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Papadopoulos S, Vidovic G, Tio J, Moysiadis T, Lioupis M, Athanasiadis AP, Abdallah A. Fat grafting in breast surgery: a retrospective single-breast centre 6-year experience. Arch Gynecol Obstet 2024:10.1007/s00404-024-07708-7. [PMID: 39235471 DOI: 10.1007/s00404-024-07708-7] [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: 03/05/2024] [Accepted: 08/18/2024] [Indexed: 09/06/2024]
Abstract
PURPOSE In recent years, fat grafting has gained importance as a valuable technique in breast surgery. As a breast center that has embraced this approach, we aimed to investigate the indications and complications of fat grafting. METHODS In this retrospective study, we examined a total of 263 lipofilling treatments on 121 patients. Five groups were identified: the reconstruction group (72.7%), consisting of 24.8% autologous and 38% implant-based reconstructions after cancer, and correction of the tuberous breasts (10.7%). An almost equivalent group (10.7%), consisted of patients treated for cosmetic reasons. Patients after breast-conserving therapy amounted to 16.5%. Twenty patients (16.5%) were treated to alleviate pain. RESULTS No major complications, and no cancer recurrence or metastasis were observed. One case of infection occurred at the injection site (infection rate: 0.38%). ANOVA showed statistically significant results for age (p < 0.001) and mean fat volume (p = 0.001). Posthoc analysis showed that the mean age of the tuberous group (21 years) was significantly smaller compared to all other categories (p < 0.001). Post-hoc analysis for fat volume indicated that the mean value for the cosmetic category (447.08 cc) was significantly greater than that of the breast-conserving and implant reconstruction categories (p = 0.009 and p = 0.030, respectively), while not significantly different from the tuberous and autologous reconstruction categories (p = 0.928 and p = 0.648, respectively). CONCLUSIONS Lipofilling has proven a valuable adjunct in reconstructive and aesthetic breast surgery with a low complication profile. The versatility of this low-cost technique and the low rate of complications make it a powerful asset of modern breast centers.
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Affiliation(s)
- Sarantos Papadopoulos
- Department of Senology, Evangelische Kliniken Gelsenkirchen, Munckelstrasse 27, 45879, Gelsenkirchen, Germany.
| | - Goran Vidovic
- Private Practice in Senology, Obstetrics and Gynecology, Bochum, Germany
| | - Joke Tio
- Department of Obstetrics and Gynecology, Breast Center, Muenster University, Muenster, Germany
| | - Theodoros Moysiadis
- Department of Computer Science, School of Sciences and Engineering, University of Nicosia, Nicosia, Cyprus
| | - Matteo Lioupis
- Department of Senology, Evangelische Kliniken Gelsenkirchen, Munckelstrasse 27, 45879, Gelsenkirchen, Germany
| | - Apostolos P Athanasiadis
- 3rd Department of Obstetrics and Gynecology, Medical School, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Abdallah Abdallah
- Department of Senology, Evangelische Kliniken Gelsenkirchen, Munckelstrasse 27, 45879, Gelsenkirchen, Germany
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2
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Hahn EA, Pugh SL, Lu HL, Vela AM, Gillespie EF, Nichols EM, Wright JL, MacDonald SM, Cahlon O, Baas C, Braunstein LZ, Fang LC, Freedman GM, Jimenez RB, Kesslering CM, Mishra MV, Mutter RW, Ohri N, Rosen LR, Urbanic JJ, Jagsi R, Mitchell SA, Bekelman JE, Cella D. Validation of Patient-Reported Outcomes in Patients With Nonmetastatic Breast Cancer Receiving Comprehensive Nodal Irradiation in the RadComp Trial. Int J Radiat Oncol Biol Phys 2024; 120:149-161. [PMID: 38739047 PMCID: PMC11329347 DOI: 10.1016/j.ijrobp.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Our purpose was to evaluate the measurement properties of patient-reported outcome (PRO) measures used in the ongoing RadComp pragmatic randomized clinical trial (PRCT). METHODS AND MATERIALS The deidentified and blinded data set included 774 English-speaking female participants who completed their 6-month posttreatment assessment. Eleven PRO measures were evaluated, including the Trial Outcome Index from the Functional Assessment of Cancer Therapy-Breast (FACT-B), Satisfaction with Breast Cosmetic Outcomes, the BREAST-Q, and selected Patient-Reported Outcomes Measurement Information System (PROMIS) measures. PROs were measured at 3 timepoints: baseline, completion of radiation therapy (RT), and 6 months post-RT. Ten variables were used as validity anchors. Pearson or Spearman correlations were calculated between PROs and convergent validity indicators. Mean PRO differences between clinically distinct categories were compared with analysis of variance methods (known-groups validity). PRO change scores were mapped to change in other variables (sensitivity to change). RESULTS Most correlations between PROs and validity indicators were large (≥0.5). Mean score for Satisfaction with Breast Cosmetic Outcomes was higher (better) for those with a lumpectomy compared with those with a mastectomy (P < .001). Mean scores for the FACT-B Trial Outcome Index and for PROMIS Fatigue and Ability to Participate in Social Roles and Activities were better for those with good baseline performance status compared with those with poorer baseline performance status (P < .05). At completion of RT and post-RT, mean scores for Satisfaction with Breast Cosmetic Outcomes and BREAST-Q Radiation were significantly different (P < .001) across categories for all Functional Assessment of Chronic Illness Therapy -Treatment Satisfaction - General items. There were medium-sized correlations between change scores for FACT-B Trial Outcome Index, Fatigue, Anxiety, and Ability to Participate in Social Roles and change scores in the Visual Analog Scale. CONCLUSIONS For patients with nonmetastatic breast cancer receiving radiation in the RadComp PRCT, our findings demonstrate high reliability and validity for important PRO measures, supporting their psychometric strength and usefulness to reflect the effect of RT on health-related quality of life.
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Affiliation(s)
- Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Hien L Lu
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Alyssa M Vela
- Department of Cardiac Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Erin F Gillespie
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elizabeth M Nichols
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jean L Wright
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Oren Cahlon
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, New York
| | - Carole Baas
- Alamo Breast Cancer Foundation, San Antonio, Texas
| | - Lior Z Braunstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - L Christine Fang
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Gary M Freedman
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rachel B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Mark V Mishra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Robert W Mutter
- Department of Radiation Oncology and Pharmacology, Mayo Clinic Axis School of Medicine, Rochester, Minnesota
| | - Nisha Ohri
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Lane R Rosen
- Department of Radiation Oncology, Willis-Knighton Health System, Shreveport, Louisiana
| | - James J Urbanic
- Department of Radiation Oncology, UC San Diego School of Medicine, San Diego, California
| | - Reshma Jagsi
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia
| | - Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Institutes of Health, Bethesda, Maryland
| | - Justin E Bekelman
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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3
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Vemuru S, Helmkamp L, Adams M, Colborn K, Parris H, Huynh V, Higgins M, Christian N, Ahrendt G, Baurle E, Lee C, Kim S, Matlock D, Cumbler E, Tevis S. Longitudinal Trends in Patient-Reported Outcomes in the First Year After Lumpectomy Versus Mastectomy. Ann Surg Oncol 2024:10.1245/s10434-024-15795-8. [PMID: 39026138 DOI: 10.1245/s10434-024-15795-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/26/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND It is unclear how patient-reported outcomes (PROs) change longitudinally after breast cancer surgery. We sought to compare trends in PROs among patients who underwent lumpectomy versus mastectomy over the first year after surgery. PATIENTS AND METHODS Newly diagnosed stage 0-III female patients with breast cancer who underwent lumpectomy or mastectomy at an academic breast center between June 2019 and March 2023 were invited to participate in a longitudinal PRO study. Enrolled patients received the BREAST-Q™ module, a validated tool measuring domains, such as satisfaction with breasts, psychosocial well-being, physical well-being, and sexual well-being. Scores for each domain were compared between the lumpectomy and mastectomy groups over the first year after surgery. Linear mixed models were used to estimate the change in PRO scores over time. RESULTS The cohort included 203 who underwent lumpectomy and 144 who underwent mastectomy. Patients who underwent lumpectomy were older, more likely to receive adjuvant radiation and endocrine therapy, and less likely to receive adjuvant chemotherapy. Patients who underwent lumpectomy demonstrated greater increases in scores over time for satisfaction with breasts, psychosocial well-being, and sexual well-being compared with patients who underwent mastectomy, after adjusting for the abovementioned covariates and receipt of reconstruction. The lumpectomy group had a larger decline in physical well-being over time compared with the mastectomy group. CONCLUSIONS Patients who underwent lumpectomy demonstrated greater satisfaction with their breasts, psychosocial well-being, and sexual well-being but worse physical well-being over the first year after surgery compared with patients who underwent mastectomy. These results may help inform early-stage breast cancer patients making decisions about their surgical care.
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Affiliation(s)
- Sudheer Vemuru
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Laura Helmkamp
- Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Monica Adams
- Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kathryn Colborn
- Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hannah Parris
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Victoria Huynh
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Madeline Higgins
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicole Christian
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gretchen Ahrendt
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Erin Baurle
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Clara Lee
- Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Simon Kim
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Dan Matlock
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ethan Cumbler
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah Tevis
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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Chauhan H, Jiwa N, Nagarajan VR, Thiruchelvam P, Hogben K, Al-Mufti R, Hadjiminas D, Shousha S, Cutress R, Ashrafian H, Takats Z, Leff DR. Clinicopathological Predictors of Positive Resection Margins in Breast-Conserving Surgery. Ann Surg Oncol 2024; 31:3939-3947. [PMID: 38520579 PMCID: PMC11076377 DOI: 10.1245/s10434-024-15153-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/20/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Ductal carcinoma in situ (DCIS) is associated with risk of positive resection margins following breast-conserving surgery (BCS) and subsequent reoperation. Prior reports grossly underestimate the risk of margin positivity with IBC containing a DCIS component (IBC + DCIS) due to patient-level rather than margin-level analysis. OBJECTIVE The aim of this study was to delineate the relative risk of IBC + DCIS compared with pure IBC (without a DCIS component) on margin positivity through detailed margin-level interrogation. METHODS A single institution, retrospective, observational cohort study was conducted in which pathology databases were evaluated to identify patients who underwent BCS over 5 years (2014-2019). Margin-level interrogation included granular detail into the extent, pathological subtype and grade of disease at each resection margin. Predictors of a positive margin were computed using multivariate regression analysis. RESULTS Clinicopathological details were examined from 5454 margins from 909 women. The relative risk of a positive margin with IBC + DCIS versus pure IBC was 8.76 (95% confidence interval [CI] 6.64-11.56) applying UK Association of Breast Surgery guidelines, and 8.44 (95% CI 6.57-10.84) applying the Society of Surgical Oncology/American Society for Radiation Oncology guidelines. Independent predictors of margin positivity included younger patient age (0.033, 95% CI 0.006-0.060), lower specimen weight (0.045, 95% CI 0.020-0.069), multifocality (0.256, 95% CI 0.137-0.376), lymphovascular invasion (0.138, 95% CI 0.068-0.208) and comedonecrosis (0.113, 95% CI 0.040-0.185). CONCLUSIONS Compared with pure IBC, the relative risk of a positive margin with IBC + DCIS is approximately ninefold, significantly higher than prior estimates. This margin-level methodology is believed to represent the impact of DCIS more accurately on margin positivity in IBC.
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MESH Headings
- Humans
- Female
- Margins of Excision
- Mastectomy, Segmental/methods
- Retrospective Studies
- Middle Aged
- Breast Neoplasms/surgery
- Breast Neoplasms/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Aged
- Adult
- Follow-Up Studies
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Ductal, Breast/pathology
- Prognosis
- Aged, 80 and over
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Affiliation(s)
- Hemali Chauhan
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Natasha Jiwa
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Paul Thiruchelvam
- Breast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK
| | - Katy Hogben
- Breast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK
| | - Ragheed Al-Mufti
- Breast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK
| | - Dimitri Hadjiminas
- Breast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK
| | - Sami Shousha
- Breast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK
- North West London Pathology, Imperial College NHS Trust, London, UK
| | - Ramsey Cutress
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Zoltan Takats
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Daniel Richard Leff
- Department of Surgery and Cancer, Imperial College London, London, UK
- Breast Unit, Charing Cross Hospital, Imperial College NHS Trust, London, UK
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5
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Nsaful J, Nartey ET, Dedey F, Bediako-Bowan A, Appiah-Danquah R, Darko K, Ankrah LNA, Akli-Nartey C, Annan JY, Dei-Asamoa J, Ahene-Amanquanor GA, Clegg-Lamptey JN. Quality of Life after Mastectomy with or without Breast Reconstruction and Breast-Conserving Surgery in Breast Cancer Survivors: A Cross-Sectional Study at a Tertiary Hospital in Ghana. Curr Oncol 2024; 31:2952-2962. [PMID: 38920708 PMCID: PMC11203203 DOI: 10.3390/curroncol31060224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/18/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024] Open
Abstract
(1) Background: Breast cancer is the leading malignancy worldwide, and in Ghana, it has a poor overall survival rate. However, approximately 50% of cases are cases of early-stage disease, and with advances in breast cancer treatment and improvements in survival, quality of life (QOL) is becoming as important as the treatment of the disease. (2) Methodology: This was a cross-sectional study of survivors who had breast-conserving surgery (BCS), mastectomy only (M) and mastectomy with breast reconstruction (BRS) from 2016 to 2020 at a tertiary hospital in Ghana, comparatively assessing their QOL using EORTC QLQ C-30 and EORTC QLQ BR-23. (3) Results: The study participants had an overall global health status (GHS) median score of 83.3 [IQR: 66.7-91.7] with no significant differences between the surgery types. The BRS group had statistically significant lower median scores for the functional scale (82.8 and 51.0) and the highest scores for the symptomatic scale (15.7 and 16.5). Body image was significantly lowest for the BRS group (83.3) [68.8-91.7] and highest (100) [91.7-100] for the BCS group (p < 0.001). (4) Conclusion: There is a need to develop support systems tailored at improving the QOL of breast cancer survivors taking into consideration the type of surgery performed.
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Affiliation(s)
- Josephine Nsaful
- Department of Surgery, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra GA-221-1570, Ghana; (F.D.); (A.B.-B.); (J.-N.C.-L.)
- Department of Surgery, Korle Bu Teaching Hospital, Accra GA-221-1570, Ghana; (R.A.-D.); (C.A.-N.); (J.Y.A.); (J.D.-A.); (G.A.A.-A.)
| | - Edmund Tetteh Nartey
- Centre for Tropical Clinical Pharmacology & Therapeutics, University of Ghana Medical School, Accra GA-221-1570, Ghana;
| | - Florence Dedey
- Department of Surgery, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra GA-221-1570, Ghana; (F.D.); (A.B.-B.); (J.-N.C.-L.)
- Department of Surgery, Korle Bu Teaching Hospital, Accra GA-221-1570, Ghana; (R.A.-D.); (C.A.-N.); (J.Y.A.); (J.D.-A.); (G.A.A.-A.)
| | - Antoinette Bediako-Bowan
- Department of Surgery, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra GA-221-1570, Ghana; (F.D.); (A.B.-B.); (J.-N.C.-L.)
- Department of Surgery, Korle Bu Teaching Hospital, Accra GA-221-1570, Ghana; (R.A.-D.); (C.A.-N.); (J.Y.A.); (J.D.-A.); (G.A.A.-A.)
| | - Rita Appiah-Danquah
- Department of Surgery, Korle Bu Teaching Hospital, Accra GA-221-1570, Ghana; (R.A.-D.); (C.A.-N.); (J.Y.A.); (J.D.-A.); (G.A.A.-A.)
| | - Kwame Darko
- National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Accra GA-221-1570, Ghana; (K.D.); (L.N.A.A.)
| | - Levi Nii Ayi Ankrah
- National Reconstructive Plastic Surgery and Burns Centre, Korle Bu Teaching Hospital, Accra GA-221-1570, Ghana; (K.D.); (L.N.A.A.)
| | - Cynthia Akli-Nartey
- Department of Surgery, Korle Bu Teaching Hospital, Accra GA-221-1570, Ghana; (R.A.-D.); (C.A.-N.); (J.Y.A.); (J.D.-A.); (G.A.A.-A.)
| | - Jessie Yaoteokor Annan
- Department of Surgery, Korle Bu Teaching Hospital, Accra GA-221-1570, Ghana; (R.A.-D.); (C.A.-N.); (J.Y.A.); (J.D.-A.); (G.A.A.-A.)
| | - Jessica Dei-Asamoa
- Department of Surgery, Korle Bu Teaching Hospital, Accra GA-221-1570, Ghana; (R.A.-D.); (C.A.-N.); (J.Y.A.); (J.D.-A.); (G.A.A.-A.)
| | | | - Joe-Nat Clegg-Lamptey
- Department of Surgery, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra GA-221-1570, Ghana; (F.D.); (A.B.-B.); (J.-N.C.-L.)
- Department of Surgery, Korle Bu Teaching Hospital, Accra GA-221-1570, Ghana; (R.A.-D.); (C.A.-N.); (J.Y.A.); (J.D.-A.); (G.A.A.-A.)
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Kim J, Han MW, Hong KY. Prospective Clinical Trial for Predicting Mastectomy Skin Flap Necrosis with Indocyanine Green Angiography in Implant-Based Prepectoral Breast Reconstruction. Aesthetic Plast Surg 2024:10.1007/s00266-024-04106-x. [PMID: 38740624 DOI: 10.1007/s00266-024-04106-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/25/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Indocyanine green angiography (ICG-A) is a useful tool for evaluating mastectomy skin flap (MSF) perfusion during breast reconstruction. However, a standardized protocol for interpreting and applying MSF perfusion after mastectomy has not been established yet. The purpose of this study is to establish criteria for assessing MSF perfusion in immediate implant-based prepectoral breast reconstruction while correlating ICG-A findings with postoperative outcomes METHODS: This prospective observational study was conducted at a single institution and involved patients with breast cancer who underwent mastectomy and immediate implant-based prepectoral breast reconstruction between August 2021 and August 2023. The terms "hypoperfused flap" and "hypoperfused area" were defined according to ICG-A perfusion. MSF exhibited < 30% perfusion, excluding the nipple and the corresponding region, respectively. Data on the hypoperfused flap, hypoperfused area, and MSF necrosis were collected. RESULTS Fifty-three breast cases were analyzed. Eight patients developed MSF necrosis (15.1%, 8/53). Of these, two patients underwent surgical debridement and revision within 3 months (3.8%, 2/53). There were nine cases of a hypoperfused flap, eight of which developed MSF necrosis. The hypoperfused flap was a significant predictor of the occurrence of MSF necrosis (p < 0.001). There was a tendency for increased full-thickness necrosis with a wider hypoperfused area. CONCLUSIONS The hypoperfused flap enabled the prediction of MSF necrosis with high sensitivity, specificity, positive predictive value, and negative predictive value. Considering the presumed correlation between the extent of the hypoperfused area and the need for revision surgery, caution should be exercised when making intraoperative decisions regarding the reconstruction method. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Jaewoo Kim
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Plastic and Reconstructive Surgery, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Man Wong Han
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Ki Yong Hong
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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7
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Tang K, Sutherland JM, Liu G, Crump T, Bazzarelli A, Dingee C, Pao JS, Warburton R, McKevitt E. Preoperative depression and anxiety associated with younger age and receipt of immediate breast reconstruction. Am J Surg 2024; 231:106-112. [PMID: 38350745 DOI: 10.1016/j.amjsurg.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/24/2024] [Accepted: 02/07/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND As survivorship for breast cancer continues to improve, emphasis of care falls upon improving patients' quality of life. Understanding physical and mental health in the preoperative period is needed to aid surgical decision making and improve patient experience. METHODS Consecutive patients awaiting total mastectomy (TM), TM with immediate breast reconstruction (IBR) and breast conserving surgery (BCS) were prospectively recruited. Scores for PHQ-9, GAD-7, Breast-Q, EQ5D(5L), PEG were collected preoperatively. Association was measured with multivariate analyses. RESULTS 477 participants (374 BSC, 46 TM, 84 IBR) were included. Younger patients and those choosing IBR reported worse depression and anxiety symptoms. Clinical tumor features did not affect patient reported outcomes. Higher Breast-Q scores were seen with BCS and lower scores with TM. CONCLUSIONS Patients scheduled for IBR and younger patients reported worse symptoms of depression and anxiety, regardless of clinical features. This will help with surgical decision making and identify patients in need for additional perioperative supports.
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Affiliation(s)
- Katelynn Tang
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Jason M Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Guiping Liu
- Centre for Health Services and Policy Research, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Trafford Crump
- Department of Surgery, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
| | - Amy Bazzarelli
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada.
| | - Carol Dingee
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada.
| | - Jin-Si Pao
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada.
| | - Rebecca Warburton
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada.
| | - Elaine McKevitt
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada; Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC, V5T 3N4, Canada.
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Schaverien MV, Singh P, Smith BD, Qiao W, Akay CL, Bloom ES, Chavez-MacGregor M, Chu CK, Clemens MW, Colen JS, Ehlers RA, Hwang RF, Joyner MM, Largo RD, Mericli AF, Mitchell MP, Shuck JW, Tamirisa N, Tripathy D, Villa MT, Woodward WA, Zacharia R, Kuerer HM, Hoffman KE. Premastectomy Radiotherapy and Immediate Breast Reconstruction: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e245217. [PMID: 38578640 PMCID: PMC10998161 DOI: 10.1001/jamanetworkopen.2024.5217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/08/2024] [Indexed: 04/06/2024] Open
Abstract
Importance Premastectomy radiotherapy (PreMRT) is a new treatment sequence to avoid the adverse effects of radiotherapy on the final breast reconstruction while achieving the benefits of immediate breast reconstruction (IMBR). Objective To evaluate outcomes among patients who received PreMRT and regional nodal irradiation (RNI) followed by mastectomy and IMBR. Design, Setting, and Participants This was a phase 2 single-center randomized clinical trial conducted between August 3, 2018, and August 2, 2022, evaluating the feasibility and safety of PreMRT and RNI (including internal mammary lymph nodes). Patients with cT0-T3, N0-N3b breast cancer and a recommendation for radiotherapy were eligible. Intervention This trial evaluated outcomes after PreMRT followed by mastectomy and IMBR. Patients were randomized to receive either hypofractionated (40.05 Gy/15 fractions) or conventionally fractionated (50 Gy/25 fractions) RNI. Main Outcome and Measures The primary outcome was reconstructive failure, defined as complete autologous flap loss. Demographic, treatment, and outcomes data were collected, and associations between multiple variables and outcomes were evaluated. Analysis was performed on an intent-to-treat basis. Results Fifty patients were enrolled. Among 49 evaluable patients, the median age was 48 years (range, 31-72 years), and 46 patients (94%) received neoadjuvant systemic therapy. Twenty-five patients received 50 Gy in 25 fractions to the breast and 45 Gy in 25 fractions to regional nodes, and 24 patients received 40.05 Gy in 15 fractions to the breast and 37.5 Gy in 15 fractions to regional nodes, including internal mammary lymph nodes. Forty-eight patients underwent mastectomy with IMBR, at a median of 23 days (IQR, 20-28.5 days) after radiotherapy. Forty-one patients had microvascular autologous flap reconstruction, 5 underwent latissimus dorsi pedicled flap reconstruction, and 2 had tissue expander placement. There were no complete autologous flap losses, and 1 patient underwent tissue expander explantation. Eight of 48 patients (17%) had mastectomy skin flap necrosis of the treated breast, of whom 1 underwent reoperation. During follow-up (median, 29.7 months [range, 10.1-65.2 months]), there were no locoregional recurrences or distant metastasis. Conclusions and Relevance This randomized clinical trial found PreMRT and RNI followed by mastectomy and microvascular autologous flap IMBR to be feasible and safe. Based on these results, a larger randomized clinical trial of hypofractionated vs conventionally fractionated PreMRT has been started (NCT05774678). Trial Registration ClinicalTrials.gov Identifier: NCT02912312.
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Affiliation(s)
- Mark V. Schaverien
- Division of Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Puneet Singh
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Benjamin D. Smith
- Division of Radiation Oncology, Department of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Wei Qiao
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Catherine L. Akay
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Elizabeth S. Bloom
- Division of Radiation Oncology, Department of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Mariana Chavez-MacGregor
- Division of Cancer Medicine, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Carrie K. Chu
- Division of Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Mark W. Clemens
- Division of Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Jessica S. Colen
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Richard A. Ehlers
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Rosa F. Hwang
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Melissa M. Joyner
- Division of Radiation Oncology, Department of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Rene D. Largo
- Division of Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Alexander F. Mericli
- Division of Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Melissa P. Mitchell
- Division of Radiation Oncology, Department of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - John W. Shuck
- Division of Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Nina Tamirisa
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Debasish Tripathy
- Division of Cancer Medicine, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Mark T. Villa
- Division of Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Wendy A. Woodward
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Rensi Zacharia
- Division of Radiation Oncology, Department of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Henry M. Kuerer
- Division of Surgery, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Karen E. Hoffman
- Division of Radiation Oncology, Department of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
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9
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Scotto L, Pizzoli SFM, Marzorati C, Mazzocco K, Pravettoni G. The impact of prophylactic mastectomy on sexual well-being: a systematic review. Sex Med Rev 2024; 12:164-177. [PMID: 38185919 DOI: 10.1093/sxmrev/qead054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Considering the increasing women's awareness of health promotion and disease prevention programs, mutation carriers are inevitably asked to face important decisions concerning the possibility of undergoing prophylactic mastectomy. Risk-reducing mastectomy (RRM) has become increasingly more common, although it has a significant impact on women's quality of life and sexual well-being. OBJECTIVES The systematic review aims to evaluate the impact of RRM on the sexuality of women with breast cancer. METHODS According to Cochrane Collaboration guidelines and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, the study quantified the effects of frontline work on the mental health of healthcare workers. This review followed the PRISMA guidelines. Three databases were systematically searched from inception to December 2022. The expression ("sexuality" OR "sexual" OR "sex") AND ("prophylactic mastectomy" OR "risk-reducing mastectomy") was searched in PubMed, Ovid Medline, and Embase. Twenty-two articles published in English until 2022 were selected. RESULTS Two studies investigated sexual experience after risk-reducing surgeries as a single outcome, while other studies analyzed the relationship between sexuality and psychosocial outcomes, risk perception, and satisfaction. In all of the included studies, significant findings in sexual dysfunction were found. The most reported problems were related to sexual satisfaction and attractiveness, body image, and loss of femininity. Last, women reported changes in the relationship with their partners. CONCLUSION RRM has a major impact on body image that affects sexual functioning and quality of life. These implications must be considered during treatment selection.
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Affiliation(s)
- Ludovica Scotto
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Silvia Francesca Maria Pizzoli
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
- Facoltà di Psicologia, Università Cattolica del Sacro Cuore, Largo A. Gemelli 1, 20123 Milan, Italy
| | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Grabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
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10
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Ayyala HS, Assel M, Aloise J, Serafin J, Tan KS, Mehta M, Puttanniah V, McCormick P, Malhotra V, Vickers A, Matros E, Lin E. Paravertebral and erector spinae plane blocks decrease length of stay compared with local infiltration analgesia in autologous breast reconstruction. Reg Anesth Pain Med 2024:rapm-2023-105031. [PMID: 38336375 PMCID: PMC11306410 DOI: 10.1136/rapm-2023-105031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/20/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Autologous breast reconstruction is associated with significant pain impeding early recovery. Our objective was to evaluate the impact of replacing surgeon-administered local infiltration with preoperative paravertebral (PVB) and erector spinae plane (ESP) blocks for latissimus dorsi myocutaneous flap reconstruction. METHODS Patients who underwent mastectomy with latissimus flap reconstruction from 2018 to 2022 were included in three groups: local infiltration, PVB, and ESP blocks. Block effect on postoperative length of stay (LOS) and the association between block status and pain, opioid consumption, time to first analgesic, and postoperative antiemetic administration were assessed. RESULTS 122 patients met the inclusion criteria for this retrospective cohort study: no block (n=72), PVB (n=26), and ESP (n=24). On adjusted analysis, those who received a PVB block had a 20-hour shorter postoperative stay (95% CI 11 to 30; p<0.001); those who received ESP had a 24-hour (95% CI 15 to 34; p<0.001) shorter postoperative stay compared with the no block group, respectively. Using either block was associated with a reduction in intraoperative opioids (23 morphine milligram equivalents (MME)), 95% CI 14 to 31, p<0.001; ESP versus no block: 23 MME, 95% CI 14 to 32, p<0.001). CONCLUSIONS Replacing surgical infiltration with PVB and ESP blocks for autologous breast reconstruction reduces LOS. The comparable reduction in LOS suggests that ESP may be a viable alternative to PVB in patients undergoing latissimus flap breast reconstruction following mastectomy. Further research should investigate whether ESP or PVB have better patient outcomes in complex breast reconstruction.
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Affiliation(s)
- Haripriya S Ayyala
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joseph Aloise
- Department of Operational Excellence, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joanna Serafin
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Meghana Mehta
- Digital Informatics & Technology Solutions Department, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vinay Puttanniah
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Patrick McCormick
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vivek Malhotra
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Evan Matros
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Emily Lin
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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11
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Ghilli M, Lisa AVE, Salgarello M, Papa G, Rietjens M, Folli S, Curcio A, Ferrari G, Caruso F, Altomare V, Friedman D, De Santis MC, De Rose F, Meduri B, De Felice F, Marino L, Cucciarelli F, Montemezzi S, Panizza P, Belli P, Caumo F, Vinci V, De Santis G, Klinger M, Roncella M. Oncoplastic and reconstructive surgery in SENONETWORK Italian breast centers: lights and shadows. Breast 2024; 73:103601. [PMID: 38043223 PMCID: PMC10731356 DOI: 10.1016/j.breast.2023.103601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023] Open
Abstract
•Despite the significance of oncoplastic procedure, an italian database is lacking. •Senonetwork established a multidisciplinary survey to assess their safety and efficacy. •Reconstructive outcomes were positive across low and high-volume centers. •After mastectomy, implant-based techniques are common. DTI reconstruction is advantageuos. •This contributes to the global understanding of effective strategies against breast cancer.
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Affiliation(s)
- Matteo Ghilli
- Breast Centre, University Hospital of Pisa (AOUP), Pisa, Italy.
| | - Andrea Vittorio Emanuele Lisa
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA - Plastic Surgery Unit, University of Milan, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marzia Salgarello
- Department of Plastic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCSDirector of the Residency Program of Plastic Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Papa
- Department of Plastic Surgery, UCO, University of Trieste, Trieste Italy
| | - Mario Rietjens
- Division of Plastic and Reconstructive Surgery, IEO, IRCCS European Institute of Oncology, Milan Italy
| | - Secondo Folli
- Chirurgia Senologica, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan Italy
| | - Annalisa Curcio
- Chirurgia Senologica Forlì-Ravenna, ASL della Romagna, Italy
| | - Guglielmo Ferrari
- S.C. di Chirurgia Senologica, A.U.S.L.-IRCCS di Reggio Emilia, Italy
| | - Francesco Caruso
- Breast centre, UO Chirurgia oncologica - Dipartimento Oncologico - Humanitas Istituto Clinico Catanese, Misterbianco (CT), Italy
| | - Vittorio Altomare
- UOC Chirurgia Senologica, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Daniele Friedman
- UOC Chirurgia Senologica, Ospedale Policlinico San Martino di Genova, Italy
| | - Maria Carmen De Santis
- SC Radioterapia, SS Radioterapia Tumori della Mammella, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fiorenza De Rose
- Department of Radiation Oncology, Santa Chiara Hospital, Trento, Italy
| | - Bruno Meduri
- Department of Radiation Oncology, Azienda Ospedaliera - Universitaria di Modena, Italy
| | - Francesca De Felice
- Radiation Oncology, Policlinico Umberto I, Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Italy
| | - Lorenza Marino
- Radioterapia Oncologica, Humanitas Istituto Clinico Catanese, Misterbianco (CT), Italy
| | - Francesca Cucciarelli
- Radiotherapy Department, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Stefania Montemezzi
- Dipartimento Patologia e Diagnostica Azienda Ospedaliera Universitaria Integrata di Verona, Italy
| | - Pietro Panizza
- IRCCS Ospedale San Raffaele, U.O. Radiologia Senologica, Milan, Italy
| | - Paolo Belli
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica Ed Ematologia, Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesca Caumo
- UOC Radiologia Senologica Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy
| | - Valeriano Vinci
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA - Plastic Surgery Unit, University of Milan, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Rozzano - Milan, Italy
| | - Giorgio De Santis
- Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell'Adulto, UNIMORE, Modena, Italy
| | - Marco Klinger
- Reconstructive and Aesthetic Plastic Surgery School, Department of Medical Biotechnology and Translational Medicine BIOMETRA - Plastic Surgery Unit, University of Milan, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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12
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Rha EY, Jeon HH, Park SH, Lee JY. Defect-Oriented Versus Back Scar-Oriented Flap Design in Breast Reconstruction with Latissimus Dorsi Musculocutaneous Flap: A Patient-Reported Satisfaction Outcome Comparison Using BREAST-Q. Aesthetic Plast Surg 2024; 48:259-265. [PMID: 37202481 DOI: 10.1007/s00266-023-03385-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/26/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND The design of the latissimus dorsi musculocutaneous flap in breast reconstruction has several options. To date, there have been no reports on the surgical outcomes with flap designed based on the defect shape of the mastectomy site and flap shape of the donor site. To compare patient satisfaction according to the flap design, we designed and conducted independent three sub-studies targeting fifty-three breast reconstruction patients using BREAST-Q© scale. METHODS In study 1, there was no difference in patient satisfaction between the group with the flap designed according to the shape of mastectomy defect (defect-oriented group) that with the flap designed according to patient's wish regardless of defect shape (back scar-oriented group). In study 2, comparing the results based on the shape of the flap, vertically designed flap showed a statistically significant difference in the psychosocial well-being. In study 3, comparing the results based on the shape of the defect, no significant difference was noted. RESULTS Even though designing a donor flap based on the shape and orientation of the mastectomy defect has no statistical significance in patient satisfaction or quality of life compared with that based on the patient preference in placement of the donor site scar, the group with the vertical donor design showed better psychosocial well-being than the group with other shapes of the donor flap. By considering the advantages and disadvantages of each flap design, enhanced patient satisfaction and durability and natural aesthetic goal can be achieved. This is the first study to compare the differences in results according to the flap design method during breast reconstruction. Patient satisfaction according to the design of the flap was investigated in the form of a questionnaire survey, and the results were displayed. In addition to breast shape, donor scars and complications were also investigated. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Eun Young Rha
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hui Hyung Jeon
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | | | - Jun Yong Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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13
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Kasgri KA, Abazari M, Badeleh SM, Badeleh KM, Peyman N. Comprehensive Review of Breast Cancer Consequences for the Patients and Their Coping Strategies: A Systematic Review. Cancer Control 2024; 31:10732748241249355. [PMID: 38767653 PMCID: PMC11107334 DOI: 10.1177/10732748241249355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Women with breast cancer usually face multiple short-term and long-term problems in dealing with their acute and chronic symptoms during and after cancer treatment. However, serious gaps remain in addressing these issues in clinical and public health practice. METHODS According to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we conducted a systematic literature search from 2000-2021 in electronic databases, including Medline, PubMed, Embase, Scopus, Web of Knowledge, and Google Scholar databases using predefined keywords. RESULTS The review identified several significant and interconnected problems in breast cancer patient's treatment and supportive care. The results revealed that these issues are very common among breast cancer patients, and specific attention and serious measures are needed to address these problems. Despite implementing different protocols and programs for covering and addressing these problems, serious gaps still exist in supporting breast cancer patients during clinical and follow-up care. CONCLUSION Developing innovative and holistic approaches and programs based on the multifactorial assessment of symptoms are suggested for addressing and covering the multidimensional requirements of this population. Consequently, thorough evaluation, education, treatment, and referrals should be provided for the most common sequelae of these patients by including appropriate medication, exercise, counselling, occupational therapy, and complementary therapies. The present study provides a more comprehensive source of information about breast cancer patient's medical and supportive needs in comparison with individual studies on symptom experiences.
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Affiliation(s)
- Kobra A. Kasgri
- Department of Midwifery, Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Morteza Abazari
- Department of Pharmaceutical Nanotechnology, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Safa M. Badeleh
- Department of Food and Drug Control, School of Pharmacy, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Kosar M. Badeleh
- Department of Sciences, Islamic Azad University, Sari Branch, Sari, Iran
| | - Nooshin Peyman
- Department of Health Education and Health Promotion, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
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14
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Bonomi R, Rapisarda IF. Areolar reconstruction: MICAP flap as a skin paddle donor site in skin sparing mastectomy and implant-based reconstruction. J Surg Case Rep 2024; 2024:rjad729. [PMID: 38239377 PMCID: PMC10795890 DOI: 10.1093/jscr/rjad729] [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: 11/27/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024] Open
Abstract
The main advantage of preserving the nipple-areola complex (NAC) in small to moderate size breasts reconstruction is that the main diameters of the breast mound remain unaltered. When for oncological reason the NAC must be excised, a paddle of skin needs to be borrowed from a donor site and transferred into the surgical defect to maintain the breast contour. While this is easily achievable with the majority of autologous reconstructions, it is very challenging in the context of implant-based reconstructions, where the primary closure of the defect leads to a flattened breast mound and suboptimal cosmetic results. In our experience, the medial intercostal artery perforator flap enables the safe resection of the NAC with concurrent reconstruction of the defect, allowing a satisfactory cosmetic result in terms of contour and projection even in the setting of implant-based reconstruction.
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Affiliation(s)
- Riccardo Bonomi
- Oncoplastic and Reconstructive Breast Unit, University Hospitals Sussex NHS Foundation Trust, Lyndhurst Road, Worthing BN11 2DH, United Kingdom
| | - I Fabio Rapisarda
- Oncoplastic and Reconstructive Breast Unit, East Sussex Healthcare NHS trust, Kings Drive, Eastbourne BN21 2UD, United Kingdom
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15
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Berben JA, Miseré RML, van der Hulst RRWJ. The influence of personality on patient-reported outcomes in women undergoing implant-based breast reconstruction. J Plast Reconstr Aesthet Surg 2023; 87:303-309. [PMID: 37925919 DOI: 10.1016/j.bjps.2023.10.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/15/2023] [Accepted: 10/07/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Despite the lack of hard evidence for causality, some women attribute their systemic complaints to their silicone breast implants. Personality and psychological distress are associated with the development of medically unexplained symptoms. It could be hypothesized that these psychological factors are related to the development of breast implant illness (BII). In a previous study, we found a relationship between personality traits and BII-related complaints in patients with cosmetic breast implants. This association may also exist in patients with implant-based breast reconstruction. OBJECTIVES This cross-sectional study evaluated the association between personality, self-reported health complaints, and health- and breast-related quality of life (QoL) in women with implant-based breast reconstruction. METHODS Women who underwent breast reconstruction between January 2015 and December 2018 in either the Maastricht University Medical Center or Zuyderland Medical Center were invited to participate in this study. Participants were asked to complete a physical complaint score form and the BREAST-Q, SF-36, and EPQ-RSS questionnaires through an online survey. The association between outcomes was analyzed with multivariate linear regression. RESULTS A total of 118 women completed the questionnaires. Social desirability and extroversion were predominant personality traits. Neuroticism levels were comparable with normative data. Neuroticism correlated significantly with health status and breast-related QoL. Health-related QoL had the strongest correlation with neuroticism (β = -2.93, β = -3.41, p < 0.001). CONCLUSION This study suggests that personality, and neuroticism in particular, may contribute to the development of medically unexplained complaints in women with implant-based reconstruction. The influence of personality on BII needs to be further investigated in large prospective studies.
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Affiliation(s)
- Juliënne A Berben
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands.
| | - Renée M L Miseré
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - René R W J van der Hulst
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
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16
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Diao K, Lei X, He W, Jagsi R, Giordano SH, Smith GL, Caudle A, Shen Y, Peterson SK, Smith BD. Patient-reported Quality of Life After Breast-conserving Surgery With Radiotherapy Versus Mastectomy and Reconstruction. Ann Surg 2023; 278:e1096-e1102. [PMID: 37232937 PMCID: PMC10592600 DOI: 10.1097/sla.0000000000005920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To compare long-term quality of life (QOL) outcomes in breast cancer survivors who received breast-conserving surgery with radiotherapy (BCS+RT) with those who received a mastectomy and reconstructive surgery (Mast+Recon) without radiotherapy and identify other important factors. BACKGROUND The long-term differences in patient-reported QOL outcomes following BCS+RT and Mast+Recon are not well understood. METHODS We identified patients from the Texas Cancer Registry with stage 0-II breast cancer diagnosed in 2009-2014 after BCS+RT or Mast+Recon without radiotherapy. Sampling was stratified by age and race and ethnicity. A paper survey was sent to 4800 patients which included validated BREAST-Q and PROMIS modules. Multivariable linear regression models were implemented for each outcome. Minimal clinically important difference for BREAST-Q and PROMIS modules, respectively, was 4 points and 2 points. RESULTS Of 1215 respondents (25.3% response rate), 631 received BCS+RT and 584 received Mast+Recon. The median interval from diagnosis to survey completion was 9 years. In adjusted analysis, Mast+Recon was associated with worse BREAST-Q psychosocial well-being (effect size: -3.80, P =0.04) and sexual well-being (effect size: -5.41, P =0.02), but better PROMIS physical function (effect size: 0.54, P =0.03) and similar BREAST-Q satisfaction with breasts, physical well-being, and PROMIS upper extremity function ( P >0.05) compared with BCS+RT. Only the difference in sexual well-being reached clinical significance. Older (≥65) patients receiving BCS+RT and younger (<50) patients receiving autologous Mast+Recon typically reported higher QOL scores. Receipt of chemotherapy was associated with detriments to multiple QOL domains. CONCLUSIONS Patients who underwent Mast+Recon reported worse long-term sexual well-being compared with BCS+RT. Older patients derived a greater benefit from BCS+RT, while younger patients derived a greater benefit from Mast+Recon. These data inform preference-sensitive decision-making for women with early-stage breast cancer.
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Affiliation(s)
- Kevin Diao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xiudong Lei
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Weiguo He
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Reshma Jagsi
- Department of Radiation Oncology, Emory University, Atlanta, GA
| | - Sharon H. Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Grace L. Smith
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Abigail Caudle
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yu Shen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Susan K. Peterson
- Department of Behavioral Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Benjamin D. Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
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17
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Walker JN, Hanson BM, Hunter T, Simar SR, Duran Ramirez JM, Obernuefemann CLP, Parikh RP, Tenenbaum MM, Margenthaler JA, Hultgren SJ, Myckatyn TM. A prospective randomized clinical trial to assess antibiotic pocket irrigation on tissue expander breast reconstruction. Microbiol Spectr 2023; 11:e0143023. [PMID: 37754546 PMCID: PMC10581127 DOI: 10.1128/spectrum.01430-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/31/2023] [Indexed: 09/28/2023] Open
Abstract
Bacterial infection is the most common complication following staged post-mastectomy breast reconstruction initiated with a tissue expander (TE). To limit bacterial infection, antibiotic irrigation of the surgical site is commonly performed despite little high-quality data to support this practice. We performed a prospective randomized control trial to compare the impact of saline irrigation alone to a triple antibiotic irrigation regimen (1 g cefazolin, 80 mg gentamicin, and 50,000 units of bacitracin in 500 mL of saline) for breast implant surgery. The microbiome in breasts with cancer (n = 16) was compared to those without (n = 16), as all patients (n = 16) had unilateral cancers but bilateral mastectomies (n = 32). Biologic and prosthetic specimens procured both at the time of mastectomy and during TE removal months later were analyzed for longitudinal comparison. Outcomes included clinical infection, bacterial abundance, and relative microbiome composition. No patient in either group suffered a reconstructive failure or developed an infection. Triple antibiotic irrigation administered at the time of immediate TE reconstruction did not reduce bacterial abundance or impact microbial diversity relative to saline irrigation at the time of planned exchange. Implanted prosthetic material adopted the microbial composition of the surrounding host tissue. In cancer-naïve breasts, relative to saline, antibiotic irrigation increased bacterial abundance on periprosthetic capsules (P = 0.03) and acellular dermal matrices (P = 0.04) and altered the microbiota on both. These data show that, relative to saline only, the use of triple antibiotic irrigation in TE breast reconstruction does impact the bacterial abundance and diversity of certain biomaterials from cancer-naïve breasts. IMPORTANCE The lifetime risk of breast cancer is ~13% in women and is treated with a mastectomy in ~50% of cases. The majority are reconstructed, usually starting with a tissue expander to help restore the volume for a subsequent permanent breast implant or the women's own tissues. The biopsychosocial benefits of breast reconstruction, though, can be tempered by a high complication rate of at least 7% but over 30% in some women. Bacterial infection is the most common complication, and can lead to treatment delays, patient physical and emotional distress and escalating health care cost. To limit this risk, plastic surgeons have tried a variety of strategies to limit bacterial infection including irrigating the pocket created after removing the breast implant with antibiotic solutions, but good-quality data are scarce. Herein, we study the value of antibiotics in pocket irrigation using a robust randomized clinical trial design and molecular microbiology approaches.
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Affiliation(s)
- Jennifer N. Walker
- Department of Microbiology and Molecular Genetics, McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
- Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Infectious Diseases, School of Public Health, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Blake M. Hanson
- Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Infectious Diseases, School of Public Health, University of Texas Health Sciences Center, Houston, Texas, USA
- Division of Infectious Disease, Department of Pediatrics, McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
- Center for Antimicrobial Resistance and Microbial Genomics, McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Tayler Hunter
- Department of Microbiology and Molecular Genetics, McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Shelby R. Simar
- Department of Epidemiology, Human Genetics & Environmental Sciences, Center for Infectious Diseases, School of Public Health, University of Texas Health Sciences Center, Houston, Texas, USA
- Division of Infectious Disease, Department of Pediatrics, McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
- Center for Antimicrobial Resistance and Microbial Genomics, McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Jesus M. Duran Ramirez
- Department of Microbiology and Molecular Genetics, McGovern Medical School, University of Texas Health Sciences Center, Houston, Texas, USA
| | - Chloe L. P. Obernuefemann
- Department of Molecular Microbiology, Washington University School of Medicine, Saint Louis, Missouri, USA
- Center for Women’s Infectious Disease Research, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Rajiv P. Parikh
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Marissa M. Tenenbaum
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Julie A. Margenthaler
- Division of Surgical Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Scott J. Hultgren
- Department of Molecular Microbiology, Washington University School of Medicine, Saint Louis, Missouri, USA
- Center for Women’s Infectious Disease Research, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Terence M. Myckatyn
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
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18
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An YY, Hwang H, Suh YJ. What Should We Know in Postoperative Surveillance Imaging After Oncoplastic Breast-Conserving Surgery with Pellet-Type Acellular Dermal Matrix? Acad Radiol 2023; 30 Suppl 2:S16-S24. [PMID: 37263859 DOI: 10.1016/j.acra.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 06/03/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to evaluate the usual postoperative imaging findings among patients who underwent oncoplastic breast-conserving surgery (BCS) with acellular dermal matrix (ADM) and to assess the clinical utility of mammography (MG) and ultrasonography (US) in follow-ups. MATERIALS AND METHODS This retrospective review of our prospectively collected database of patients who underwent oncoplastic BCS with ADM was conducted with IRB approval and in HIPPA compliance. A total of 105 patients whose follow-up MG and US studies over 2years after surgery were available were included in this study. Postoperative imaging findings were analyzed based on sequential MG and US follow-ups. The clinical outcomes and pathological data were also reviewed. The diagnostic performance of MG and US for postoperative surveillance was assessed. RESULTS On MG, ADM presented as an oval (99/105, 94.3%), circumscribed/obscured (65/105, 61.9%), and high-density (56/105, 53.3%) mass with calcifications (54/105, 51.4%). On US, the ADM-filled cavity presented as an oval (93/105, 88.6%), circumscribed (70/105, 66.7%), heterogenous echoic (65/105, 61.9%) mass with marginal/posterior acoustic shadowing (95/105, 90.5%) on US. During the follow-up period (mean, 46.1months; range, 26-58 months), four tumor recurrences were diagnosed (4/105, 3.8%). One tumor recurrence detected on MG presented as microcalcifications (1/4, 25%), which were differentiated from benign postoperative calcifications due to their suspicious morphology and location. Two additional recurrences (2/4, 50%), which were MG-negative small masses or intraductal lesions, were detected on US. One tumor recurrence was missed on both MG+US and was detected by magnetic resonance imaging performed at clinician's request. The sensitivity and specificity of MG, US, and MG+US for postoperative surveillance were 25%, 50% and 75% and 100%, 98% and 98%, respectively. CONCLUSION Recognition and adequate interpretation of the usual findings after oncoplastic BCS with ADM insertion are important in postoperative imaging surveillance. The sole use of MG is not sufficient for the detection of mass-type tumor recurrence due to the density of inserted ADM fillers. Therefore, the combined use of MG+US could serve as a useful postoperative surveillance tool with increased sensitivity in this population.
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Affiliation(s)
- Yeong Yi An
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic Unversity of Korea, Suwon, Republic of Korea (Y.Y.A., H.H.)
| | - Hyejung Hwang
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic Unversity of Korea, Suwon, Republic of Korea (Y.Y.A., H.H.)
| | - Young Jin Suh
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic Unversity of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Republic of Korea (Y.J.S.).
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19
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Zhu C, Chen M, Liu Y, Li P, Ye W, Ye H, Ye Y, Liu Z, Liang C, Liu C. Value of mammographic microcalcifications and MRI-enhanced lesions in the evaluation of residual disease after neoadjuvant therapy for breast cancer. Quant Imaging Med Surg 2023; 13:5593-5604. [PMID: 37711784 PMCID: PMC10498223 DOI: 10.21037/qims-22-1170] [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: 10/27/2022] [Accepted: 07/17/2023] [Indexed: 09/16/2023]
Abstract
Background Microcalcifications persist even if a patient with breast cancer achieves pathologic complete response (pCR) as confirmed by surgery after neoadjuvant treatment (NAT). In practice, surgeons tend to remove all the microcalcifications. This study aimed to explore the correlation between changes in the extent of microcalcification after NAT and pathological tumor response and compare the accuracy of mammography (MG) and magnetic resonance imaging (MRI) in predicting the size of residual tumors. Methods This was a retrospective study which included a consecutive series of patients in Guangdong Provincial People's Hospital. Between January 2010 and January 2020, 127 patients with breast cancer and Breast Imaging Reporting and Data System (BI-RADS) 4-5 microcalcifications were included in this study. The maximum diameter of the microcalcifications on MG and lesion enhancement on MRI pre- and post-NAT were measured. The correlations between the changes in residual microcalcifications on MG and pCR were analyzed. Intraclass correlation coefficients (ICCs) were computed between the extent of the residual microcalcifications, residual enhancement, and residual tumor size. Results There were no statistically significant differences in the changes in microcalcifications after NAT according to the RECIST criteria on MRI (P=0.09) and Miller-Payne grade (P=0.14). MRI showed a higher agreement than did residual microcalcifications on MG in predicting residual tumor size (ICC: 0.771 vs. 0.097). Conclusions MRI is more accurate for evaluating residual tumor size in breast cancer. In our study, the extent of microcalcifications on MG after NAT had nearly no correlation with the pathological size of the residual tumor. Therefore, residual tumors with microcalcifications may not necessarily be a contraindication to breast-conserving surgery.
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Affiliation(s)
- Chao Zhu
- Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China
- Department of Radiology, Ningyuan County People’s Hospital, Yongzhou, China
| | - Minglei Chen
- Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Yulin Liu
- Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China
| | - Pinxiong Li
- Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China
| | - Weitao Ye
- Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China
| | - Huifen Ye
- Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China
| | - Yunrui Ye
- Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China
| | - Zaiyi Liu
- Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China
| | - Changhong Liang
- Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China
| | - Chunling Liu
- Department of Radiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China
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20
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Sanchez D, Bloomquist E, Wright H, Barnavon Y. Immediate Nipple Reconstruction With Areolar Flaps After Nipple Excision. Ann Plast Surg 2023; 91:211-214. [PMID: 37489961 DOI: 10.1097/sap.0000000000003570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
ABSTRACT Nipple-sparing mastectomies (NSMs) have become a common surgical approach in the management of invasive breast cancers and ductal carcinoma in situ, and as a risk-reducing approach in genetically predisposed patients. The current standard of care in the management of positive nipple margin after NSM is total excision of the nipple-areola complex. In this article, we aimed to present a case series describing a novel approach to positive nipple margins with nipple-only excision and immediate nipple reconstruction using areolar flaps in patients who underwent NSM for noninvasive tumors. We conducted a retrospective review of patients who underwent NSM and were found to have positive nipple margins and underwent subsequent nipple excision with immediate areolar flap reconstruction. We identified 6 patients who underwent NSM and were found to have nipple margins-5 for ductal carcinoma in situ and 1 for invasive ductal carcinoma. These patients underwent nipple excision with immediate reconstruction using "sickle" flaps. We concluded that if nipple excision and immediate reconstruction with areolar sickle flaps can be performed, it results in good aesthetic outcomes without compromising oncologic results.
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Affiliation(s)
| | | | | | - Yoav Barnavon
- Plastic Surgery, Memorial Healthcare System, Hollywood, FL
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21
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Song YC, Huang Z, Fang H, Tang Y, Jing H, Song YW, Jin J, Liu YP, Chen B, Tang Y, Qi SN, Lu NN, Li N, Li YX, Wang SL. Breast-conserving surgery versus mastectomy for treatment of breast cancer after neoadjuvant chemotherapy. Front Oncol 2023; 13:1178230. [PMID: 37496664 PMCID: PMC10368492 DOI: 10.3389/fonc.2023.1178230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Abstract
Background To compare recurrence and survival outcomes between breast-conserving surgery (BCS) and mastectomy after neoadjuvant chemotherapy (NACT). Methods The data of 730 patients who underwent NACT between 2000 and 2014 were retrospectively reviewed. A total of 104 (14.2%) patients received BCS and 626 (85.8%) received mastectomy. Locoregional recurrence (LRR), distant metastases (DM), disease-free survival (DFS), breast cancer-specific survival (BCSS), and overall survival (OS) were analyzed using the Kaplan-Meier method. The impact of BCS versus mastectomy on outcomes was assessed by multivariate Cox models. Inverse probability of treatment weighting (IPTW) was used to balance covariates between the two groups. Results The median follow-up of BCS and mastectomy groups were 86.5 and 87.4 months, respectively. There were significant differences in distribution of most baseline characteristics between two groups. Compared with those who underwent mastectomy, the patients with BCS had similar 5-year LRR, DM, and DFS rates, but had significantly higher 5-year BCSS (98.9% vs. 90.4%, P = 0.005) and OS (98.9% vs. 90.1%, P = 0.003) rates. Multivariate analysis also showed that BCS significantly improved BCSS (HR = 0.27, 95% CI: 0.08-0.85, P = 0.025) and OS (HR = 0.25, 95% CI: 0.08-0.79, P = 0.018). After IPTW adjustment, the LRR, DM, DFS, BCSS and OS between two groups had no significant differences. Conclusions The recurrence and survival outcomes are comparable with BCS and mastectomy. Thus, BCS is a safe treatment option for selected breast cancer patients after NACT.
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Affiliation(s)
- Yu-Chun Song
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhou Huang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Hui Fang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Jing
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong-Wen Song
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Jin
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital &Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Yue-Ping Liu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Tang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Nan Qi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning-Ning Lu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye-Xiong Li
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shu-Lian Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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22
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Wignarajah P, Malata CM, Benson JR. Oncoplastic and reconstructive breast surgery. Front Oncol 2023; 13:1176915. [PMID: 37448512 PMCID: PMC10338173 DOI: 10.3389/fonc.2023.1176915] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/15/2023] [Indexed: 07/15/2023] Open
Abstract
This article provides an overview of the principles and techniques of oncoplastic and reconstructive breast surgery for patients with early-stage breast cancer. Oncoplastic breast surgery (OPBS) with partial breast reconstruction is a natural evolution in the application of breast conserving surgery and permits wide surgical resection of tumours that might otherwise mandate mastectomy and whole breast reconstruction. These reconstructive techniques must be optimally selected and integrated with ablative breast surgery together with non-surgical treatments such as radiotherapy and chemotherapy that may be variably sequenced with each other. A multidisciplinary approach with shared decision-making is essential to ensure optimal clinical and patient-reported outcomes that address oncological, aesthetic, functional and psychosocial domains. Future practice of OPBS must incorporate routine audit and comprehensive evaluation of outcomes.
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Affiliation(s)
- Primeera Wignarajah
- Department of Breast Surgery, Royal Marsden Hospital NHS Trust, London, United Kingdom
- Department of Breast Surgery, Cambridge Breast Unit, Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Charles M Malata
- Department of Breast Surgery, Cambridge Breast Unit, Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Department of Plastic and Reconstructive Surgery, Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Anglia Ruskin University School of Medicine, Cambridge/Chelmsford, United Kingdom
| | - John R Benson
- Department of Breast Surgery, Cambridge Breast Unit, Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Anglia Ruskin University School of Medicine, Cambridge/Chelmsford, United Kingdom
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23
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Gil GOB, de Andrade WP, Diniz PHC, Cantidio FS, Queiroz IN, Gil MLBV, Almeida CAM, Caldeira PPR, Regalin M, Silva-Filho AL. A phase II randomized clinical trial to assess toxicity and quality of life of breast cancer patients with hypofractionated versus conventional fractionation radiotherapy with regional nodal irradiation in the context of COVID-19 crisis. Front Oncol 2023; 13:1202544. [PMID: 37388233 PMCID: PMC10301738 DOI: 10.3389/fonc.2023.1202544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose This study, conducted during the COVID-19 crisis, primarily aimed to compare the acute toxicity between conventional fractionated radiation therapy (CF-RT) with hypofractionated radiation therapy (HF-RT) among patients who underwent breast-conserving surgery or mastectomy in whom breast or chest wall and regional nodal irradiation (RNI) were indicated. The secondary endpoints were both acute and subacute toxicity, cosmesis, quality of life, and lymphedema features. Methods In this open and non-inferiority randomized trial, patients (n = 86) were randomly allocated 2:1 in the CF-RT arm (n = 33; 50 Gy/25 fractions ± sequential boost [10 Gy/5 fractions]) versus the HF-RT arm (n = 53; 40 Gy/15 fractions ± concomitant boost [8 Gy/15 fractions]). Toxic effects and cosmesis evaluation used the Common Terminology Criteria for Adverse Events, version 4.03 (CTCAE) and the Harvard/National Surgical Adjuvant Breast and Bowel Project (NSABP)/Radiation Therapy Oncology Group (RTOG) scale. For the patient-reported quality of life (QoL), the European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30) and the breast cancer-specific supplementary questionnaire (QLQ-BR23) were used. Lymphedema was assessed by comparing volume differences between the affected and contralateral arms using the Casley-Smith formula. Results Grade 2 and grade 3 dermatitis were lower with HF-RT than with CF-RT (28% vs. 52%, and 0% vs. 6%, respectively; p = 0.022). HF-RT had a lower rate of grade 2 hyperpigmentation (23% vs. 55%; p = 0.005), compared to CF-RT. No other differences in overall rates of physician-assessed grade 2 or higher and grade 3 or higher acute toxicity between HF-RT and CF-RT were registered. There was no statistical difference between groups regarding cosmesis, lymphedema rate (13% vs. 12% HF-RT vs. CF-RT; p = 1.000), and functional and symptom scales, during both the irradiation period and after 6 months of the end of treatment. The results revealed that the subset of patients up to 65 years or older did not show a statistical difference between both arm fractionation schedules (p > 0.05) regarding skin rash, fibrosis, and lymphedema. Conclusion HF-RT was non-inferior to CF-RT, and moderate hypofractionation showed lower rates of acute toxicity, with no changes in quality-of-life outcomes. Clinical trial registration ClinicalTrials.gov, identifier NCT40155531.
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Affiliation(s)
- Gabriel Oliveira Bernardes Gil
- Department of Radiation Oncology, Rede Mater Dei and Hospital da Baleia, Belo Horizonte, Minas Gerais, Brazil
- Gynecology Department, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Botucatu, São Paulo, Brazil
| | - Warne Pedro de Andrade
- Gynecology Department, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Botucatu, São Paulo, Brazil
- ONCOBIO, Grupo Oncoclinicas, Department of Gynecology and Obstetrics of the School of Medicine of the Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paulo Henrique Costa Diniz
- Department of Oncology, Rede Mater Dei, Belo Horizonte, Minas Gerais, Brazil
- Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Farley Soares Cantidio
- Department of Radiation Oncology, Rede Mater Dei and Hospital da Baleia, Belo Horizonte, Minas Gerais, Brazil
| | - Izabella Nobre Queiroz
- Department of Radiation Oncology, Hospital da Baleia, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | - Marcos Regalin
- Department of Radiation Oncology, Rede Mater Dei and Hospital da Baleia, Belo Horizonte, Minas Gerais, Brazil
| | - Agnaldo Lopes Silva-Filho
- Gynecology Department, Universidade Estadual Paulista “Júlio de Mesquita Filho”, Botucatu, São Paulo, Brazil
- Department of Radiation Oncology, Rede Mater Dei, Belo Horizonte, Minas Gerais, Brazil
- Department of Gynecology and Obstetrics of the School of Medicine of the Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Beaulieu-Jones BR, Fefferman A, Woods AP, Shewmaker G, Zhang T, Roh DS, Sachs TE, Merrill A, Ko NY, Cassidy MR. Impact of Race, Ethnicity, Primary Language, and Insurance on Reconstruction after Mastectomy for Patients with Breast Cancer at an Urban, Academic Safety-Net Hospital. J Am Coll Surg 2023; 236:1071-1082. [PMID: 36524735 DOI: 10.1097/xcs.0000000000000531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Disparities in breast reconstruction have been observed in national cohorts and single-institution studies based on race, ethnicity, insurance, and language. However, little is known regarding whether safety-net hospitals deliver more or less equitable breast reconstruction care in comparison with national cohorts. STUDY DESIGN We performed a retrospective study of patients with either invasive breast cancer or ductal carcinoma in situ diagnosed and treated at our institution (January 1, 2009, to December 31, 2014). The rate of, timing of, and approach to breast reconstruction were assessed by race, ethnicity, insurance status, and primary language among women who underwent mastectomy. Reasons for not performing reconstruction were also analyzed. RESULTS A total of 756 women with ductal carcinoma in situ or nonmetastatic invasive cancer were identified. The median age was 58.5 years, 56.2% were non-White, 33.1% were non-English-speaking, and 48.9% were Medicaid/uninsured patients. A total of 142 (18.8%) underwent mastectomy during their index operation. A total of 47.9% (n = 68) did not complete reconstruction. Reasons for not performing reconstruction included patient preference (n = 22), contraindication to immediate reconstruction (ie, locoregionally advanced disease prohibiting immediate reconstruction) without follow-up for consideration of delayed reconstruction (n = 12), prohibitive medical risk or contraindication (ie, morbid obesity; n = 8), and progression of disease, prohibiting reconstruction (n = 7). Immediate and delayed reconstruction were completed in 43.7% and 8.5% of patients. The rate of reconstruction was inversely associated with tumor stage (odds ratio 0.52, 95% CI 0.31 to 0.88), but not race, ethnicity, insurance, or language, on multivariate regression. CONCLUSIONS At a safety-net hospital, we observed rates of reconstruction at or greater than national estimates. After adjustment for clinical attributes, rates did not vary by race, ethnicity, insurance or language. Future research is needed to understand the role of reconstruction in breast cancer care and how to advance shared decision-making among diverse patients.
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Affiliation(s)
- Brendin R Beaulieu-Jones
- Department of Surgery (Beaulieu-Jones), Boston University, Boston, MA
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Ann Fefferman
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Alison P Woods
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Woods)
| | - Grant Shewmaker
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Tina Zhang
- Department of Medicine (Zhang), Boston University, Boston, MA
| | - Daniel S Roh
- Section of Plastic and Reconstructive Surgery (Roh), Boston University, Boston, MA
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Teviah E Sachs
- Section of Surgical Oncology (Sachs, Merrill, Cassidy), Boston University, Boston, MA
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Andrea Merrill
- Section of Surgical Oncology (Sachs, Merrill, Cassidy), Boston University, Boston, MA
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Naomi Y Ko
- Section of Hematology and Oncology (Ko), Boston University, Boston, MA
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
| | - Michael R Cassidy
- Section of Surgical Oncology (Sachs, Merrill, Cassidy), Boston University, Boston, MA
- Boston Medical Center, and School of Medicine (Beaulieu-Jones, Fefferman, Shewmaker, Roh, Sachs, Merrill, Ko, Cassidy), Boston University, Boston, MA
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25
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Pawloski KR, Srour MK, Moo TA, Sevilimedu V, Nelson JA, Garcia P, Kirstein LJ, Morrow M, Tadros AB. Timing of Chemotherapy and Patient-Reported Outcomes After Breast-Conserving Surgery and Mastectomy with Immediate Reconstruction. Ann Surg Oncol 2023; 30:2897-2909. [PMID: 36737530 PMCID: PMC11110643 DOI: 10.1245/s10434-023-13148-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/09/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Receipt of chemotherapy is associated with decreased satisfaction after breast surgery, but whether timing as adjuvant versus neoadjuvant (NAC) affects patient-reported outcomes (PROs) is unclear. We examined associations between chemotherapy timing and PROs after breast-conserving surgery (BCS) and mastectomy with immediate reconstruction (M-IR). METHODS In this retrospective cohort study of patients with stage I-III breast cancer undergoing chemotherapy between January 2017 and December 2019, we compared satisfaction with breasts (SABTR) and chest physical well-being (PWB-CHEST) between chemotherapy groups in BCS and M-IR cohorts. Median SABTR and PWB-CHEST scores (scale 0-100) were compared between chemotherapy groups at baseline and for 3 years postoperatively. Factors associated with SABTR and PWB-CHEST at 1 and 2 years were assessed with multivariable linear regression. RESULTS Overall, 640 patients had BCS and 602 had M-IR; 210 (33%) BCS patients and 294 (49%) M-IR patients had NAC. Following BCS, SABTR was higher than baseline at all postoperative timepoints, whereas 3-year SABTR remained similar to baseline following M-IR, independent of chemotherapy timing. In both surgical cohorts, PWB-CHEST was lowest after NAC at 6 months compared with baseline but was similar to adjuvant counterparts by 3 years. NAC was not a statistically significant predictor of SABTR or PWB-CHEST in either surgical cohort on multivariable analysis. CONCLUSIONS For patients with breast cancer who require chemotherapy, neoadjuvant versus adjuvant timing does not impact long-term PROs in this study. These findings may inform shared decision making regarding the sequence of treatment in patients with operable disease.
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Affiliation(s)
- Kate R Pawloski
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marissa K Srour
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tracy-Ann Moo
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Varadan Sevilimedu
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paula Garcia
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laurie J Kirstein
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Monica Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Audree B Tadros
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Lee KT, Kim J, Jeon BJ, Pyon JK, Bang SI, Mun GH. Longitudinal analysis of long-term outcomes of abdominal flap-based microsurgical reconstruction and two-stage prosthetic reconstruction. Sci Rep 2023; 13:4062. [PMID: 36906629 PMCID: PMC10008543 DOI: 10.1038/s41598-023-31218-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 03/08/2023] [Indexed: 03/13/2023] Open
Abstract
Two-stage tissue expander/implant (TE/I) and deep inferior epigastric perforator (DIEP) flaps are the two main pillars of breast reconstruction. This study aimed to conduct a longitudinal analysis of long-term outcomes after immediate DIEP- and TE/I-based reconstruction. This retrospective cohort study included patients with breast cancer who underwent immediate DIEP- or TE/I-based reconstruction between 2012 and 2017. The cumulative incidence of major complications, defined as unplanned reoperation/readmission due to complications, was analyzed by the reconstruction modality and its independent association. In total, 1,474 cases (1,162 TE/I and 312 DIEP cases) were analyzed, with a median follow-up of 58 months. The 5-year cumulative incidence of major complications was significantly higher in the TE/I group (10.3% vs. 4.7%). On the multivariable analyses, the use of DIEP flap was associated with a significantly reduced risk of major complications compared to that of TE/I. A more prominent association was observed in the analysis of patients who received adjuvant radiotherapy. Restricting analysis to those who received adjuvant chemotherapy revealed no differences between the two groups. The rate of reoperation/readmission for improving aesthetic outcomes was similar in the two groups. Long-term risks for unexpected reoperation/readmission may differ between DIEP- and TE/I-based immediate reconstruction.
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Affiliation(s)
- Kyeong-Tae Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Jina Kim
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Byung Joon Jeon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Jai Kyong Pyon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Sa Ik Bang
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea
| | - Goo-Hyun Mun
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, South Korea.
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Chettri SR, Pignone MP, Deal AM, Sepucha KR, Blizard LB, Huh R, Liu YJ, Ubel PA, Lee CN. Patient-Reported Outcomes of Breast Reconstruction: Does the Quality of Decisions Matter? Ann Surg Oncol 2023; 30:1891-1900. [PMID: 36437408 DOI: 10.1245/s10434-022-12785-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 10/23/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about how the quality of decisions influences patient-reported outcomes (PROs). We hypothesized that higher decision quality for breast reconstruction would be independently associated with better PROs. METHODS We conducted a prospective cohort study of patients undergoing mastectomy with or without reconstruction. Patients were enrolled before surgery and followed for 18 months. We used BREAST-Q scales to measure PROs and linear regression models to explore the relationship between decision quality (based on knowledge and preference concordance) and PROs. Final models were adjusted for baseline BREAST-Q score, radiation, chemotherapy, and major complications. RESULTS The cohort included 101 patients who completed baseline and 18-month surveys. Breast reconstruction was independently associated with higher satisfaction with breasts (β = 20.2, p = 0.0002), psychosocial well-being (β = 14.4, p = 0.006), and sexual well-being (β = 15.7, p = 0.007), but not physical well-being. Patients who made a high-quality decision had similar PROs as patients who did not. Among patients undergoing mastectomy with reconstruction, higher decision quality was associated with lower psychosocial well-being (β = -14.2, p = 0.01). CONCLUSIONS Breast reconstruction was associated with better PROs in some but not all domains. Overall, making a high-quality decision was not associated with better PROs. However, patients who did not have reconstruction had a trend toward better well-being after making a high-quality decision, whereas patients who did have reconstruction had poorer well-being after making a high-quality decision. Additional research on the relationship between decision quality and PROs is needed.
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Affiliation(s)
- Shibani R Chettri
- The Ohio State University College of Public Health, Columbus, OH, USA
| | - Michael P Pignone
- Department of Internal Medicine, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.,Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karen R Sepucha
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lillian B Blizard
- Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Ruth Huh
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Eli Lilly, Indianapolis, IN, USA
| | | | - Peter A Ubel
- Fuqua Business School, Duke University, Durham, NC, USA
| | - Clara N Lee
- The Ohio State University College of Public Health, Columbus, OH, USA. .,The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA.
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McKevitt E, Saleeb M, Liu G, Warburton R, Pao JS, Dingee C, Bazzarelli A, Tang K, Crump T, Sutherland JM. Differences in Preoperative Health-Related Quality of Life between Women Receiving Mastectomy or Breast Conserving Surgery in a Prospectively Recruited Cohort of Breast Cancer Patients. Curr Oncol 2022; 30:118-129. [PMID: 36661659 PMCID: PMC9857337 DOI: 10.3390/curroncol30010010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/06/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
As rates of total mastectomy rise, the relationships between surgery modality with domains of health-related quality of life is not well understood. This study reports differences in depression, anxiety, pain, and health status among a cohort of women scheduled to receive total mastectomy or breast-conserving surgery. Patient-reported outcomes measured preoperative differences between patients receiving total mastectomy or breast-conserving surgery in a cross-sectional design. Regression analyses was used to model health outcomes and adjust for patient demographics on patient measures. Participants scheduled for total mastectomy were more likely to report more severe symptoms of depression and anxiety. This association was non-significant after adjusting for demographic differences. Younger participants were more likely to be scheduled for total mastectomy. Age was negatively associated with symptoms of depression and anxiety. Screening patients for mental health symptoms may be particularly important among younger patients who were more likely to report depression and anxiety before their surgery and were more likely to receive total mastectomy.
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Affiliation(s)
- Elaine McKevitt
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
| | - Maria Saleeb
- Centre for Health Services and Policy Research, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Guiping Liu
- Centre for Health Services and Policy Research, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Rebecca Warburton
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
| | - Jin-Si Pao
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
| | - Carol Dingee
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
| | - Amy Bazzarelli
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
- Providence Breast Centre, Mount Saint Joseph Hospital, 3080 Prince Edward Street, Vancouver, BC V5T 3N4, Canada
| | - Katelynn Tang
- Department of Surgery, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada
| | - Trafford Crump
- Department of Surgery, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | - Jason M. Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
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Schumacher JR, Zahrieh D, Chow S, Taylor J, Wills R, Hanlon BM, Rathouz PJ, Tucholka JL, Neuman HB. Increasing socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making through a shared decision-making intervention (A231701CD): protocol for a cluster randomised clinical trial. BMJ Open 2022; 12:e063895. [PMID: 36396308 PMCID: PMC9677005 DOI: 10.1136/bmjopen-2022-063895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/25/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Socioeconomic disparities for breast cancer surgical care exist. Although the aetiology of the observed socioeconomic disparities is likely multifactorial, patient engagement during the surgical consult is critical. Shared decision-making may reduce health disparities by addressing barriers to patient engagement in decision-making that disproportionately impact socioeconomically disadvantaged patients. In this trial, we test the impact of a decision aid on increasing socioeconomically disadvantaged patients' engagement in breast cancer surgery decision-making. METHODS AND ANALYSIS This multisite randomised trial is conducted through 10 surgical clinics within the National Cancer Institute Community Oncology Research Program (NCORP). We plan a stepped-wedge design with clinics randomised to the time of transition from usual care to the decision aid arm. Study participants are female patients, aged ≥18 years, with newly diagnosed stage 0-III breast cancer who are planning breast surgery. Data collection includes a baseline surgeon survey, baseline patient survey, audio-recording of the surgeon-patient consultation, a follow-up patient survey and medical record data review. Interviews and focus groups are conducted with a subset of patients, surgeons and clinic stakeholders. The effectiveness of the decision aid at increasing patient engagement (primary outcome) is evaluated using generalised linear mixed-effects models. The extent to which the effect of the decision aid intervention on patient engagement is mediated through the mitigation of barriers is tested in joint linear structural equation models. Qualitative interviews explore how barriers impact engagement, especially for socioeconomically disadvantaged women. ETHICS AND DISSEMINATION This protocol has been approved by the National Cancer Institute Central Institutional Review Board, and Certificate of Confidentiality has been obtained. We plan to disseminate the findings through journal publications and national meetings, including the NCORP network. Our findings will advance the science of medical decision-making with the potential to reduce socioeconomic health disparities. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03766009).
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Affiliation(s)
| | - David Zahrieh
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, New York, USA
| | - Selina Chow
- Medicine-Geriatrics and Palliative Care, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - John Taylor
- Medicine-Geriatrics and Palliative Care, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Rachel Wills
- Medicine-Geriatrics and Palliative Care, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Bret M Hanlon
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Paul J Rathouz
- Population Health, University of Texas at Austin Dell Seton Medical Center, Austin, Texas, USA
| | - Jennifer L Tucholka
- Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Heather B Neuman
- Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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30
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Lee RXN, Cardoso MJ, Cheung KL, Parks RM. Immediate breast reconstruction uptake in older women with primary breast cancer: systematic review. Br J Surg 2022; 109:1063-1072. [PMID: 35909248 PMCID: PMC10364779 DOI: 10.1093/bjs/znac251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/22/2022] [Accepted: 07/04/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND Postmastectomy immediate breast reconstruction (PMIBR) may improve the quality of life of patients with breast cancer, of whom older women (aged 65 years or more) are a growing proportion. This study aimed to assess PMIBR in older women with regard to underlying impediments (if any). METHODS MEDLINE, Embase, and PubMed were searched by two independent researchers up to June 2022. Eligible studies compared PMIBR rates between younger and older women with invasive primary breast cancer. RESULTS A total of 10 studies (2012-2020) including 466 134 women were appraised, of whom two-thirds (313 298) were younger and one-third (152 836) older. Only 10.0 per cent of older women underwent PMIBR in contrast to 45.0 per cent of younger women. Two studies explored factors affecting uptake of PMIBR in older women; surgeon-associated (usual practice), patient-associated (socioeconomic status, ethnicity, and co-morbidities), and system-associated (insurance status and hospital location) factors were identified. CONCLUSION Uptake of PMIBR in older women is low with definable (and some correctable) barriers.
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Affiliation(s)
- Rachel Xue Ning Lee
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
- Queen’s Medical Centre Campus, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Maria Joao Cardoso
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
- Breast Unit, Champalimaud Foundation and Nova Medical School Lisbon, Lisbon, Portugal
| | - Kwok Leung Cheung
- Nottingham Breast Cancer Research Centre, University of Nottingham, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Ruth M Parks
- Correspondence to: Ruth M. Parks, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Uttoxeter Road, Derby DE22 3DT, UK (e-mail: )
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31
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Hammond DC, Little AK. The Role of Premastectomy Mastopexy and Breast Reduction in the Reconstruction of the Enlarged or Ptotic Breast. Plast Reconstr Surg 2022; 150:270-280. [PMID: 35666158 DOI: 10.1097/prs.0000000000009340] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The indications for nipple-sparing mastectomy have broadened over time. Patients undergoing nipple-sparing mastectomy who have enlarged or ptotic breasts are at risk for skin flap and/or nipple-areola complex necrosis. Premastectomy mastopexy or breast reduction may reduce the risk for these complications. METHODS A retrospective review was undertaken in a series of patients who underwent premastectomy reduction mammaplasty or mastopexy followed by nipple-sparing mastectomy and immediate staged tissue expander/implant-based breast reconstruction. In each case, a subnipple biopsy was performed at the premastectomy procedure to clear it of any potential malignant involvement. In addition, the area under the areola was undermined to maximize the effect of the delay phenomenon on the eventual survival of the nipple-areola complex. Final reconstruction involved tissue expander exchange for a permanent implant with associated fat grafting. Data regarding surgical timing and selected postoperative complications were recorded. RESULTS In total, 39 implant-based reconstructions were performed in 20 patients. There were no cases of mastectomy flap necrosis, and partial necrosis of the nipple-areola complex with delayed wound healing was seen in two breasts in the same patient. All patients eventually completed the reconstructive process successfully. CONCLUSION Premastectomy mastopexy or breast reduction may afford a protective effect against mastectomy flap or nipple-areola complex necrosis in patients with large or ptotic breasts who subsequently undergo nipple-sparing mastectomy with immediate breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Dennis C Hammond
- From Spectrum Health Plastic Surgery Residency; and Partners in Plastic Surgery
| | - Andrea K Little
- From Spectrum Health Plastic Surgery Residency; and Partners in Plastic Surgery
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Yehia ZA, Punglia RS, Wong J. Integration of Radiation and Reconstruction After Mastectomy. Semin Radiat Oncol 2022; 32:237-244. [DOI: 10.1016/j.semradonc.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Weber WP, Shaw J, Pusic A, Wyld L, Morrow M, King T, Mátrai Z, Heil J, Fitzal F, Potter S, Rubio IT, Cardoso MJ, Gentilini OD, Galimberti V, Sacchini V, Rutgers EJT, Benson J, Allweis TM, Haug M, Paulinelli RR, Kovacs T, Harder Y, Gulluoglu BM, Gonzalez E, Faridi A, Elder E, Dubsky P, Blohmer JU, Bjelic-Radisic V, Barry M, Hay SD, Bowles K, French J, Reitsamer R, Koller R, Schrenk P, Kauer-Dorner D, Biazus J, Brenelli F, Letzkus J, Saccilotto R, Joukainen S, Kauhanen S, Karhunen-Enckell U, Hoffmann J, Kneser U, Kühn T, Kontos M, Tampaki EC, Carmon M, Hadar T, Catanuto G, Garcia-Etienne CA, Koppert L, Gouveia PF, Lagergren J, Svensjö T, Maggi N, Kappos EA, Schwab FD, Castrezana L, Steffens D, Krol J, Tausch C, Günthert A, Knauer M, Katapodi MC, Bucher S, Hauser N, Kurzeder C, Mucklow R, Tsoutsou PG, Sezer A, Çakmak GK, Karanlik H, Fairbrother P, Romics L, Montagna G, Urban C, Walker M, Formenti SC, Gruber G, Zimmermann F, Zwahlen DR, Kuemmel S, El-Tamer M, Vrancken Peeters MJ, Kaidar-Person O, Gnant M, Poortmans P, de Boniface J. Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy. Breast 2022; 63:123-139. [PMID: 35366506 PMCID: PMC8976143 DOI: 10.1016/j.breast.2022.03.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/03/2022] [Accepted: 03/14/2022] [Indexed: 12/31/2022] Open
Abstract
Aim Demand for nipple- and skin- sparing mastectomy (NSM/SSM) with immediate breast reconstruction (BR) has increased at the same time as indications for post-mastectomy radiation therapy (PMRT) have broadened. The aim of the Oncoplastic Breast Consortium initiative was to address relevant questions arising with this clinically challenging scenario. Methods A large global panel of oncologic, oncoplastic and reconstructive breast surgeons, patient advocates and radiation oncologists developed recommendations for clinical practice in an iterative process based on the principles of Delphi methodology. Results The panel agreed that surgical technique for NSM/SSM should not be formally modified when PMRT is planned with preference for autologous over implant-based BR due to lower risk of long-term complications and support for immediate and delayed-immediate reconstructive approaches. Nevertheless, it was strongly believed that PMRT is not an absolute contraindication for implant-based or other types of BR, but no specific recommendations regarding implant positioning, use of mesh or timing were made due to absence of high-quality evidence. The panel endorsed use of patient-reported outcomes in clinical practice. It was acknowledged that the shape and size of reconstructed breasts can hinder radiotherapy planning and attention to details of PMRT techniques is important in determining aesthetic outcomes after immediate BR. Conclusions The panel endorsed the need for prospective, ideally randomised phase III studies and for surgical and radiation oncology teams to work together for determination of optimal sequencing and techniques for PMRT for each patient in the context of BR Autologous breast reconstruction is increasingly preferred over implants in the setting of radiation therapy. Use of patient-reported outcomes is endorsed. Shape and size of reconstructed breasts can hinder radiotherapy planning. There is a need for randomised phase III trials.
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Affiliation(s)
- Walter Paul Weber
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Jane Shaw
- Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
| | - Andrea Pusic
- Brigham and Women's/Dana Farber Cancer Center, USA
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Monica Morrow
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tari King
- Department of Surgery, Brigham and Women's Hospital / Dana Farber Cancer Institute, USA
| | - Zoltán Mátrai
- Department of Breast and Sarcoma Surgery, National Institute of Oncology, Budapest, Hungary
| | - Jörg Heil
- Department of Obstetrics and Gynecology, University of Heidelberg, Medical School, Heidelberg, Germany
| | - Florian Fitzal
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Shelley Potter
- Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Clifton, Bristol, UK
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | - Maria-Joao Cardoso
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, And Nova Medical School, Lisbon, Portugal
| | | | | | - Virgilio Sacchini
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emiel J T Rutgers
- Department of Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - John Benson
- Cambridge Breast Unit, Addenbrooke's Hospital Cambridge, Cambridge, UK; Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation TRUST, School of Medicine, Anglia Ruskin University, Cambridge, UK
| | - Tanir M Allweis
- Hadassah Medical Center & Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Martin Haug
- Breast Center and Department of Plastic, Reconstructive, Aesthetic and Handsurgery University Hospital Basel, University of Basel, Basel, Switzerland
| | - Regis R Paulinelli
- Federal University of Goiás, Araújo Jorge Hospital, Goiás Anti-Cancer Association, Goiás, Brazil
| | - Tibor Kovacs
- Jiahui Internatioonal Hospital Shanghai, China; Guy's and St. Thomas' NHS Foundation Trust London, UK
| | - Yves Harder
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | | | - Eduardo Gonzalez
- Departament of Mastology, Breast Unit- Instituto de Oncología Angel H Roffo, Buenos Aires Univesity. Buenos Aires, Argentina
| | - Andree Faridi
- Department of Senology/Breast Center, University Hospital Bonn, Germany
| | - Elisabeth Elder
- Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney, Australia
| | - Peter Dubsky
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Breast Center, Hirslanden Clinic St. Anna, Lucerne, Switzerland
| | - Jens-Uwe Blohmer
- Department of Gynecology and Breast Center, Charité University Hospital, Berlin, Germany
| | - Vesna Bjelic-Radisic
- Breast Unit, Helios University Hospital, University Witten/Herdecke, Wuppertal, Germany
| | - Mitchel Barry
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Susanne Dieroff Hay
- Patient Advocacy Group, Oncoplastic Breast Consortium, President, the Swedish Breast Cancer Association, Stockholm, Sweden
| | - Kimberly Bowles
- Patient Advocacy Group, Oncoplastic Breast Consortium, Not Putting on A Shirt, Pittsburgh, USA
| | - James French
- Westmead Breast Cancer Institute, Westmead Hospital, University of Sydney, Australia
| | - Roland Reitsamer
- Breast Center Salzburg, University Clinic Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Rupert Koller
- Department of Plastic, Aesthetic and Reconstructive Surgery, Vienna Health Services, Clinic Landstrasse and Clinic Ottakring, Vienna, Austria
| | - Peter Schrenk
- Breast Cancer Center, Kepler University Hospital, Linz, Austria
| | | | - Jorge Biazus
- Division of Breast Surgery, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Fabricio Brenelli
- Breast Oncology Division, University of Campinas, Campinas, São Paulo, Brazil
| | - Jaime Letzkus
- San Borja Arriaran Clinical Hospital, University of Chile, Chile
| | | | | | - Susanna Kauhanen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ulla Karhunen-Enckell
- Tampere University Hospital, Department of Surgery and Tays Cancer Center, Tampere, Finland
| | - Juergen Hoffmann
- Breast Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery - Burn Center, BG Trauma Center Ludwigshafen/Rhine, Hand and Plastic Surgery, University Heidelberg, Heidelberg, Germany
| | - Thorsten Kühn
- Interdisciplinary Breast Center, Klinikum Esslingen, Germany
| | | | - Ekaterini Christina Tampaki
- Department of Plastic, Reconstructive Surgeryand Burn Unit, KAT Athens Hospital and Trauma Center, Athens, Greece
| | | | - Tal Hadar
- Hadassah Medical Center & Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Giuseppe Catanuto
- Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Catania, Italy
| | | | - Linetta Koppert
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Pedro F Gouveia
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, And Nova Medical School, Lisbon, Portugal
| | - Jakob Lagergren
- Department of Surgery, Capio St Goran's Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Tor Svensjö
- Department of Surgery, Central Hospital, Kristianstad, Sweden
| | - Nadia Maggi
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Elisabeth A Kappos
- Breast Center and Department of Plastic, Reconstructive, Aesthetic and Handsurgery University Hospital Basel, University of Basel, Basel, Switzerland
| | | | | | - Daniel Steffens
- Breast Center, University Hospital Basel, Basel, Switzerland
| | - Janna Krol
- Breast Center, University Hospital Basel, Basel, Switzerland
| | | | | | - Michael Knauer
- Breast Center Eastern Switzerland, St. Gallen, Switzerland
| | - Maria C Katapodi
- University of Basel, Basel, Switzerland; Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
| | - Susanne Bucher
- Breast Center, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Nik Hauser
- Breast Center, Hirslanden Clinic Aarau, Aarau, Frauenarztzentrum Aargau AG, Baden, Switzerland
| | - Christian Kurzeder
- Breast Center, University Hospital Basel, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Rosine Mucklow
- Patient Advocacy Group, Oncoplastic Breast Consortium, Basel, Switzerland
| | - Pelagia G Tsoutsou
- University Hospital Geneva, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Atakan Sezer
- Department of Surgery, Trakya University Medical School Hospital, Turkey
| | - Güldeniz Karadeniz Çakmak
- Department of Surgery, The School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | | | - Patricia Fairbrother
- Patient Advocacy Group, Oncoplastic Breast Consortium, Breakthrough Breast Cancer, Association Breast Surgery UKBCC, Kedleston, UK
| | - Laszlo Romics
- Department of Surgery, New Victoria Hospital, Glasgow, UK
| | - Giacomo Montagna
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cicero Urban
- Breast Unit, Hospital Nossa Senhora Das Graças, Curitiba, Brazil
| | - Melanie Walker
- Breast Endocrine and General Surgery Unit, The Alfred, Melbourne, Australia; Breast Surgeons of Australia and New Zealand (BreastSurgANZ), Australia
| | - Silvia C Formenti
- Department of Radiation Oncology and Meyer Cancer Center, Weill Cornell Medicine, USA
| | - Guenther Gruber
- Institute for Radiotherapy, Klinik Hirslanden, 8032, Zurich, Switzerland; University of Berne, 3000, Bern, Switzerland
| | - Frank Zimmermann
- Clinic of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - Daniel Rudolf Zwahlen
- Department of Radiation Oncology, Cantonal Hospital of Winterthur, Winterthur, Switzerland
| | - Sherko Kuemmel
- Department of Gynecology and Breast Center, Charité University Hospital, Berlin, Germany; Breast Unit, Kliniken Essen-Mitte, Germany
| | - Mahmoud El-Tamer
- Breast Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marie Jeanne Vrancken Peeters
- Department of Surgical Oncology Netherlands Cancer Institute, Antoni van Leeuwenhoek & Amsterdam University Medical Center, Netherlands
| | - Orit Kaidar-Person
- Breast Radiation Therapy Unit, Sheba Tel Hashomer, Ramat Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Michael Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Philip Poortmans
- Iridium Netwerk and University of Antwerp, Wilrijk-Antwerpen, Belgium
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery, Capio St Göran's Hospital, Stockholm, Sweden
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Sewart E, Turner NL, Conroy EJ, Cutress RI, Skillman J, Whisker L, Thrush S, Barnes N, Holcombe C, Potter S. The Impact of Radiotherapy on Patient-reported Outcomes of Immediate Implant-based Breast Reconstruction With and Without Mesh. Ann Surg 2022; 275:992-1001. [PMID: 32657919 DOI: 10.1097/sla.0000000000004245] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To explore the impact of PMRT on PROs of IBBR performed with and without mesh. SUMMARY OF BACKGROUND DATA PMRT is increasingly given to improve breast cancer outcomes but can adversely impact complications after IBBR.Little; however, is known about the impact of PMRT on the PROs of IBBR, especially when mesh is used. METHODS The implant Breast Reconstruction evAluation prospective cohort study recruited consecutive women undergoing immediate IBBR from 81 UK breast and plastic surgical units. Demographic, operative, oncological, and 3-month complication data were collected, and patients consented to receive validated PRO questionnaires at 18-months. The association between IBBR, PMRT, and PROs were investigated using mixed-effects regression models adjusted for clinically-relevant confounders and including a random-effect to account for potential clustering by center. RESULTS A total of 1163 women consented to receive 18-month questionnaires of whom 730 (63%) completed it. Patients undergoing PMRT (214 patients) reported worse PROs in 3 BREAST-Q domains: satisfaction with breasts [-6.27 points, P = 0.008, 95% confidence interval (CI) (-10.91, -1.63)], satisfaction with outcome [-7.53 points, P = 0.002, CI (-12.20, -2.85)] and physical well-being [-6.55 points, P < 0.001, CI (-9.43, -3.67)]. Overall satisfaction was worse in the PMRT group [OR 0.497, P = 0.002, CI (0.32, 0.77)]. These effects were not ameliorated by mesh use. CONCLUSIONS PMRT may adversely affect PROs after IBBR irrespective of whether mesh is used. These findings should be discussed with all patients considering IBBR and when indications for PMRT are borderline to enable informed decision-making regarding oncological and reconstructive treatment options. TRIAL REGISTRATION ISRCTN37664281.
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Affiliation(s)
- Emma Sewart
- Population Health Sciences, Bristol Medical School, Clifton, Bristol, UK
| | - Nicholas L Turner
- Population Health Sciences, Bristol Medical School, Clifton, Bristol, UK
| | - Elizabeth J Conroy
- Liverpool Clinical Trials Centre (LCTC), University of Liverpool, Liverpool, UK
| | - Ramsey I Cutress
- Faculty of Medicine, Cancer Sciences Unit, University of Southampton, Somers Cancer Research Building, University Hospital Southampton, Southampton, UK
| | - Joanna Skillman
- Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Lisa Whisker
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Steven Thrush
- Breast Unit, Worcester Royal Hospital, Worcester, UK
| | - Nicola Barnes
- Nightingale Breast Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - Chris Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
| | - Shelley Potter
- Population Health Sciences, Bristol Medical School, Clifton, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
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Ritter M, Oberhauser I, Montagna G, Zehnpfennig L, Schaefer K, Ling BM, Levy J, Soysal SD, Müller M, López LC, Schwab FD, Kurzeder C, Haug M, Kappos EA, Weber WP. Comparison of patient-reported outcomes among different types of oncoplastic breast surgery procedures. J Plast Reconstr Aesthet Surg 2022; 75:3068-3077. [PMID: 35732566 DOI: 10.1016/j.bjps.2022.04.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 03/03/2022] [Accepted: 04/12/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study aims to compare patient-reported outcomes (PROs) after different types of oncoplastic surgery (OPS) procedures and correlate the results with previously published normative data from women with no prior history of breast cancer (BC) and breast surgery. METHODS Cross-sectional study of patients with stage I-II BC undergoing a specific selection of OPS procedures from 04/2012 to 12/2018 by three breast surgeons at a single tertiary referral hospital in Switzerland. PROs were evaluated using the postoperative BREAST-Q questionnaire. RESULTS One hundred twenty-seven patients met the inclusion criteria and were surveyed. All OPS techniques achieved comparably elevated scores in satisfaction with breasts, psychosocial, and sexual well-being. Compared to normative data of healthy women, all OPS groups postoperatively achieved significantly better satisfaction with breasts, psychosocial, and sexual well-being. CONCLUSION This study shows high PROs across all types of OPS, which were superior to normative data from healthy women. Our findings confirm that OPS is associated with high quality of life and patient satisfaction.
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Affiliation(s)
- Mathilde Ritter
- Breast Center, University Hospital of Basel, Basel, Switzerland
| | - Ida Oberhauser
- Breast Center, University Hospital of Basel, Basel, Switzerland
| | - Giacomo Montagna
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lea Zehnpfennig
- Breast Center, University Hospital of Basel, Basel, Switzerland
| | | | - Barbara M Ling
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Jeremy Levy
- Biometrical Practice BIOP, Basel, Switzerland
| | - Savas D Soysal
- Breast Center, University Hospital of Basel, Basel, Switzerland
| | - Madleina Müller
- Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland
| | | | - Fabienne D Schwab
- Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland
| | - Christian Kurzeder
- Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland
| | - Martin Haug
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Elisabeth A Kappos
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Walter P Weber
- Breast Center, University Hospital of Basel, Basel, Switzerland
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Post-Mastectomy Radiation Therapy: Applications and Advancements. CURRENT BREAST CANCER REPORTS 2022. [DOI: 10.1007/s12609-022-00449-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hanson SE, Lei X, Roubaud MS, DeSnyder SM, Caudle AS, Shaitelman SF, Hoffman KE, Smith GL, Jagsi R, Peterson SK, Smith BD. Long-term Quality of Life in Patients With Breast Cancer After Breast Conservation vs Mastectomy and Reconstruction. JAMA Surg 2022; 157:e220631. [PMID: 35416926 PMCID: PMC9008558 DOI: 10.1001/jamasurg.2022.0631] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Treatment options for early breast cancer include breast-conserving surgery with radiation therapy (RT) or mastectomy and breast reconstruction without RT. Despite marked differences in these treatment strategies, little is known with regard to their association with long-term quality of life (QOL). Objective To evaluate the association of treatment with breast-conserving surgery with RT vs mastectomy and reconstruction without RT with long-term QOL. Design, Setting, and Participants This comparative effectiveness research study used data from the Texas Cancer Registry for women diagnosed with stage 0-II breast cancer and treated with breast-conserving surgery or mastectomy and reconstruction between 2006 and 2008. The study sample was mailed a survey between March 2017 and April 2018. Data were analyzed from August 1, 2018 to October 15, 2021. Exposures Breast-conserving surgery with RT or mastectomy and reconstruction without RT. Main Outcomes and Measures The primary outcome was satisfaction with breasts, measured with the BREAST-Q patient-reported outcome measure. Secondary outcomes included BREAST-Q physical well-being, psychosocial well-being, and sexual well-being; health utility, measured using the EuroQol Health-Related Quality of Life 5-Dimension, 3-Level questionnaire; and local therapy decisional regret. Multivariable linear regression models with weights for treatment, age, and race and ethnicity tested associations of the exposure with outcomes. Results Of 647 patients who responded to the survey (40.0%; 356 had undergone breast-conserving surgery, and 291 had undergone mastectomy and reconstruction), 551 (85.2%) confirmed treatment with breast-conserving surgery with RT (n = 315) or mastectomy and reconstruction without RT (n = 236). Among the 647 respondents, the median age was 53 years (range, 23-85 years) and the median time from diagnosis to survey was 10.3 years (range, 8.4-12.5 years). Multivariable analysis showed no significant difference between breast-conserving surgery with RT (referent) and mastectomy and reconstruction without RT in satisfaction with breasts (effect size, 2.71; 95% CI, -2.45 to 7.88; P = .30) or physical well-being (effect size, -1.80; 95% CI, -5.65 to 2.05; P = .36). In contrast, psychosocial well-being (effect size, -8.61; 95% CI, -13.26 to -3.95; P < .001) and sexual well-being (effect size, -10.68; 95% CI, -16.60 to -4.76; P < .001) were significantly worse with mastectomy and reconstruction without RT. Health utility (effect size, -0.003; 95% CI, -0.03 to 0.03; P = .83) and decisional regret (effect size, 1.32; 95% CI, -3.77 to 6.40; P = .61) did not differ by treatment group. Conclusions and Relevance The findings support equivalence of breast-conserving surgery with RT and mastectomy and reconstruction without RT with regard to breast satisfaction and physical well-being. However, breast-conserving surgery with RT was associated with clinically meaningful improvements in psychosocial and sexual well-being. These findings may help inform preference-sensitive decision-making for women with early-stage breast cancer.
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Affiliation(s)
- Summer E Hanson
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Xiudong Lei
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston
| | - Margaret S Roubaud
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
| | - Sarah M DeSnyder
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Abigail S Caudle
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Simona F Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Karen E Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Grace L Smith
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston.,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor
| | - Susan K Peterson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston
| | - Benjamin D Smith
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston.,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
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Racz JM, Harless CA, Hoskin TL, Day CN, Nguyen MDT, Harris AM, Boughey JC, Hieken TJ, Degnim AC. Sexual Well-Being After Nipple-Sparing Mastectomy: Does Preservation of the Nipple Matter? Ann Surg Oncol 2022; 29:10.1245/s10434-022-11578-1. [PMID: 35385996 DOI: 10.1245/s10434-022-11578-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/21/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The primary aim of this study was to evaluate patient-reported outcome measures in patients undergoing mastectomy with and without breast reconstruction (immediate or delayed) with and without nipple preservation. METHODS All female patients undergoing mastectomy between 2011 and 2015 at Mayo Clinic Rochester were identified and were mailed the BREAST-Q survey. Breast satisfaction, psychosocial well-being, and sexual well-being were evaluated and compared by surgery type using Wilcoxon rank-sum tests for univariate analysis and linear regression for multivariable analysis adjusting for potential confounders. RESULTS Of 1547 patients, 771 completed the BREAST-Q survey (response rate 50%). Of these 771 respondents, 237 (31%) did not have reconstruction, 198 (26%) had nipple-sparing mastectomy with reconstruction (NSM), and 336 (44%) had skin-sparing mastectomy with reconstruction (SSM) ± nipple-areolar complex (NAC) reconstruction (via surgery ± tattoo). Patients with breast reconstruction had consistently higher BREAST-Q scores versus those without. Comparing NSM with all SSMs, there was no difference in satisfaction with breasts (mean 71.8 vs. 70.2, p = 0.21) or psychosocial well-being (mean 81.9 vs. 81.3, p = 0.47); however, sexual well-being was significantly higher in the NSM group on univariate (mean 64.5 vs. 58.0, p = 0.002) and multivariable (β = -4.69, p = 0.03) analysis. Sexual well-being scores were similar for NSM and the SSM subgroups with any type of NAC reconstruction. CONCLUSIONS This study demonstrates that NSM positively impacts patient sexual well-being after breast reconstruction compared with SSM, particularly SSM without nipple reconstruction or tattoo. SSM with any type of NAC reconstruction achieved similar satisfaction and sexual well-being to those undergoing NSM.
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Affiliation(s)
- Jennifer M Racz
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Tanya L Hoskin
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Courtney N Day
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - Ann M Harris
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Amy C Degnim
- Department of Surgery, Mayo Clinic, Rochester, MN, USA.
- Mayo Clinic Rochester, Rochester, MN, USA.
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Mohan SC, Siegel E, Tran H, Ozcan L, Alban R, Shariff S, Mirocha J, Chung A, Giuliano A, Dang C, Anand K, Shane R, Amersi F. Effects of paravertebral blocks versus liposomal bupivacaine on hospital utilization after mastectomy with reconstruction. Am J Surg 2022; 224:938-942. [DOI: 10.1016/j.amjsurg.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 11/25/2022]
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Wang W, Sun T, Meng Y, Xu M, Zhang Y, Shao Q, Song Y, Li J. Dosimetric Evaluation of Incidental Irradiation to the Internal Mammary Chain After Surgery in Breast Cancer Patients. Front Oncol 2022; 12:839831. [PMID: 35311065 PMCID: PMC8928457 DOI: 10.3389/fonc.2022.839831] [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: 12/20/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose The low rate of internal mammary node (IMN) recurrence was attributed to systemic therapy and internal mammary chain (IMC) coverage by the tangential fields of irradiation. This study aimed to evaluate the incidental irradiation dose to the IMC in breast cancer patients after surgery and to estimate the clinical predictive parameters affecting the magnitude of the IMC. Materials and Methods A total of 138 patients treated with postmastectomy radiotherapy and 210 patients undergoing radiotherapy after breast-conserving surgery (BCS) in our hospital were retrospectively analyzed. The mean dose (Dmean) to the IMC and the first to third intercostal spaces of IMC levels (ICS1–3) were evaluated. We evaluated the IMC coverage according to the type of surgery and whether the ipsilateral supraclavicular fossa (SCF) was included in the irradiation field. Results The incidental radiation dose to the IMC was 29.69 Gy, and the dose delivered to the IMC, ICS1, and ICS2 showed a greater coverage in the modified radical mastectomy (MRM) group when compared with the BCS group (32.85 vs. 27.1 Gy, 26.6 vs. 12.5 Gy, 34.63 vs. 30.42 Gy). The dose delivered to ICS3 showed no difference between the MRM and BCS groups (37.41 vs. 36.24 Gy). Furthermore, 131 patients (37.64%) received radiotherapy to the chest wall and ipsilateral SCF. In the univariate analysis, both surgery type and SCF irradiation were parameters affecting the Dmean of incidental radiation to the IMC (r = −0.179, P = 0.001; r = −0.175, P = 0.001). In the multivariate analysis, surgery type was the only correlative factor that affected incidental radiation dose to the IMC (r = –3.534, P = 0.000). Conclusion The real influencing factor of incidental dose to the IMC was the surgery form rather than the accession of SCF irradiation.
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Affiliation(s)
- Wei Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Tao Sun
- Department of Medical Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yingtao Meng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Min Xu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yingjie Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Qian Shao
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yuanfang Song
- Department of Radiation Oncology, Wei Hai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, China
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Special Considerations in Patients with Early-Stage Breast Cancer and Survivors. Obstet Gynecol Clin North Am 2022; 49:195-208. [DOI: 10.1016/j.ogc.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Baker BG, Chadwick S, Patel N, Jeevan R. Comparative UK Cross-sectional Study of Breast Cancer Patient-Reported Outcomes for Breast-Conserving Surgery and Immediate Reconstruction, Including Contribution to an International Collaborative Pilot Study. J Plast Reconstr Aesthet Surg 2022; 75:2172-2179. [PMID: 35341709 DOI: 10.1016/j.bjps.2022.02.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/20/2022] [Accepted: 02/15/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Breast-conserving surgery (BCS) with adjuvant radiotherapy is oncologically comparable to mastectomy with immediate breast reconstruction (IBR) in treating breast cancer. This tertiary UK centre cross-sectional study compared BCS patient-reported outcomes with those of immediate implant-based (IBR) and free flap reconstruction (FFR), and included a contribution to a pilot international collaboration co-ordinated through the Organisation for Economic Cooperation and Development (OECD). METHODS Validated BREAST-Q™ 'satisfaction with breasts' modules were administered to 271 consecutive patients for six months after unilateral BCS, IBR, or FFR were conducted between June and October 2018. Risk adjustment data were collected on age, body mass index, smoking, radiotherapy, specimen weight, and tumour burden. RESULTS A total of 190 women returned completed questionnaires (131 BCS, 42 IBR, 17 FFR; 70% response rate). BCS scores (mean 68, standard deviation (SD) 23) were higher than those for IR overall (62, SD 23, p=0.04) and IBR (61, 24, p=0.03) but equivalent to those for FFR (66, SD 23, p=0.33). There was no significant difference in Q-Scores between the IBR and FFR groups (p=0.77). Scores were only minimally changed by risk adjustment and comparable to OECD mean international scores for IBR (61) and FFR (66). CONCLUSIONS This is the first study to compare BCS and IR outcomes using a validated scale. BREAST-Q™ 'satisfaction with breasts' scores were comparable between BCS and FFR but significantly lower following IBR.
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Affiliation(s)
- Benjamin G Baker
- Department of Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sarah Chadwick
- Department of Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Naomi Patel
- Department of Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ranjeet Jeevan
- Department of Plastic Surgery, Manchester University NHS Foundation Trust, Manchester, UK.
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43
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Impact of Incision Placement on Ischemic Complications in Microsurgical Breast Reconstruction. Plast Reconstr Surg 2022; 149:316-322. [PMID: 35077404 DOI: 10.1097/prs.0000000000008770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nipple-sparing mastectomy is associated with greater patient satisfaction than non-nipple-sparing approaches. Although various nipple-sparing mastectomy incisions have been described, the authors hypothesized that incision location would impact the rate and location of ischemic complications to the mastectomy skin flap. METHODS A prospectively maintained database was queried to identify patients who underwent nipple-sparing mastectomy with immediate microsurgical reconstruction with a minimum postoperative follow-up of 12 months. The impact of incision location on postoperative ischemic complications was investigated. Major complications were defined as those that required reexploration in the operating room or inpatient management; minor complications were amenable to outpatient management. Multivariable logistic and linear regression were performed to investigate risk factors for postoperative complications following breast reconstruction. RESULTS Eighty-seven patients met inclusion criteria. The following nipple-sparing mastectomy incisions were used: radial with a periareolar extension (39 percent), inframammary fold (31 percent), vertical with a periareolar extension (22 percent), vertical (6 percent), and radial (2 percent). Seven patients (8 percent) had major complications, whereas twenty-six patients (29.9 percent) developed minor postoperative complications. Inframammary fold incisions were associated with significantly greater rates of mastectomy skin flap necrosis (p = 0.002), whereas periareolar incisions were associated with significantly greater rates of postoperative nipple-areola complex necrosis (p = 0.04). CONCLUSIONS The authors report a significant association between incision location and ischemic complications to the breast skin envelope in microsurgical breast reconstruction. The authors observed a significant association of inframammary fold and periareolar incisions with mastectomy skin flap and nipple-areola complex necrosis, respectively. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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44
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Zhong YM, Tong F, Shen J. Lympho-vascular invasion impacts the prognosis in breast-conserving surgery: a systematic review and meta-analysis. BMC Cancer 2022; 22:102. [PMID: 35073848 PMCID: PMC8787911 DOI: 10.1186/s12885-022-09193-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/10/2022] [Indexed: 02/08/2023] Open
Abstract
Background It is estimated that breast cancer (BC) incidence, especially that of early-stage breast cancer cases continues to rise due to increased universal screening. Breast-conserving surgery (BCS) is the main intervention for early-stage BC. Lympho-vascular invasion (LVI) is reported to influence breast cancer prognosis but its prognostic value in breast-conserving treatment is controversial. Methods A search was conducted on the Cochrane library, PubMed, Web of Science, and EMBASE from inception to December 1st, 2021, without language restrictions, to identify studies that explored the prognosis of lympho-vascular invasion in breast-conserving surgery. Reviews of each study were conducted, and data extracted. The meta-analysis was performed with StataSE 16. Study quality assessment was evaluated using the Newcastle–Ottawa Scale. Results Overall, 15 studies with 21,704 patients deemed eligible for this study. Event-free survival (EFS), disease-free survival (DFS), overall survival (OS), distant metastases (DM), loco-regional recurrence (LRR), local recurrence (LR), breast recurrence (BR), disease specific survival (DSS), and breast cancer specific survival (BCSS), were extracted from each study. We found that LVI leads to poor OS (HR = 1.46, 95% CI: 1.17–1.83), DM (HR = 2.08, 95% CI: 1.66–2.60) and LR (HR = 2.00, 95% CI: 1.54–2.61). Conclusions We confirmed that early-stage BC patients with LVI-positive have poorer OS, DFS, LRR, BCSS, DM and LR following receiving BCS than those LVI-negative patients. Mastectomy, in combination with radical systemic therapies could be considered, especially in those requiring second surgery. How to change the impact of LVI on the local recurrence rate and long-term survival in patients who undergo BCS may be a valuable research direction in the future. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09193-0.
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45
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Oh MY, Kim Y, Kim J, Cheun JH, Jung JG, Kim HK, Lee HB, Han W. Comparison of Long-Term Oncological Outcomes in Oncoplastic Breast Surgery and Conventional Breast-Conserving Surgery for Breast Cancer: A Propensity Score-Matched Analysis. J Breast Cancer 2022; 24:520-530. [PMID: 34979598 PMCID: PMC8724379 DOI: 10.4048/jbc.2021.24.e52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/15/2021] [Accepted: 12/08/2021] [Indexed: 12/26/2022] Open
Abstract
PURPOSE The oncoplastic breast-conserving surgery (OPS) technique, combined with the principles of oncological safety and plastic surgery, results in complete tumor resection while preserving the natural appearance of the breast. The purpose of this study was to evaluate the long-term oncological results after OPS compared with conventional breast-conserving surgery (BCS) for early breast cancer. METHODS The medical records of patients who underwent breast cancer surgery and adjuvant radiation therapy at Seoul National University Hospital between 2011 and 2014 were reviewed. Ipsilateral breast tumor recurrence (IBTR)-free survival rate and recurrence-free survival (RFS) rates were compared between the OPS and BCS groups. RESULTS One-to-one propensity score matching was conducted, yielding 371 patients in each group. The mean tumor distance from the nipple was shorter, and the mean retrieved specimen size and pathologic tumor size, including ductal carcinoma in situ, were larger in the OPS group than in the conventional BCS group (p < 0.001). Surgical margin positivity was not significantly different between the two groups (p = 0.777). The surgical technique was not significantly associated with IBTR (OPS versus conventional BCS, 5-year survival rate, 96.9% vs. 98.6%; p = 0.355) and RFS (5-year survival rate, 92.9% vs. 94.5%; p = 0.357) on the log-rank test. Multivariate analysis revealed that OPS versus conventional BCS was not significantly associated with survival outcomes. CONCLUSION We observed no significant differences in long-term IBTR and RFS between the OPS and conventional BCS groups in this retrospective analysis. OPS can be an oncologically and surgically safe alternative option for conventional BCS for early breast cancer.
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Affiliation(s)
- Moon Young Oh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yumi Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,CHA Gangnam Medical Center, CHA University College of Medicine, Seoul, Korea
| | - Jiho Kim
- Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Ho Cheun
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Gwang Jung
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hong-Kyu Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Byoel Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Wonshik Han
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
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Michael A, Olawoye O, Ademola S, Ugwu E, Sarimiye F, Ayandipo O, Aderibigbe R, Iyun A, Oluwatosin O. Postmastectomy breast reconstruction awareness and attitudes in Nigerian women with breast cancer: A descriptive, cross sectional survey. JOURNAL OF CLINICAL SCIENCES 2022. [DOI: 10.4103/jcls.jcls_28_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Laustsen-Kiel CM, Lauritzen E, Langhans L, Engberg Damsgaard T. Study protocol for a 10-year prospective observational study, examining lymphoedema and patient-reported outcome after breast reconstruction. BMJ Open 2021; 11:e052676. [PMID: 34873005 PMCID: PMC8650483 DOI: 10.1136/bmjopen-2021-052676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Over the last decades, treatment of breast cancer has become increasingly more effective. Consequently, an increasing number of women are living with late effects of breast cancer treatment, including disfiguring scars, deformity or asymmetry of the breast, secondary lymphoedema and other physical and psychosocial late effects. Data from this study will provide knowledge on how to guide breast reconstruction in the future towards outcomes with fewer complications, higher long-term quality of life (QoL) and satisfaction with the aesthetic outcome. The development of secondary lymphoedema, for which the effect of breast reconstruction has yet to be established, will be thoroughly examined. METHODS AND ANALYSIS Women receiving breast reconstruction (autologous and implant based) at the Department of Plastic Surgery and Burns Treatment, Rigshospitalet, will be invited to participate. The patients will be followed for 10 years postoperatively. Demographic, health-related, oncological characteristics and treatment data will be registered. Validated assessment tools, such as the BREAST-Q and Beck Depression Inventory, will be used to measure an extensive range of clinical outcomes, including QoL, life and aesthetic satisfaction and depression. Arm range of motion will be measured with a goniometer and lymphoedema by bioimpedance spectroscopy, compared with circular arm measurements. ETHICS AND DISSEMINATION This study will be conducted according to the 5th version of the Helsinki Declaration. The regional ethical committee for Capital Region Denmark did not find the study notifiable, according to the law of the committee § 1, part 4. All data will be anonymised before its publication. This study will be conducted according to the Danish data protection regulation and is catalogued and approved by the Capital Region Head of Knowledge Centre. According to the Danish health law § 46, part 2, this study does not need the Danish Patient Safety Authority's approval. The findings of this study will be submitted to international peer-reviewed journals.
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Affiliation(s)
| | - Elisabeth Lauritzen
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Linnea Langhans
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Tine Engberg Damsgaard
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
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Differences in Time Burden across Local Therapy Strategies for Early-stage Breast Cancer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3904. [PMID: 34745797 PMCID: PMC8568370 DOI: 10.1097/gox.0000000000003904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/01/2021] [Indexed: 11/26/2022]
Abstract
"Time burden" (time required during treatment) is relevant when choosing a local therapy option for early-stage breast cancer but has not been rigorously studied. We compared the time burden for three common local therapies for breast cancer: (1) lumpectomy plus whole-breast irradiation (Lump+WBI), (2) mastectomy without radiation or reconstruction (Mast alone), and (3) mastectomy without radiation but with reconstruction (Mast+Recon). Methods Using the MarketScan database, we identified 35,406 breast cancer patients treated from 2000 to 2011 with these local therapies. We quantified the total time burden as the sum of inpatient days (inpatient-days), outpatient days excluding radiation fractions (outpatient-days), and radiation fractions (radiation-days) in the first two years postdiagnosis. Multivariable regression evaluated the effect of local therapy on inpatient-days and outpatient-days adjusted for patient and treatment covariates. Results Adjusted mean number of inpatient-days was 1.0 for Lump+WBI, 2.0 for Mast alone, and 3.1 for Mast+Recon (P < 0.001). Adjusted mean number of outpatient-days was 42.9 for Lump+WBI, 42.2 for Mast alone, and 45.8 for Mast+Recon (P < 0.001). The mean number of radiation-days for Lump+WBI was 32.4. Compared with Mast+Recon (48.9 days), total adjusted time burden was 4.7 days shorter for Mast alone (44.2 days) and 27.4 days longer for Lump+WBI (76.3 days). However, use of a 15 fraction WBI regimen would reduce the time burden differential between Lump+WBI and Mast+Recon to just 10.0 days. Conclusions Although Mast+Recon confers the highest inpatient and outpatient time burden, Lump+WBI carries the highest total time burden. Increased use of hypofractionation will reduce the total time burden for Lump+WBI.
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Amouzou KS, Ketevi AA, Sambiani DM, Caroli A. Female breast cancer in sub-Saharan Africa: A PRISMA-S-compliant systematic review of surgery. J Surg Oncol 2021; 125:336-351. [PMID: 34738640 DOI: 10.1002/jso.26720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/25/2021] [Accepted: 09/25/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND In sub-Saharan countries (SSAs), the advanced stage at diagnosis and the limited surgical interventions of female breast cancer (FBC) lead to poor outcomes. This study assessed current modalities of FBC surgeries. METHODS Six literature databases (Medline, Embase, African Journal Online, Google Scholar, Web of Science, Cochrane Library) were searched, plus a manual search, in 2011-2021. We included primary data studies with any setting and presurgeries or postsurgeries treatments, we excluded non-English language studies, editorials, and grey literature. RESULTS The search yielded 21 observational studies (16 retrospective, 3 prospective, and 2 case reports). Of the total 6900 patients, 4121 (60%) patients underwent FBC surgical excision only, and 751/2779 (27%) conservative surgery (BCS) or therapy (BCT). All studies reported similar use of mastectomy (>60%), the FBC surgical excision/reconstruction studies displayed more neoadjuvant chemotherapy (536/2779, 19% vs. 215/4121, 5%), and radiotherapy or adjuvant radiotherapy (1461/2779, 52% vs. 411/3921, 4%). Patients' age, histological classification, staging, and follow-up data were often missing. CONCLUSIONS The FBC complexity requires structured management by general and plastic surgeons, radiotherapy specialists, and obstetrician-gynecologists through shared guidelines, protocols, and specific programs of public health. In SSAs, FBC surgical strategies should point at decreasing radical mastectomy and increasing BCS/BCT.
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Affiliation(s)
- Komla Séna Amouzou
- Department of Surgery, University of Lomé, Sylvanus Olympio Teaching Hospital, Lomé, Togo
| | - Ameyo Ayoko Ketevi
- Department of Gynaecology, University of Lomé, Sylvanus Olympio Teaching Hospital, Lomé, Togo
| | | | - Angela Caroli
- Radiotherapy Unit, Centro di Riferimento Oncologico, IRCCS-National Cancer Institute, Aviano, Pordenone, Italy
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50
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Coudé Adam H, Frisell A, Liu Y, Sackey H, Oikonomou I, Docherty Skogh AC, Frisell J, de Boniface J. Effect of radiotherapy on expanders and permanent implants in immediate breast reconstruction: long-term surgical and patient-reported outcomes in a large multicentre cohort. Br J Surg 2021; 108:1474-1482. [PMID: 34694356 DOI: 10.1093/bjs/znab333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 08/17/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Current evidence for the effects of radiotherapy (RT) on implant-based immediate breast reconstruction (IBR) is limited by short follow-up and lack of patient-reported outcomes (PROs). It is central to integrate long-term comprehensive outcome data into the preoperative decision-making process. The aim of the present study was to determine long-term surgical outcomes and PROs in relation to RT after implant-based IBR. METHODS This was a longitudinal cohort study of PRO data obtained in surveys conducted in 2012 and 2020 using the BREAST-Q questionnaire. All women undergoing therapeutic mastectomy and implant-based IBR between 1 January 2007 and 31 December 2011 at four breast centres in Stockholm, Sweden, were identified. The endpoint was implant removal owing to surgical complications or patient preference. RESULTS Median follow-up was 120 (range 1-171) months. After 754 IBRs in 729 women, implant removal occurred in 128 (17 per cent): 34 of 386 (8.8 per cent) in the no-RT group, 20 of 64 (31.3 per cent) in the group with previous RT, and 74 of 304 (24.3 per cent) in the postoperative RT group (P < 0.001). Implant removal was because of surgical complications in 60 instances (7.9 per cent), and patient preference in 68 (9.0 per cent). The BREAST-Q response rate was 72.2 per cent. Women with previous RT scored lower than those without RT on all scales, apart from psychosocial well-being. Women with postoperative RT scored lower only on physical well-being. No scores in the two RT groups had deteriorated between the survey time points, whereas satisfaction with breasts and overall outcome had decreased in the no-RT group. CONCLUSION Although RT was significantly associated with higher implant removal rates, PROs remained stable over 8 years despite irradiation.
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Affiliation(s)
- Hannah Coudé Adam
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Axel Frisell
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Yihang Liu
- Department of Surgery, Capio St Göran's Hospital, Stockholm, Sweden
| | - Helena Sackey
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Ira Oikonomou
- Department of Surgery, South General Hospital, Stockholm, Sweden.,Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Ann-Charlot Docherty Skogh
- Department of Surgery, South General Hospital, Stockholm, Sweden.,Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Jan Frisell
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Breast and Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Capio St Göran's Hospital, Stockholm, Sweden
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