Comparison of Surgical and Oncological Outcomes between Chest Wall Perforator Flaps and Therapeutic Mammoplasty

Current practice and provision of oncoplastic breast-conserving surgery in the UK: results of the ANTHEM national practice questionnaire

PURPOSE

Oncoplastic breast-conserving surgery (OPBCS) may be a better option than mastectomy ± immediate breast reconstruction (IBR) for women with breast cancer but studies directly comparing the techniques are lacking. We surveyed UK breast units to determine the current practice of OPBCS to inform the design of a future comparative study.

METHODS

An electronic survey was developed to explore the current practice of OPBCS. This included the local availability of volume displacement and/or replacement techniques; number of cases performed; contraindications and approach to contralateral symmetrisation. Summary data for each survey item were calculated and overall provision of care examined.

RESULTS

58 UK centres completed the survey, including 43 (74%) stand-alone breast and 15 (26%) combined breast/plastics units. Over 40% of units (n = 24) treated more than 500 cancers/year. Most units offered volume displacement techniques (TMs) (97%). Over two-thirds (n = 39. 67%) of units offered local perforator flaps (LPF). Approximately a half of units (10/19) not performing LPF were planning to introduce them in the next 12-24 months. A third (n = 19, 33%) of units routinely performed simultaneous contralateral symmetrisation mostly with two-surgeon operating. There were limited oncological restrictions to OPBCS with no contraindications for multifocal cancers in most centres; 65% of units (36/55) offered OPBCS for multicentric disease. Extensive DCIS was a contraindication in a minority of units.

CONCLUSIONS

OPBCS is widely available in the UK but contraindications and approaches to contralateral symmetrisation were variable. Work is now needed to prospectively evaluate the outcomes of OPBCS vs mastectomy ± IBR to support informed decision-making.

Direct to implant reconstruction with adjustable permanent Becker implant expanders with ADM following de-epithelised skin reducing mastectomy in high-risk overweight and obese patients with severe ptosis

Overweight and obese patients with severe ptosis undergoing mastectomy and reconstruction present a challenge to the oncoplastic breast surgeon. This paper investigates early-to medium-term outcome of high-risk overweight and obese women with severe ptosis undergoing de-epithelised skin reducing mastectomy and direct to implant reconstruction with Becker implant expanders. From Nov 2016 and April 2021, 20 Wise pattern skin reducing mastectomies (SRM) were performed, 18 with Adjustable Permanent Becker Implant expanders (APBI) and 2 with fixed volume implants. Median age was 48 years (27-73), and median FU was 21 months (4-49). There were 8 smokers and 7 patients needed radiation treatment. In the ABPI group, there was one infection, 3 patients had threatened wounds which needed revision, and one patient lost her implant. There was no locoregional recurrence or distant metastasis. There was 1 week delay in adjuvant chemotherapy for a patient with wound issues following reconstruction. One patient is awaiting autologous reconstruction following deformity subsequent to radiation treatment. In conclusion the use of APBI following de-epithelised skin reduction surgery in this high-risk group is an option with acceptable early-to medium-term outcome.