for tumors both high in volume and difficult in location. Highly satisfactory cosmetic outcomes extend the indications for conservative surgery, further reduce the mastectomy rate, and limit adverse aesthetic sequelae.
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Berry MG, Fitoussi AD, Curnier A, Couturaud B, Salmon RJ. Oncoplastic breast surgery: a review and systematic approach. J Plast Reconstr Aesthet Surg 2009; 63:1233-43. [PMID: 19559661 DOI: 10.1016/j.bjps.2009.05.006] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 04/10/2009] [Accepted: 05/02/2009] [Indexed: 12/20/2022]
Abstract
Oncoplastic breast surgery (OBS) is relatively new, but has made rapid progress from its tentative steps of infancy in the 1990s. The recent Milanese Consensus Conference on Breast Conservation concluded that, firstly, oncoplastic techniques are warranted to allow wide excision and clear margins without compromising cosmesis. Secondly, such surgery is ideally performed at the same time as oncological excision. Whilst technically more challenging than standard breast conserving therapy (BCT), OBS is well proven, if not yet widely practised, both oncologically and aesthetically and a review of the available techniques is perhaps timely. The roots of breast conserving therapy can be traced to the 1930s, actually due to advances made in radiotherapy, and the last 20 years have seen it become firmly established. This review aims to summarise the key historical developments and latest innovations in OBS. Not only are our patients, who expect not only safe cancer treatment but a satisfactory aesthetic outcome, increasingly informed and demanding, but longer follow up has stimulated surgeons to improve outcomes. In many cases, particularly with ptosis and macromastia, the cancer can be treated, usually with wider excision margins, simultaneously improving the aesthetic appearance. Present at the birth of OBS, the Institut Curie has continued to introduce innovative techniques over the last two decades and a systematic approach, comprising nine basic techniques, has evolved to allow high quality treatment of any and all breast cancers suitable for OBS.
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Affiliation(s)
- M G Berry
- Departement de Chirurgie, Institut Curie, Paris, France.
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Hoffmann J, Wallwiener D. Classifying breast cancer surgery: a novel, complexity-based system for oncological, oncoplastic and reconstructive procedures, and proof of principle by analysis of 1225 operations in 1166 patients. BMC Cancer 2009; 9:108. [PMID: 19356240 PMCID: PMC2679762 DOI: 10.1186/1471-2407-9-108] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 04/08/2009] [Indexed: 11/17/2022] Open
Abstract
Background One of the basic prerequisites for generating evidence-based data is the availability of classification systems. Attempts to date to classify breast cancer operations have focussed on specific problems, e.g. the avoidance of secondary corrective surgery for surgical defects, rather than taking a generic approach. Methods Starting from an existing, simpler empirical scheme based on the complexity of breast surgical procedures, which was used in-house primarily in operative report-writing, a novel classification of ablative and breast-conserving procedures initially needed to be developed and elaborated systematically. To obtain proof of principle, a prospectively planned analysis of patient records for all major breast cancer-related operations performed at our breast centre in 2005 and 2006 was conducted using the new classification. Data were analysed using basic descriptive statistics such as frequency tables. Results A novel two-type, six-tier classification system comprising 12 main categories, 13 subcategories and 39 sub-subcategories of oncological, oncoplastic and reconstructive breast cancer-related surgery was successfully developed. Our system permitted unequivocal classification, without exception, of all 1225 procedures performed in 1166 breast cancer patients in 2005 and 2006. Conclusion Breast cancer-related surgical procedures can be generically classified according to their surgical complexity. Analysis of all major procedures performed at our breast centre during the study period provides proof of principle for this novel classification system. We envisage various applications for this classification, including uses in randomised clinical trials, guideline development, specialist surgical training, continuing professional development as well as quality of care and public health research.
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Affiliation(s)
- Jürgen Hoffmann
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany.
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