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Golijanin D, Radovanović Z, Radovanović D, Đermanović A, Starčević S, Đermanović M. Molecular subtype and risk of local recurrence after nipple‑sparing mastectomy for breast cancer. Oncol Lett 2024; 28:389. [PMID: 38966584 PMCID: PMC11223028 DOI: 10.3892/ol.2024.14522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 06/03/2024] [Indexed: 07/06/2024] Open
Abstract
The present study aimed to investigate whether local recurrence (LR) after nipple-sparing mastectomy (NSM) and reconstruction was associated with i) Ki67 values and molecular subtypes of the initial lesions, and ii) the size of the initial tumor and the size of the implant. A total of 156 patients with breast cancer with a mean age of 51.58 years (age range, 26-75 years) who underwent NSM with primary implant breast reconstruction were analyzed. After surgery, the mean follow-up time was 59.26 months (range, 17-85 months). Molecular subtypes, Ki67 values, estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status were recorded for each patient. Additionally, information regarding the size of the implant and the initial tumor size were collected. The information was used to assess LR. For univariate analyses of risk factors, χ2 test, Fisher's exact test, Mann-Whitney U test and Student's t-test for independent samples were used. For multivariate analyses, a Cox proportional-hazards model was used. NSM was the primary treatment for breast cancer in 34/156 patients (21.8%), while 122/156 (78.2%) of patients received neoadjuvant chemotherapy followed by surgery. Luminal B was the most frequent molecular subtype, detected in 82/156 patients (52.6%), whereas the luminal A subtype was detected in 37 patients (23.7%) and the HER2-enriched subtype was detected in 17/156 patients (10.9%). Ki67 expression was low in 13/156 patients (8.3%), while medium expression was detected in 78/156 patients (50.0%) and high expression was present in 58/156 patients (37.2%). LR was noted in 17/156 patients (10.9%). As determined by univariate analysis, lower ER (P=0.010) and PR (P=0.008) expression were indicated to be significant risk factors for LR. In conclusion, in the present patient cohort, low ER and PR expression were risk factors for LR of breast cancer, whereas Ki67 status and molecular subtype were not statistically significant risk factors for LR. Additionally, the size of the initial tumor and the size of the implant were not risk factors for LR. These findings are consistent with the current literature, and should be utilized when discussing treatment options and potential clinical outcomes with patients prior to surgical management.
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Affiliation(s)
- Danica Golijanin
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Republic of Serbia
- Clinic for Surgical Oncology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Republic of Serbia
| | - Zoran Radovanović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Republic of Serbia
- Clinic for Surgical Oncology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Republic of Serbia
| | - Dragana Radovanović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Republic of Serbia
- Department for Anesthesiology with Reanimatology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Republic of Serbia
| | - Aleksandar Đermanović
- Clinic for Surgical Oncology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Republic of Serbia
| | - Sanja Starčević
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Republic of Serbia
- Department for Anesthesiology with Reanimatology, Oncology Institute of Vojvodina, 21204 Sremska Kamenica, Republic of Serbia
| | - Marija Đermanović
- Department for Neonatology, Institute for Child and Youth Health Care of Vojvodina, 21000 Novi Sad, Republic of Serbia
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Spoor J, Heeling E, Collewijn RC, van der Ploeg IMC, Hoornweg MJ, Russell N, van den Berg JG, Vrancken Peeters MJFTD, van Duijnhoven FH. Intraoperative frozen section of subareolar tissue in nipple-sparing mastectomy: Towards a less is more approach. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108320. [PMID: 38581755 DOI: 10.1016/j.ejso.2024.108320] [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: 11/08/2023] [Revised: 02/09/2024] [Accepted: 04/02/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Nipple preservation contributes to aesthetic outcome and quality of life in women undergoing Skin-Sparing Mastectomy (SSM) with immediate breast reconstruction for the treatment of breast cancer. Intraoperative Frozen Section (IFS) has been advocated to facilitate conversion from Nipple-Sparing Mastectomy (NSM) to SSM in cases with positive subareolar margins. This study investigated the application of IFS at our comprehensive cancer centre. METHODS In this single-centre retrospective study, for all patients who underwent therapeutic NSM with IFS from 2000 to 2021 pathological reports, patient- and tumour characteristics were retrieved. RESULTS In total 640 women were included in whom 662 intended NSMs with IFS had been performed. Sensitivity and specificity of frozen section compared with definitive histopathology were 75.2% and 98.5% respectively. In six women with a false positive result, the nipple had been removed. In 16 out of 32 women with a false negative result, the nipple was excised in a second procedure. In total 115 nipples were resected. In 40% of these nipples, no residual disease was detected. DISCUSSION IFS is a moderately sensitive and highly specific diagnostic tool to detect positive subareolar margins. An alternative approach is to omit frozen section but take intraoperative biopsies of the sub areolar margin, which are postoperatively analysed with definitive formalin-fixed paraffin-embedded histopathology. This allows for shared decision making regarding nipple excision in cases where minimal disease is found in subareolar tissue or cases with an indication for post-mastectomy radiotherapy.
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Affiliation(s)
- Jonathan Spoor
- Department of Surgical Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Department of Epidemiology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Eva Heeling
- Department of Surgical Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Romy C Collewijn
- Faculty of Medicine, University of Amsterdam, Amsterdam, the Netherlands
| | - Iris M C van der Ploeg
- Department of Surgical Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Marije J Hoornweg
- Department of Plastic- and Reconstructive Surgery, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Nicola Russell
- Department of Radiation Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Jose G van den Berg
- Department of Pathology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Marie-Jeanne F T D Vrancken Peeters
- Department of Surgical Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, the Netherlands; Department of Surgery, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Frederieke H van Duijnhoven
- Department of Surgical Oncology, Netherlands Cancer Institute Antoni van Leeuwenhoek, Amsterdam, the Netherlands.
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King CA, Shaposhnik G, Sayyed AA, Bartholomew AJ, Bozzuto LM, Sosin M, Greenwalt IT, Fan KL, Song D, Tousimis EA. Expanded Indications for Nipple-Sparing Mastectomy and Immediate Breast Reconstruction in Patients Older Than 60 Years. Ann Plast Surg 2024; 92:279-284. [PMID: 38394268 DOI: 10.1097/sap.0000000000003750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Although nipple-sparing mastectomy (NSM) and immediate breast reconstruction (IBR) have long been praised for excellent cosmetic results and the resultant psychosocial benefits, the feasibility and safety of these procedures in patients older than 60 years have yet to be demonstrated in a large population. METHODS Patients undergoing NSM with or without IBR at the MedStar Georgetown University Hospital between 1998 and 2017 were included. Patient demographics, surgical intervention, and complication and recurrence events were retrieved from electronic medical records. Primary outcomes were recurrence and complication rates by age groups older and younger than 60 years. RESULTS There were 673 breasts from 397 patients; 58 (8.6%) older than 60 years and 615 (91.4%) younger than 60 years with mean follow-up of 5.43 (0.12) years. The mean age for those older than 60 was 63.9 (3.3) years, whereas that for those younger than 60 was 43.1 (7.9) years (P < 0.001). The older than 60 group had significantly higher prevalence of diabetes, rates of therapeutic (vs prophylactic) and unilateral (vs bilateral) NSM, and mastectomy weight. However, there were no significant differences by age group in complication rates or increased risk of locoregional or distant recurrence with age. CONCLUSIONS Based on similar complication profiles in both age groups, we demonstrate safety and feasibility of both NSM and IBR in the aging population. Despite increased age and comorbidity status, appropriately selected older women were able to achieve similar outcomes to younger women undergoing NSM with or without IBR.
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Affiliation(s)
| | - Guy Shaposhnik
- From the Division of Breast Surgery, Department of Surgery
| | - Adaah A Sayyed
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| | | | - Laura M Bozzuto
- Division of Surgical Oncology, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Michael Sosin
- Plastic Surgery Arts of NJ, Private Practice, New Brunswick, NJ
| | | | - Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - David Song
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| | - Eleni A Tousimis
- Department of Breast Surgical Oncology, Cleveland Clinic Indian River Hospital, Vero Beach, FL
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Youn S, Lee E, Peiris L, Olson D, Lesniak D, Rajaee N. Spare the Nipple: A Systematic Review of Tumor Nipple-Distance and Oncologic Outcomes in Nipple-Sparing Mastectomy. Ann Surg Oncol 2023; 30:8381-8388. [PMID: 37620525 DOI: 10.1245/s10434-023-14143-6] [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: 10/27/2022] [Accepted: 07/24/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Preserving the nipple-areolar complex (NAC) in breast cancer surgery improves patient satisfaction and quality of life. The oncologic safety of NSM in tumors < 2 cm from the nipple remains in question. We conducted a systematic review to determine whether TND < 2 cm was associated with increased risk of LRR in patients undergoing NSM. METHODS We included studies of invasive or in situ breast cancer < 2 cm from NAC undergoing NSM which reported LRR rates. LRR rates were stratified by TND and culminated across studies. Cohort study quality was assessed using Newcastle-Ottawa Criteria. Meta-analysis was not possible due to heterogeneity in reporting survival outcomes. RESULTS We identified seven retrospective cohort studies with 2295 patients and 18 case series with 3507 patients. Direct tumor involvement of NAC was considered an absolute contraindication to NSM in all studies. In cohort studies, median follow-up was 31-112 (range 14-204) months. Cohorts with TND < 2 cm did not have a significantly higher rate of LRR. Amongst case series, 275 patients had TND < 2 cm. Combined LRR in case series was 2.6%, with median follow-up 10.4-71 (range 0-158) months. CONCLUSIONS Our systematic review did not identify TND < 2 cm as a significant risk factor for LRR. NSM appears oncologically safe in select patients with TND < 2 cm. Given the improved quality of life associated with NSM compared to skin-sparing mastectomy, we suggest NSM as the procedure of choice in appropriately selected patients.
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Affiliation(s)
- Susie Youn
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada.
| | - Esther Lee
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - Lashan Peiris
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - David Olson
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - David Lesniak
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
| | - Nikoo Rajaee
- Department of Surgery, University of Alberta Hospital, Edmonton, AB, Canada
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Ugurlu MU, Bugdayci O, Akmercan A, Kaya H, Akin Telli T, Akoglu H, Gulluoglu BM. Prediction of nipple involvement in breast cancer after neoadjuvant chemotherapy: Should we rely on breast MRI to preserve the nipple? Breast Cancer Res Treat 2023; 201:417-424. [PMID: 37490171 DOI: 10.1007/s10549-023-07041-8] [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: 05/24/2023] [Accepted: 07/05/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Indications for nipple sparing mastectomy (NSM) is extending to post-neoadjuvant chemotherapy (NAC) setting. Eligibility for NSM with an optimum tumor-nipple distance (TND) after NAC is unclear. We examined predictive factors for nipple tumor involvement in patients undergoing total mastectomy following NAC. METHODS Clinical and pathological data from prospectively collected medical records of women with invasive breast carcinoma, who were undergone NAC and total mastectomy with sentinel lymph node biopsy and/or axillary lymph node dissection were analyzed. PreNAC and postNAC magnetic resonance imaging (MRI) views were examined and a cut-off TND value for predicting the negative nipple tumor status was determined. RESULTS Among 180 women, the final mastectomy specimen analysis revealed that 12 (7%) had nipple involvement as invasive carcinoma. Patients with nipple involvement had more postNAC multifocal/multicentric tumors (p: 0.03), larger tumors on preNAC and postNAC images (p: 0.002 and p < 0.001), shorter median TNDs on preNAC and postNAC images (7 mm-IQR 1.5-14, p: 0.005 and 8.5 mm-IQR 3-15.5, p < 0.001, respectively), more nipple retraction on preNAC and postNAC images (p: 0.007 and p: 0.006) and more nipple areola complex skin thickening (> 2mm) on preNAC and postNAC images (p < 0.001 and p: 0.01). The best likelihood ratios (LR) belonged to the postNAC positivity of the < 20 mm TND, with a + LR of 3.40, and - LR of 0.11 for nipple involvement. PreNAC positivity of the < 20 mm TND also had a similar - LR of 0.14. CONCLUSION A TND-cut-off ≥ 2 cm on preNAC and postNAC MRI was shown to be highly predictive of negative nipple tumor involvement.
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Affiliation(s)
- M Umit Ugurlu
- Department of General Surgery, Breast and Endocrine Surgery Unit, Marmara University School of Medicine, Istanbul, Turkey.
| | - Onur Bugdayci
- Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ahmet Akmercan
- Department of General Surgery, Breast and Endocrine Surgery Unit, Marmara University School of Medicine, Istanbul, Turkey
| | - Handan Kaya
- Department of Pathology, Marmara University School of Medicine, Istanbul, Turkey
| | - Tugba Akin Telli
- Department of Medical Oncology, Marmara University School of Medicine, Istanbul, Turkey
| | - Haldun Akoglu
- Department of Emergency Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Bahadir M Gulluoglu
- Department of General Surgery, Breast and Endocrine Surgery Unit, Marmara University School of Medicine, Istanbul, Turkey
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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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Zaborowski AM, Roe S, Rothwell J, Evoy D, Geraghty J, McCartan D, Prichard RS. A systematic review of oncological outcomes after nipple-sparing mastectomy for breast cancer. J Surg Oncol 2023; 127:361-368. [PMID: 36208279 DOI: 10.1002/jso.27115] [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: 07/05/2022] [Revised: 09/13/2022] [Accepted: 09/23/2022] [Indexed: 02/01/2023]
Abstract
Nipple-sparing mastectomy is an alternative to skin-sparing mastectomy in select patients. Increasing evidence supports its use in the setting of breast cancer, however concerns still exist regarding oncological safety. The aim of this systematic review was to evaluate long-term oncological outcomes of patients who underwent nipple-sparing mastectomy for breast cancer. A systematic review of the literature was performed to evaluate oncological outcomes in patients with breast cancer who underwent nipple-sparing mastectomy. Five major databases (PubMed, Embase, Scopus, Web of Science and Cochrane) were searched. The review included all original articles published in English reporting long-term oncological outcomes. 2334 studies were identified. After applying inclusion and exclusion criteria, 17 retrospective studies involving 7107 patients were included. The indication for nipple-sparing mastectomy was invasive carcinoma in 6069 patients (85.4%) and in situ disease in 1038 (14.6%). Median follow up was 48 months (range 25-94). The weighted mean rates of local recurrence and recurrence involving the nipple-areola complex were 5.4% (0.9-11.9) and 1.3% (0-4.9), respectively. The weighted mean distant failure rate was 4.8% (1.5-23.0). Therapeutic nipple-sparing mastectomy is oncologically safe in select patients with breast cancer.
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Affiliation(s)
- Alexandra M Zaborowski
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Simon Roe
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Jane Rothwell
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Denis Evoy
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - James Geraghty
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Damian McCartan
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
| | - Ruth S Prichard
- Department of Breast and Endocrine Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland
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Muacevic A, Adler JR. An Algorithm for Selecting Buoy Skin Paddle Design for Flap Monitoring in Total Autologous Breast Reconstruction After Nipple-Sparing Mastectomy. Cureus 2023; 15:e33443. [PMID: 36751161 PMCID: PMC9897697 DOI: 10.7759/cureus.33443] [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] [Accepted: 01/06/2023] [Indexed: 01/09/2023] Open
Abstract
Introduction Monitoring buried flaps in reconstructive breast surgery is challenging, and the ideal technique is controversial. Established options include leaving an exterior ("buoy" or "sentinel") skin paddle versus invasive implantable devices to avoid removing the paddle later. Technical modifications and an algorithm for strategic skin paddle positioning to circumvent this while avoiding complex monitoring equipment are proposed. Patients and methods Patients in whom buoy skin paddles were utilized for breast flap monitoring by a single surgeon were reviewed. Indications, demographic details, precise monitoring paddle location, and flap outcomes were evaluated. An algorithm and classification system were then formulated. Results Thirteen buoy skin paddles were utilized in seven patients (mean age: 43.5 years; range: 31-65) to monitor reconstructive flaps performed for risk-reducing mastectomies (four patients and seven breasts), therapeutic mastectomy (one breast), and revision surgery (three patients and five breasts). The flaps comprised seven deep inferior epigastric artery perforators (DIEPs), four superficial inferior epigastric arteries (SIEAs), and two pedicled latissimus dorsi (LDs) (mean free flap weight: 809 g; average mastectomy weight (n = 10 breasts): 467 g; range: 248-864). The skin paddles were located horizontally along the inframammary crease or vertically inferior to the nipple-areola or both. All flap transfers were successful with no re-explorations. All patients declined the monitoring paddle excision, and none have requested breast mound revision for poor cosmesis or contour deformities. Conclusion Vertical and horizontal skin paddles proved reliable for buried flap monitoring without recourse to invasive and expensive equipment. When designed appropriately, they do not require revision surgery. An algorithmic classification of skin paddle location to enable this is proposed.
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Long-Term Cancer Recurrence Rates Following Nipple-Sparing Mastectomy: A 10-year Follow-up Study. Plast Reconstr Surg 2022; 150:13S-19S. [PMID: 35943969 DOI: 10.1097/prs.0000000000009495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the increased utilization of nipple-sparing mastectomies (NSM), there is limited data examining long-term cancer recurrence rates in these patients. The objective of this study was to analyze breast cancer recurrence in patients who received therapeutic NSM with a median of 10 years of follow-up. METHODS All patients undergoing NSM at a single institution were retrospectively reviewed temporally to obtain a median of 10-years of follow up. Patient demographic factors, mastectomy specimen pathology, and oncologic outcomes were analyzed. Univariate analysis was performed to identify independent risk factors for locoregional recurrence. RESULTS 126 therapeutic NSM were performed on 120 patients. The most frequently observed tumor histology included invasive ductal carcinoma (48.4%) and ductal carcinoma in situ (38.1%). Mean tumor size was 1.62 cm. Multifocal or multicentric disease and lymphovascular invasion were present in 31.0% and 10.3% of NSM specimens, respectively. Sentinel lymph node biopsy was performed in 84.9% of NSM and 17.8% were positive. The rate of positive frozen subareolar biopsy was 7.3% (n=82) and permanent subareolar pathology was 9.5% (n=126). The most frequently observed pathologic tumor stages was stage I (44.6%) and stage 0 (33.9%). Incidence of recurrent disease was 3.17% per mastectomy and 3.33% per patient. Upon univariate analysis, no demographic, operative, or tumor-specific variables were independent risk factors for locoregional recurrence. CONCLUSIONS Overall recurrence rates are low in patients undergoing NSM at a median follow-up of 10-years. Close surveillance should remain a goal for patients and their providers to promptly identify potential recurrence.
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Francis EC, Dimovska EOF, Chou HH, Lin YL, Cheng MH. Nipple-sparing mastectomy with immediate breast reconstruction with a deep inferior epigastric perforator flap without skin paddle using delayed primary retention suture. J Surg Oncol 2022; 125:1202-1210. [PMID: 35298037 DOI: 10.1002/jso.26852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study investigated the outcomes of nipple-sparing mastectomy (NSM) with a deep inferior epigastric perforator (DIEP) flap using delayed primary retention suture (DPRS) to achieve superior breast esthetics. METHODS Between December 2010 and March 2021, patients who underwent NSM with DIEP flap were inset with or without a skin paddle (using DPRS) as Group A or B, respectively. Demographics, operative findings, complications, BREAST-Q questionnaire, and Manchester scar scale were compared between two groups. RESULTS Twelve patients underwent 12 unilateral reconstructions in Group A, while 12 patients underwent 13 DIEP flaps in Group B. There was no significant difference in demographics, ischemia time, flap-used weight and percentage, complications of hematoma, infection, re-exploration, partial flap loss, and total flap loss (All p > 0.05, respectively). At a mean 9 months of follow-up, the Breast-Q "Satisfaction with surgeon" domain was significant in Group B (p = 0.04). At a mean 12 months of follow-up, the overall Manchester scar scale of 10.3 in Group B was statistically superior to 12.6 in Group A (p = 0.04). CONCLUSIONS The NSM with a DIEP flap using DPRS is a reliable and straightforward technique. It can provide greater cosmesis of the reconstructed breast mound in a single-stage procedure.
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Affiliation(s)
- Eamon C Francis
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Plastic and Reconstructive Surgery, Royal College of Surgeons in Ireland, Dublin, 2, Ireland
| | - Eleonora O F Dimovska
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Hsu-Huan Chou
- Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Ling Lin
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Huei Cheng
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Center for Lymphedema Microsurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Section of Plastic Surgery, The University of Michigan, Ann Arbor, Michigan, USA
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11
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Fu M, Chen Q, Zeng L, Hong T, Zou Q, Yuan Y, Yi W. Prognosis Comparison Between Nipple-Sparing Mastectomy and Total Mastectomy in Breast Cancer: A Case-Control Study After Propensity Score Matching. Ann Surg Oncol 2021; 29:2221-2230. [PMID: 34802105 PMCID: PMC8933300 DOI: 10.1245/s10434-021-11044-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 10/20/2021] [Indexed: 12/03/2022]
Abstract
Background Currently, the operation rate of nipple-sparing mastectomy (NSM) is increasing. However, the long-term prognosis of NSM is not well documented. We utilized the Surveillance, Epidemiology, and End Results (SEER) database to analyze the long-term prognosis of NSM compared with total mastectomy (TM). Methods Population-level data of female breast cancer patients treated with NSM and TM were extracted from 1998 to 2016 from the SEER database. Propensity score matching (PSM) was performed to reduce the influence of selection bias and confounding variables in comparisons. Kaplan-Meier analysis, log-rank test, and Cox proportional hazard regression were performed. Results A total of 5765 patients underwent NSM, which increased from 266 in 2004–2009 to 5370 in 2010–2016. A total of 134,528 patients underwent TM, and the number of patients undergoing TM continued to decline. The overall survival (OS) and breast cancer-specific survival (BCSS) were similar between the NSM group and the TM group (P = 0.058 and 0.87, respectively). For OS, subgroup analysis showed that patients with age ≥ 46, White race, median household income ≥ $70,000, hormone receptor-positive, and HER2 negative had a better prognosis for treatment with NSM. There was no significant difference in BCSS between the NSM group and the TM group. Conclusions In recent years, the clinical application of NSM has been increasing. NSM is a proper procedure for breast cancer patients to achieve long-term survival. Supplementary Information The online version contains supplementary material available at 10.1245/s10434-021-11044-4.
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Affiliation(s)
- Mengdie Fu
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qitong Chen
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Liyun Zeng
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Tao Hong
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qiongyan Zou
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yunchang Yuan
- Department of Thoracic Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
| | - Wenjun Yi
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
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12
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Wu ZY, Kim HJ, Lee JW, Chung IY, Kim J, Lee SB, Son BH, Eom JS, Jeong JH, Gong G, Kim HH, Ahn SH, Ko B. Factors Predicting Locoregional Recurrence After Neoadjuvant Chemotherapy and Nipple-Sparing/Skin-Sparing Mastectomy With Immediate Breast Reconstruction. Front Oncol 2021; 11:675955. [PMID: 34277421 PMCID: PMC8281333 DOI: 10.3389/fonc.2021.675955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background Few data are available on the risk factors of locoregional recurrence (LRR) after neoadjuvant chemotherapy (NACT) and immediate breast reconstruction (IBR) in breast cancer. Herein, we evaluated the factors predicting LRR in a large series of patients who underwent either nipple- (NSM) or skin-sparing mastectomy (SSM) with IBR after NACT. Methods We retrospectively analyzed 609 breast cancer patients who underwent NACT and NSM/SSM with IBR between February 2010 and June 2017. Factors associated with an increased risk of LRR were analyzed by univariate (chi-square or Fisher's exact test) and multivariate (Cox proportional hazard regression model) analyses. Results During a median follow-up of 63 months, LRR as the first event occurred in 73 patients, and the 5-year cumulative LRR rate was 10.8%. Multivariate analysis revealed post-NACT Ki67 ≥ 10% [hazard ratio (HR), 2.208; 95% confidence interval (CI), 1.295-3.765; P = 0.004], high tumor grade (HR, 1.738; 95% CI, 1.038-2.908; P = 0.035), and presence of lymphovascular invasion (LVI) (HR, 1.725; 95% CI, 1.039-2.864; P = 0.035) as independently associated with increased LRR risk. The 10-year LRR rate was 8.5% for patients with none of the three associated risk factors, 11.6% with one factor, 25.1% with two factors, and 33.7% with all three factors (P < 0.001). Conclusions Post-NACT Ki67 ≥ 10%, high tumor grade, and presence of LVI are independently associated with an increased risk of developing LRR after NACT and NSM/SSM with IBR. Future prospective trials are warranted to decrease the risk of LRR in patients with associated risk factors.
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Affiliation(s)
- Zhen-Yu Wu
- Department of Breast Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jong Won Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Il Yong Chung
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jisun Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sae Byul Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Byung-Ho Son
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jin Sup Eom
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Ho Jeong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Gyungyub Gong
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hak Hee Kim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sei-Hyun Ahn
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - BeomSeok Ko
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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13
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Ng EEI, Quah GS, Graham S, Kanesalingam K, Meybodi F, Hsu J, Elder EE, French J. Immediate prepectoral implant reconstruction using TiLOOP Bra Pocket results in improved patient satisfaction over dual plane reconstruction. ANZ J Surg 2021; 91:701-707. [PMID: 33634944 DOI: 10.1111/ans.16670] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/18/2021] [Accepted: 01/28/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Implant-based reconstruction accounts for the majority of breast reconstructive procedures performed in Australia. More recently, immediate prepectoral implant reconstruction using the TiLOOP Bra Pocket has gained popularity. This study compares post-surgical complications and patient-reported quality of life outcomes between immediate prepectoral and dual plane implant reconstruction. METHODS A retrospective study of 80 consecutive patients who underwent nipple-sparing mastectomies and immediate implant reconstruction was conducted. Implants were either completely covered with TiLOOP Bra and/or TiLOOP Bra Pocket (pfm medical, Cologne, Germany) and secured in the prepectoral space (prepectoral group) or placed in the subpectoral plane with inferolateral mesh coverage (dual plane group). Data surrounding patient demographics, clinical details and post-surgical outcomes were compared. Patient-related quality of life outcomes were assessed with the Breast-Q questionnaire. RESULTS A total of 80 patients (109 breasts) operated on between June 2016 and December 2018 were included. The prepectoral and dual plane groups comprised of 40 patients each, including 50 and 59 operated breasts, respectively. Post-operative complications were comparable with 11 (22%) overall complications in the prepectoral group and eight (14%) in the dual plane group (P = 0.313). Implant loss was uncommon with four (8%) cases in the prepectoral group and five (8.5%) in the dual plane group (P = 0.929). Patient-reported quality of life outcomes were superior after prepectoral reconstruction with patients reporting a significantly higher score in the satisfaction with breasts domain (68.9 versus 57.5; P = 0.036). CONCLUSION Immediate prepectoral implant reconstruction with the TiLOOP Bra Pocket was associated with improved patient satisfaction and demonstrated no difference in early post-operative outcomes.
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Affiliation(s)
- E-Ern Ian Ng
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Gaik Si Quah
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Susannah Graham
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Kavitha Kanesalingam
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Farid Meybodi
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jeremy Hsu
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, Sydney, New South Wales, Australia
| | - Elisabeth E Elder
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, Sydney, New South Wales, Australia
| | - James French
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Sydney Medical School, Sydney, New South Wales, Australia
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14
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Wu ZY, Kim HJ, Lee JW, Chung IY, Kim JS, Lee SB, Son BH, Eom JS, Kim SB, Jung KH, Gong G, Kim HH, Ahn SH, Ko B. Long-term Oncologic Outcomes of Immediate Breast Reconstruction vs Conventional Mastectomy Alone for Breast Cancer in the Setting of Neoadjuvant Chemotherapy. JAMA Surg 2021; 155:1142-1150. [PMID: 33052412 DOI: 10.1001/jamasurg.2020.4132] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance An increasing number of patients with breast cancer receiving neoadjuvant chemotherapy (NACT) undergo immediate breast reconstruction (IBR) with nipple-sparing mastectomy (NSM) or skin-sparing mastectomy (SSM) as surgical treatment. However, the oncologic efficacy and safety of this treatment sequencing strategy is unclear. Objective To compare the long-term oncologic outcomes of IBR with NSM/SSM and conventional mastectomy (CM) alone for breast cancer in the NACT setting. Design, Setting, and Participants A retrospective, propensity score-matched case-control study was conducted at Asan Medical Center, Seoul, Korea. A total of 1266 patients with breast cancer who underwent NACT followed by mastectomy with or without breast reconstruction between January 1, 2010, and November 30, 2016, were included. Data analysis was performed from July 1, 2019, to January 24, 2020. After propensity score matching, 323 patients who underwent IBR with NSM/SSM and 323 who underwent CM alone were selected for comparison of long-term oncologic outcomes. Main Outcomes and Measures The 5-year local recurrence-free survival, disease-free survival, distant metastasis-free survival, and overall survival rates were calculated using the Kaplan-Meier method and compared using log-rank tests. Hazard ratios (HRs) and 95% CIs were estimated using the Cox proportional hazards regression model. Results After matching, the median follow-up periods were 67 (range, 17-125) months for the IBR group and 68 (range, 17-126) months for the CM-alone group. Median age of the women in the IBR group was 42 (range, 23-72) years; median age of those in the CM-alone group was 46 (range, 30-75) years. No significant differences were observed between the IBR and CM-alone groups in local recurrence (3.7% vs 3.4%; P = .83), regional recurrence (7.1% vs 5.3%; P = .33), or distant metastasis (17.3% vs 18.6%; P = .68) rates. There was also no significant difference between the IBR and CM-alone groups in 5-year local recurrence-free survival (95.6% vs 96.7%; HR, 1.124; 95% CI, 0.495-2.549; P = .78), disease-free survival (76.5% vs 79.9%; HR, 1.089; 95% CI, 0.790-1.500; P = .60), distant metastasis-free survival (82.5% vs 82.5%; HR, 0.941; 95% CI, 0.654-1.355; P = .74), or overall survival (92.0% vs 89.3%; HR, 0.847; 95% CI, 0.530-1.353; P = .49) rates. Conclusions and Relevance The long-term oncologic outcomes of IBR with NSM/SSM for breast cancer in this study appeared to be comparable to those of CM alone after NACT, suggesting the feasibility of IBR with NSM/SSM in the NACT setting.
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Affiliation(s)
- Zhen-Yu Wu
- Asan Medical Center, Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Department of Breast Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hee-Jeong Kim
- Asan Medical Center, Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Won Lee
- Asan Medical Center, Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Il-Yong Chung
- Asan Medical Center, Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji-Sun Kim
- Asan Medical Center, Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sae-Byul Lee
- Asan Medical Center, Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byung-Ho Son
- Asan Medical Center, Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin-Sup Eom
- Asan Medical Center, Department of Plastic Surgery, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Bae Kim
- Asan Medical Center, Department of Oncology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyung Hae Jung
- Asan Medical Center, Department of Oncology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gyungyub Gong
- Asan Medical Center, Department of Pathology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hak Hee Kim
- Asan Medical Center, Department of Radiology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sei-Hyun Ahn
- Asan Medical Center, Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - BeomSeok Ko
- Asan Medical Center, Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Seoul, Republic of Korea
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15
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A Propensity Score-matched Analysis of Long-term Oncologic Outcomes After Nipple-sparing Versus Conventional Mastectomy for Locally Advanced Breast Cancer. Ann Surg 2020; 276:386-390. [PMID: 33201107 DOI: 10.1097/sla.0000000000004416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare the long-term oncologic outcomes of nipple-sparing mastectomy (NSM) with those of conventional mastectomy (CM) in patients with locally advanced breast cancer (LABC) receiving neoadjuvant chemotherapy (NACT). SUMMARY OF BACKGROUND DATA NSM has been increasingly implemented in patients with breast cancer. However, oncologic efficacy of NSM in patients with LABC has not been sufficiently demonstrated. METHODS The study group comprised 850 patients with clinical stage IIB to IIIC breast cancer who underwent NACT followed by either NSM and immediate breast reconstruction or CM alone. After propensity score-matching, 418 patients were included in the analysis. Local recurrence-free survival, disease-free survival (DFS), distant metastasis-free survival, and overall survival (OS) rates were calculated using the Kaplan-Meier method and compared using log-rank tests between the NSM and CM groups. RESULTS After matching, the mean follow-up period was 70 ± 25 months for the NSM group and 74 ± 27 months for the CM group (P = 0.181). There were no significant differences between the groups in terms of 6-year local recurrence-free survival (91.6% vs. 95.8%; P = 0.239), DFS (70.5% vs. 73.4%; P = 0.583), distant metastasis-free survival (79.8% vs. 77.4%; P = 0.320), or OS (87.6% vs. 84.8%; P = 0.465) rates. Additionally, we identified 30 patients in the NSM group who initially presented with tumor extension in the subareolar area; the nipple-areola complex was successfully preserved after NACT, and no recurrence at the nipple was observed in these patients. CONCLUSIONS In this matched control study, we demonstrated comparable long-term oncologic outcomes between NSM with immediate reconstruction and CM alone after NACT for LABC. In patients who had tumors extending to the subareolar area before NACT, NSM can be tried if tumor involvement of the nipple-areola complex appears resolved on imaging studies after chemotherapy.
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16
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Tumor-to-Nipple Distance in Selecting Patients for Nipple-sparing Mastectomy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2963. [PMID: 32802657 PMCID: PMC7413816 DOI: 10.1097/gox.0000000000002963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/15/2020] [Indexed: 12/03/2022]
Abstract
Nipple-sparing mastectomy (NSM) is a valid option for carefully selected cases. Oncologic guidelines have not been established, but proximity of the tumor to the nipple, tumor size, lymph node involvement, and neoadjuvant chemotherapy have been suggested as contraindications to nipple preservation. This study describes our experience with NSM in relation to these factors, in particular distance of tumor from the nipple, to help establish evidence-based guidelines for NSM.
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17
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Shumway DA, Momoh AO, Sabel MS, Jagsi R. Integration of Breast Reconstruction and Postmastectomy Radiotherapy. J Clin Oncol 2020; 38:2329-2340. [PMID: 32442071 DOI: 10.1200/jco.19.02850] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Dean A Shumway
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Adeyiza O Momoh
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI
| | - Michael S Sabel
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
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18
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Kim S, Lee S, Bae Y, Lee S. Nipple-sparing mastectomy for breast cancer close to the nipple: a single institution's 11-year experience. Breast Cancer 2020; 27:999-1006. [PMID: 32372321 DOI: 10.1007/s12282-020-01104-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study aimed to analyze our 11-year experience using NSM with immediate breast reconstruction in breast cancer. METHODS Between January 2007 and December 2015, 251 NSMs were performed on 251 women with breast cancer for therapeutic purpose at Pusan National University Hospital. RESULTS The clinical and pathologic mean tumor size was 3.1 cm. Based on preoperative imaging, mean distance between tumor and nipple was 2.5 cm. Among 251 tumors, 119 cases (47.4%) and 69 cases (27.5%) with a distances ≤ 2 cm and ≤ 1 cm, respectively, were detected. There were 11 patients (4.4%) with locoregional recurrences during the mean follow-up period of 68.0 months. Of these 11 cases, one (0.4%) had local recurrence in the retained NAC, and the others had recurrence in the chest wall or skin. CONCLUSION Unless clinical and histological evidence of nipple involvement, NSM can be an oncologically safe surgical option for breast cancer, even if the tumor is located close to the nipple.
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Affiliation(s)
- Sunhyun Kim
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, Republic of Korea
| | - Seokwon Lee
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, Republic of Korea.
| | - Youngtae Bae
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, Republic of Korea
| | - Seungju Lee
- Department of Surgery and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
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19
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Metere A, Fabiani E, Lonardo MT, Giannotti D, Pace D, Giacomelli L. Nipple-Sparing Mastectomy Long-Term Outcomes: Early and Late Complications. MEDICINA-LITHUANIA 2020; 56:medicina56040166. [PMID: 32276470 PMCID: PMC7230840 DOI: 10.3390/medicina56040166] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/27/2020] [Accepted: 04/06/2020] [Indexed: 12/29/2022]
Abstract
Background and Objectives: The surgical choice treatment of the breast cancer mostly depends on the stage of the disease. In the last years, breast cancer surgery has moved from being destructive to being more respectful of the anatomical and physiological integrity of the gland. The aim of the breast surgery should be finalized to obtain the best aesthetic and functional results, respecting the principles of oncologic radicality. The present study is a retrospective analysis aimed to evaluate the long-term outcomes of a conservative technique like the nipple-sparing mastectomy. Materials and Methods: We observed 894 patients with a median age of 47.5 years old, underwent nipple-sparing mastectomy between 2002–2017. The data acquired include population and tumor characteristics, patient reconstructive outcomes, including locoregional, regional, and distant metastases; other variables, among nipple–areola complex necrosis and infection were collected. Results: The complications detected were considered as “early” within 1 month later the nipple-sparing mastectomy or “late” after this time. The overall complications rate (early and late) and the overall survival and the relapses detected by this study were comparable with those reported in the literature. In order to identify factors that correlate with complications, either early or later, it has been processed an evaluation of the univariate analysis showing adjuvant chemotherapy as the only predictive factor for late complications, while we encountered no predictors for early complications. Conclusions: The present study adds to the data already present in literature, demonstrating that the nipple-sparing mastectomy is a safe procedure, providing good oncological and aesthetic results in patients carefully selected.
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Affiliation(s)
- Alessio Metere
- Surgical Sciences Department, “Sapienza” University of Rome, Viale Regina Elena 261, 00161 Rome, Italy;
- Correspondence:
| | - Elisabetta Fabiani
- Emergency Department, Aurelia Hospital, Via Aurelia, 860, 00165 Rome, Italy;
| | - Maria Teresa Lonardo
- Department of Surgery, Ospedali Riuniti di Anzio-Nettuno, Via Cupa dei Marmi, 00042 Anzio, Italy;
| | - Domenico Giannotti
- Department of Surgery, Ospedale Belcolle, Strada Sammartinese snc, 01100 Viterbo, Italy;
| | - Daniela Pace
- Valmontone Hospital, Via dei Lecci snc, 00038 Valmontone, Italy;
| | - Laura Giacomelli
- Surgical Sciences Department, “Sapienza” University of Rome, Viale Regina Elena 261, 00161 Rome, Italy;
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20
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Oncologic Outcomes of Nipple-sparing Mastectomy and Immediate Reconstruction After Neoadjuvant Chemotherapy for Breast Cancer. Ann Surg 2020; 274:e1196-e1201. [PMID: 32209903 DOI: 10.1097/sla.0000000000003798] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the oncologic outcomes and risk factors for locoregional recurrence (LRR) and nipple-areola complex recurrence (NR) in a large series of breast cancer patients who underwent nipple-sparing mastectomy (NSM) and immediate reconstruction after neoadjuvant chemotherapy (NACT). SUMMARY OF BACKGROUND DATA The use of NSM and immediate reconstruction in breast cancer patients receiving NACT is increasing. However, the oncologic safety of this approach is unclear. PATIENTS AND METHODS A total of 310 breast cancer patients (319 breasts) who underwent NACT and NSM between February 2010 and November 2016 were retrospectively analyzed. Clinical and pathologic factors associated with increased risks of LRR and NR were analyzed using univariate (Chi-square or Fisher exact test) and multivariate (Cox proportional hazard regression model) analyses. RESULTS During a mean follow-up of 63 ± 22 months, 38 cases had LRR as the first event, including 6 cases of NR as the first event. The 5-year cumulative LRR and NR rates were 11.0% and 1.9%, respectively. In univariate analysis, clinical T stage, pathologic nodal status, histologic grade, lymphovascular invasion, and post-NACT Ki67 status were associated with increased LRR risk, and post-NACT Ki67 status was the only significant risk factor for NR. In multivariate analysis, post-NACT Ki67 ≥10% (hazard ratio, 4.245; 95% confidence interval, 1.865-9.663; P = 0.001) was an independent risk factor for LRR. CONCLUSIONS NSM and immediate reconstruction seem to be oncologically safe with acceptable LRR and NR rates for appropriately selected breast cancer patients treated with NACT. Post-NACT Ki67 ≥10% was associated with increased risk of LRR or NR, and therefore, necessitates cautious follow-up.
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21
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Naoum GE, Salama L, Niemierko A, Vieira BL, Belkacemi Y, Colwell AS, Winograd J, Smith B, Ho A, Taghian AG. Single Stage Direct-to-Implant Breast Reconstruction Has Lower Complication Rates Than Tissue Expander and Implant and Comparable Rates to Autologous Reconstruction in Patients Receiving Postmastectomy Radiation. Int J Radiat Oncol Biol Phys 2020; 106:514-524. [DOI: 10.1016/j.ijrobp.2019.11.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/31/2019] [Accepted: 11/03/2019] [Indexed: 01/03/2023]
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22
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Julien L, Genet J, Leymarie N, Honart JF, Rimareix F, Mazouni C, Kolb F, De Frémicourt K, Conversano A, Marchal F, Simon E, Brix M, Sarfati B. [Comparing outcomes of Immediate Breast reconstruction with and without use of radiotherapy]. ANN CHIR PLAST ESTH 2020; 65:181-197. [PMID: 32007227 DOI: 10.1016/j.anplas.2019.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Breast cancer and its treatment remains a public health problem. There is still a lack of epidemiological data concerning complications and aesthetic results bound to radiotherapy after an immediate breast reconstruction. The objective of this study was to compare outcomes of immediate breast reconstruction regardless to the use of radiotherapy (history of radiotherapy or adjuvant radiation therapy), in order to determine risk factor of complications and bad aesthetic results. METHODS We conducted a retrospective study between January 2014 and December 2016 at the hospital "Gustave Roussy" in Paris, concerning breast cancer patients who needed immediate breast reconstruction after total mastectomy. The primary endpoint was to assess the failure rate of reconstruction and the aesthetic result, the secondary endpoint assessed the early and late rate of complications. We realized a multivariate analysis in order to identify risks factors that may predict complications. RESULTS Three hundred and thirty three patients have been included: 157 in the "radiotherapy group" compared to 176 in the "no radiotherapy group". Preoperative characteristics were comparable. Average follow-up was between 1 and 3years without missing. Patients who benefited from radiotherapy had an equal risk failure of reconstruction. The subgroup analysis revealed non-significant differences: 12.7% failure rate reconstruction in the "radiotherapy group" vs. 12.5%. We could notify a better rate of "excellent results" in the "no radiotherapy group": 35% vs. 8.2%. Secondary outcomes were comparable. CONCLUSIONS Radiotherapy related to immediate breast reconstruction didn't increase the failure rate of reconstruction or aesthetic results, comparatively to non-irradiated patients. It is therefore permissible to suggest an immediate breast reconstruction to any patients which would benefit from a total mastectomy followed by radiotherapy; in order to prevent them from a secondary breast reconstruction, who could be physically and psychologically more impactful.
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Affiliation(s)
- L Julien
- Department of plastic and maxillofacial surgery, hôpital Cenral, CHRU Nancy, 54000 Nancy, France.
| | - J Genet
- Department of plastic and maxillofacial surgery, hôpital Cenral, CHRU Nancy, 54000 Nancy, France
| | - N Leymarie
- Department of cancer surgery, institut de cancérologie Gustave-Roussy, 75000 Villejuif, France
| | - J-F Honart
- Department of cancer surgery, institut de cancérologie Gustave-Roussy, 75000 Villejuif, France
| | - F Rimareix
- Department of cancer surgery, institut de cancérologie Gustave-Roussy, 75000 Villejuif, France
| | - C Mazouni
- Department of cancer surgery, institut de cancérologie Gustave-Roussy, 75000 Villejuif, France
| | - F Kolb
- Department of cancer surgery, institut de cancérologie Gustave-Roussy, 75000 Villejuif, France
| | - K De Frémicourt
- Department of cancer surgery, institut de cancérologie Gustave-Roussy, 75000 Villejuif, France
| | - A Conversano
- Department of cancer surgery, institut de cancérologie Gustave-Roussy, 75000 Villejuif, France
| | - F Marchal
- Department of cancer surgery, institut de cancérologie de Lorraine, 54000 Vandoeuvre-les-Nancy, France
| | - E Simon
- Department of plastic and maxillofacial surgery, hôpital Cenral, CHRU Nancy, 54000 Nancy, France
| | - M Brix
- Department of plastic and maxillofacial surgery, hôpital Cenral, CHRU Nancy, 54000 Nancy, France
| | - B Sarfati
- Department of cancer surgery, institut de cancérologie Gustave-Roussy, 75000 Villejuif, France
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What Is in a Number? Evaluating a Risk Assessment Tool in Immediate Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2585. [PMID: 32537315 PMCID: PMC7288883 DOI: 10.1097/gox.0000000000002585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/22/2019] [Indexed: 02/06/2023]
Abstract
Supplemental Digital Content is available in the text. Ischemic complications after immediate breast reconstruction have devastating consequences; however, individual risk assessment remains challenging. We seek to develop an intraoperative assessment tool to assist in estimating risk of ischemic complications in immediate breast reconstruction.
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Yang CQ, Ji F, Gao HF, Zhang LL, Yang M, Zhu T, Chen MY, Li JQ, Wang K. The Role of Sharp Dissection in Nipple-Sparing Mastectomy: A Safe Procedure with No Necrosis of the Nipple-Areolar Complex. Cancer Manag Res 2019; 11:10223-10228. [PMID: 31824192 PMCID: PMC6900313 DOI: 10.2147/cmar.s230787] [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: 09/12/2019] [Accepted: 11/20/2019] [Indexed: 11/23/2022] Open
Abstract
Background Nipple-sparing mastectomy (NSM) is becoming increasingly accepted as a treatment for breast disease; however, nipple-areolar complex (NAC) necrosis, a frequent severe postoperative complication, inhibits the popularity of this procedure. This study reports the technical aspects and short-term postoperative outcomes of NSM. Methods A single-center, retrospective review of 110 patients treated with NSM at our institution from November 2015 to September 2018 was performed. The primary outcome was the incidence of NAC necrosis. Results A total of 130 NSMs performed on 110 patients were included in our study. Median patient age was 42 years. We performed a sharp dissection by using a scalpel, raising 3–5 mm thick flaps, and continuing onto the undersurface of the NAC. None of the 110 patients appeared to have NAC necrosis or mastectomy skin flap necrosis. However, discoloration or ischemia of the NAC with eschar formation presented between postoperative days 3 and 7 in six nipples; four nipples were ischemic, and two were discolored. No infection was detected in any of the 110 patients. All NACs were intact after an average follow-up of 30 months, and no local or systemic recurrence was detected in those breast cancer cases. Conclusion NSM can be safely performed in properly selected patients. Nipple necrosis was avoided using a special surgical technique, and other complications occurred at an acceptable rate.
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Affiliation(s)
- Ci-Qiu Yang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Fei Ji
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Hong-Fei Gao
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Liu-Lu Zhang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Mei Yang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Teng Zhu
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Min-Yi Chen
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Jie-Qing Li
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Kun Wang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
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Valero MG, Muhsen S, Moo TA, Zabor EC, Stempel M, Pusic A, Gemignani ML, Morrow M, Sacchini VS. Increase in Utilization of Nipple-Sparing Mastectomy for Breast Cancer: Indications, Complications, and Oncologic Outcomes. Ann Surg Oncol 2019; 27:344-351. [PMID: 31823173 DOI: 10.1245/s10434-019-07948-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Nipple-sparing mastectomy (NSM) is increasingly performed for invasive breast cancer. Growing evidence supporting the oncologic safety of NSM has led to its widespread use and broadened indications. In this study, we examine the indications, complications, and long-term outcomes of therapeutic NSM. METHODS From 2003 to 2016, women undergoing NSM for invasive cancer or ductal carcinoma in situ (DCIS) were identified from a prospectively maintained database. Patient and disease characteristics were compared by procedure year, while complications were compared by procedure year using generalized mixed-effects models accounting for a random surgeon effect. Overall survival and time to recurrence were examined. RESULTS Of the 467 therapeutic NSMs, 337 (72%) were invasive cancer, 126 (27%) were DCIS, and 4 (1%) were phyllodes tumors. Median age was 45 years (range 24-75) and median follow-up among survivors was 39.4 months. Three hundred and fifty-seven (76.4%) cases were performed in 2011 or after. When comparing NSMs performed before and after 2011, there was a significant increase in NSMs performed for invasive tumors (58% vs. 77%; p < 0.001). There was no difference in family history, genetic mutations, smoking status, neoadjuvant chemotherapy, prior radiation, nodal involvement, or tumor subtype. Twenty-one (4.5%) nipple excisions were performed, of which 14 were performed for cancer at the nipple margin. Forty-four breasts (9.4%) had complications that required re-operation. Fifteen patients had locoregional recurrence or distant metastasis. CONCLUSIONS NSM use for invasive carcinoma has doubled at our institution since 2011, while postoperative complications and recurrence rates remain low. Our experience supports the selective use of NSM in the malignant setting with careful patient selection.
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Affiliation(s)
- Monica G Valero
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shirin Muhsen
- 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
| | - Emily C Zabor
- Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michelle Stempel
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea Pusic
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mary L Gemignani
- 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
| | - Virgilio S Sacchini
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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26
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Wong SM, Erdmann-Sager J. ASO Author Reflections: Nipple-Sparing Mastectomy Increasingly Utilized for Patients with Locally Advanced Disease Who Demonstrate Response to Neoadjuvant Chemotherapy. Ann Surg Oncol 2019; 26:849-850. [PMID: 31749077 DOI: 10.1245/s10434-019-07942-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Stephanie M Wong
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Jessica Erdmann-Sager
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
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Does Staged Breast Reduction before Nipple-Sparing Mastectomy Decrease Complications? A Matched Cohort Study between Staged and Nonstaged Techniques. Plast Reconstr Surg 2019; 144:1023-1032. [DOI: 10.1097/prs.0000000000006121] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Ng IE, Elder E, French J. How to do an immediate prepectoral implant reconstruction with the TiLoop bra pocket. ANZ J Surg 2019; 90:360-361. [DOI: 10.1111/ans.15516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/22/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Ian E‐Ern Ng
- Westmead Breast Cancer InstituteWestmead Hospital Sydney New South Wales Australia
- Department of Breast and Endocrine SurgeryConcord Hospital Sydney New South Wales Australia
| | - Elisabeth Elder
- Westmead Breast Cancer InstituteWestmead Hospital Sydney New South Wales Australia
- Discipline of SurgerySydney Medical School, The University of Sydney Sydney New South Wales Australia
| | - James French
- Westmead Breast Cancer InstituteWestmead Hospital Sydney New South Wales Australia
- Discipline of SurgerySydney Medical School, The University of Sydney Sydney New South Wales Australia
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Chu CK, Davis MJ, Abu-Ghname A, Winocour SJ, Losken A, Carlson GW. Implant Reconstruction in Nipple Sparing Mastectomy. Semin Plast Surg 2019; 33:247-257. [PMID: 31632208 DOI: 10.1055/s-0039-1696988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Nipple sparing mastectomy has been popularized in the modern era of breast cancer treatment due to its touted advantages with regard to resultant body image and reconstructive outcome. Implant-based techniques remain the most prevalent means of breast reconstruction. Special considerations regarding patient selection and technique are reviewed for implant reconstruction in the setting of mastectomy with nipple preservation. Applications for prepectoral and direct-to-implant reconstruction are discussed and published outcomes are summarized.
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Affiliation(s)
- Carrie K Chu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew J Davis
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Amjed Abu-Ghname
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Sebastian J Winocour
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Albert Losken
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Grant W Carlson
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.,Division of Plastic and Reconstructive Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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Wong SM, Chun YS, Sagara Y, Golshan M, Erdmann-Sager J. National Patterns of Breast Reconstruction and Nipple-Sparing Mastectomy for Breast Cancer, 2005-2015. Ann Surg Oncol 2019; 26:3194-3203. [PMID: 31342383 DOI: 10.1245/s10434-019-07554-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND The purpose of this study was to explore national patterns in the uptake of breast reconstruction and nipple-sparing mastectomy (NSM). METHODS We used the National Cancer Database to identify all women who underwent mastectomy for stage 0-III breast cancer between 2005-2015. Multivariable logistic regression was used to determine factors associated with receipt of reconstruction, with subset analyses performed to determine trends and predictors of NSM in those who underwent mastectomy with reconstruction. RESULTS Our cohort consisted of 395,815 women, 238,568 (60.3%) who underwent mastectomy alone and 157,247 (39.7%) who underwent mastectomy followed by reconstruction. The use of breast reconstruction increased from 22.3% of mastectomy cases in 2005 to 49.7% of mastectomy cases in 2015 (odds ratio [OR] 9.7, 95% confidence interval [CI] 7.3-12.8). Among those receiving reconstruction, the use of NSM increased from 1.7% in 2005 to 14.3% in 2015 (OR 9.4, 95% CI 7.1-12.5), with increased utilization among those with early-stage and locally advanced disease, such that by 2015, NSM was performed in 15.3% of mastectomies with reconstruction for DCIS, 14.3% of mastectomies with reconstruction for stage I-II breast cancer, and 10.7% of mastectomies with reconstruction for stage III breast cancer. Factors strongly predicting receipt of NSM included age < 45 years, smaller clinical tumor size, clinically node negative disease, use of neoadjuvant therapy, and facility type. CONCLUSIONS There has been a dramatic increase in the use of breast reconstruction and NSM between 2005-2015. Further prospective studies evaluating oncologic outcomes of NSM in locally advanced breast cancer are warranted.
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Affiliation(s)
- Stephanie M Wong
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Yoon S Chun
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Yasuaki Sagara
- Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Mehra Golshan
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - Jessica Erdmann-Sager
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
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Bartholomew AJ, Dervishaj OA, Sosin M, Kerivan LT, Tung SS, Caragacianu DL, Willey SC, Tousimis EA. Neoadjuvant Chemotherapy and Nipple-Sparing Mastectomy: Timing and Postoperative Complications. Ann Surg Oncol 2019; 26:2768-2772. [DOI: 10.1245/s10434-019-07418-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Indexed: 11/18/2022]
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33
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Vieira RADC, Ribeiro LM, Carrara GFA, Abrahão-Machado LF, Kerr LM, Nazário ACP. Effectiveness and Safety of Implant-Based Breast Reconstruction in Locally Advanced Breast Carcinoma: A Matched Case-Control Study. Breast Care (Basel) 2019; 14:200-210. [PMID: 31558894 DOI: 10.1159/000496429] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 12/21/2018] [Indexed: 12/28/2022] Open
Abstract
Background Immediate implant-based breast reconstruction (IBBR) is rarely performed in patients with locally advanced breast carcinoma (LABC). It has not been considered the best indication, and the literature is scarce about this subject. Patients and Methods A retrospective matched case-control study was performed in patients with LABC submitted to neoadjuvant chemotherapy (NCT). Forty-eight patients undergoing immediate IBBR were matched with 96 patients undergoing conventional mastectomy. Patients were matched according to 2 models based on prognostic characteristics prior to NCT and response to NCT. Local recurrence and disease-free survival were compared between the groups. In the IBBR group, local complications were evaluated. Results In all, 196 patients were evaluated. The mean tumour size of IBBR patients was 5.8 cm. 83.3% (180/196) of the patients had clinical stage III. At a mean follow-up of 74.7 months, the local recurrence rate was 6.2% (3/48), 15.6% (15/96) and 13.7% (13/95) in the IBBR, model 1 and model 2 groups, respectively (p > 0.05). Disease-free survival was higher in the IBBR group than in the model 1 group (mean 88.8 vs. 73.7 months; p = 0.05). In the group submitted to IBBR, 14.6% (7/48) of patients presented loss of prosthesis and 48.8% (20/41) developed capsular contracture. Conclusion Immediate IBBR may be a safe and effective surgical procedure in selected patients with LABC.
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Affiliation(s)
- René Aloisio da Costa Vieira
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Barretos, Brazil.,Postgraduate Program in Oncology, Barretos Cancer Hospital, Barretos, Brazil
| | - Luciana Machado Ribeiro
- Department of Mastology and Breast Reconstruction, Barretos Cancer Hospital, Barretos, Brazil.,Postgraduate Program in Oncology, Barretos Cancer Hospital, Barretos, Brazil.,Postgraduate Program in Gynecology, Department of Gynecology, Discipline of Mastology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | | | - Ligia Maria Kerr
- Department of Pathology, Barretos Cancer Hospital, Barretos, Brazil
| | - Afonso Celso Pinto Nazário
- Postgraduate Program in Gynecology, Department of Gynecology, Discipline of Mastology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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34
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Expanded Algorithm and Updated Experience with Breast Reconstruction Using a Staged Nipple-Sparing Mastectomy following Mastopexy or Reduction Mammaplasty in the Large or Ptotic Breast. Plast Reconstr Surg 2019; 143:688e-697e. [DOI: 10.1097/prs.0000000000005425] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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35
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Kim H, Park SJ, Woo KJ, Bang SI. Comparative Study of Nipple-Areola Complex Position and Patient Satisfaction After Unilateral Mastectomy and Immediate Expander-Implant Reconstruction Nipple-Sparing Mastectomy Versus Skin-Sparing Mastectomy. Aesthetic Plast Surg 2019; 43:313-327. [PMID: 30746565 DOI: 10.1007/s00266-018-1217-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Major surgical concerns associated with nipple-sparing mastectomy (NSM) are partial or total nipple-areola complex (NAC) loss, decreased sensation, and nipple malposition. Patient satisfaction and NAC outcomes including malposition in patients who have undergone unilateral expander-implant reconstruction after NSM as compared with skin-sparing mastectomy (SSM) remain unclear. Therefore, the aim of this study was to assess patient satisfaction and NAC outcomes of breast cancer patients who underwent spared or reconstructed NAC after unilateral NSM as compared with unilateral SSM. METHODS Patients who underwent immediate expander-implant breast reconstruction following unilateral NSM or SSM were included. Medical records of patients from April 2010 to February 2014 were retrospectively reviewed. Reconstruction-related complications such as infection, seroma, haematoma, delayed wound healing, and reconstruction failure were recorded. NAC outcome analysis was performed using preoperative and postoperative digital photographs for each patient. Patient satisfaction with the reconstructed breast and NAC was assessed using a study-specific questionnaire. RESULTS Delayed wound healing occurred in 18 of 55 NSM patients and 15 of 85 SSM patients (p = 0.040). Final reconstruction failure occurred in 0 NSM patients and 6 SSM patients (p = 0.043). The mean photography analysis score of total aesthetic outcome was 13.12 ± 2.39 in the NSM group and 14.06 ± 2.75 in the SSM group (p = 0.052). The mean questionnaire score of NAC position was 2.88 ± 0.85 in the NSM group and 3.80 ± 0.84 in the SSM group (p = 0.001). The mean questionnaire score of NAC sensitivity was 2.12 ± 0.58 in the NSM group and 1.84 ± 0.46 in the SSM group (p = 0.003). Satisfaction with the reconstructed breast was similar (p = 0.913) after NSM and SSM. CONCLUSIONS We observed no significant difference in breast reconstruction satisfaction between the NSM and SSM groups. Although overall satisfaction with breast reconstruction is high, patients in the NSM group often report dissatisfaction with nipple position. With a favourable score for NAC position, skin-sparing mastectomy followed by NAC reconstruction can be considered as a balanced alternative to NSM for properly selected patients with breast cancer. 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)
- Hyungsuk Kim
- Department of Plastic Surgery, Choonhae Hospital, Busan, South Korea
| | - Sun-June Park
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Kyong-Je Woo
- Department of Plastic Surgery, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Sa Ik Bang
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
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Zarba Meli E, Cattin F, Curcio A, Manna E, Samorani D, Tognali D, Gennaro M, Loreti A, Folli S, Fortunato L. Surgical delay may extend the indications for nipple-sparing mastectomy: A multicentric study. Eur J Surg Oncol 2019; 45:1373-1377. [PMID: 30826199 DOI: 10.1016/j.ejso.2019.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/05/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Nipple-sparing mastectomy (NSM) is considered an oncologically sound procedure but necrosis of the nipple-areola complex (NAC) or skin flaps is a concern, particularly in the presence of risk factors. To increase the indications for NSM and decrease such complications, different procedures of "surgical delay" (SD) have been described. MATERIALS AND METHODS A retrospective analysis of patients who underwent SD for NSM at four Italian Breast Centers from 2014 to 2017 was performed. SD generally consisted of a periareolar or "hemi-batwing" incision, dissecting the skin and the NAC from the underlying breast tissue. NSM was scheduled after 2-3 weeks. RESULTS Eighty-eight procedures were analyzed. Mild complications of SD were registered in 7.9% of cases. NSM was performed in 85 cases, whereas in three cases (3.4%) a "skin-sparing" mastectomy was necessary due to positivity of the retroareolar biopsy for cancer at SD. A direct-to- implant (DTI) reconstruction was performed in 42 cases (49.4%), while in 43 (50.6%) a tissue-expander (TE) was inserted. After NSM, eight complications (9.4%) were recorded: one total necrosis (1.2%), one partial necrosis (1.2%) and four minimal ischemia (4.7%) of NAC, one skin flap necrosis (1.2%), one haematoma (1.2%). In only two cases (2.3%) prosthesis removal was needed. Aesthetic outcome was evaluated excellent or good in 92.9% of cases. At a median follow-up of 24 months no local recurrences were seen. CONCLUSION This is the largest series of SD with NSM presented so far in the literature. In our experience, SD extends indications for NSM in high-risk women.
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Affiliation(s)
- Emanuele Zarba Meli
- Department of Surgery, San Giovanni-Addolorata Hospital, Via dell'Amba Aradam 9, 00199, Rome, Italy.
| | - Federico Cattin
- Department of Surgery, Stabilimento Franchini, Santarcangelo di Romagna, Presidio Ospedaliero di Rimini, AUSL Romagna, Via Pedrignone 3, 47822, Santarcangelo di Romagna (RN), Italy
| | - Annalisa Curcio
- Department of Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Via Carlo Forlanini 34, 47121, Forlì, Italy
| | - Elena Manna
- Department of Surgery, San Giovanni-Addolorata Hospital, Via dell'Amba Aradam 9, 00199, Rome, Italy
| | - Domenico Samorani
- Department of Surgery, Stabilimento Franchini, Santarcangelo di Romagna, Presidio Ospedaliero di Rimini, AUSL Romagna, Via Pedrignone 3, 47822, Santarcangelo di Romagna (RN), Italy
| | - Daniela Tognali
- Department of Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Via Carlo Forlanini 34, 47121, Forlì, Italy
| | - Massimiliano Gennaro
- Department of Surgery, Istituto Nazionale Tumori, Via Giacomo Venezian 1, 20133, Milano, Italy
| | - Andrea Loreti
- Department of Surgery, San Giovanni-Addolorata Hospital, Via dell'Amba Aradam 9, 00199, Rome, Italy
| | - Secondo Folli
- Department of Surgery, Istituto Nazionale Tumori, Via Giacomo Venezian 1, 20133, Milano, Italy
| | - Lucio Fortunato
- Department of Surgery, San Giovanni-Addolorata Hospital, Via dell'Amba Aradam 9, 00199, Rome, Italy
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Storm-Dickerson T, Sigalove NM. The breast surgeons' approach to mastectomy and prepectoral breast reconstruction. Gland Surg 2019; 8:27-35. [PMID: 30842925 DOI: 10.21037/gs.2018.11.06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of this review article is to discuss and highlight the data, techniques and our experience performing mastectomies in the setting of prepectoral breast reconstruction. Using a systematic review of the approach to mastectomy in the oncologic setting encompassing patient selection, safety, anatomy and methods including a literature review of mastectomy trends, safety data and outcomes, anatomy and our experience, we are able to illustrate the safety and utility of this technique. The literature strongly supports the oncologic safety of these methods. This review also supports the use of these techniques as a surgical approach to any mastectomy, with or without reconstruction, and addresses many of the factors involved in improving and maximizing outcomes. While, there are multiple and equally efficacious approaches to mastectomy, several surgical techniques can be used to improve outcomes and ensure optimal flap viability.
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Affiliation(s)
- Toni Storm-Dickerson
- Department of Surgical Oncology, Compass Oncology, PeaceHealth Medical Center, Washington State University School of Medicine, Vancouver, WA, USA
| | - Noemi M Sigalove
- Department of Breast Surgery, Comprehensive Breast Center of Arizona, Arizona Center for Cancer Care, Scottsdale, AZ, USA
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Agha RA, Al Omran Y, Wellstead G, Sagoo H, Barai I, Rajmohan S, Borrelli MR, Vella-Baldacchino M, Orgill DP, Rusby JE. Systematic review of therapeutic nipple-sparing versus skin-sparing mastectomy. BJS Open 2018; 3:135-145. [PMID: 30957059 PMCID: PMC6433323 DOI: 10.1002/bjs5.50119] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 10/10/2018] [Indexed: 12/16/2022] Open
Abstract
Background The use of nipple‐sparing mastectomy (NSM) is increasing, despite unproven oncological safety in the therapeutic setting. The aim of this systematic review was to determine the safety and efficacy of NSM compared with skin‐sparing mastectomy (SSM). Methods A literature search of all original studies including RCTs, cohort studies and case–control studies comparing women undergoing therapeutic NSM or SSM for breast cancer was undertaken. Primary outcomes were oncological outcomes; secondary outcomes were clinical, aesthetic, patient‐reported and quality‐of‐life outcomes. Data analysis was undertaken to explore the relationship between NSM and SSM, and preselected outcomes. Heterogeneity was assessed using the Cochrane tests. Results A total of 690 articles were identified, of which 14 were included. There was no statistically significant difference in 5‐year disease‐free survival and mortality for NSM and SSM groups, where data were available. Local recurrence rates were also similar for NSM and SSM (3·9 versus 3·3 per cent respectively; P = 0·45). NSM had a partial or complete nipple necrosis rate of 15·0 per cent, and a higher complication rate than SSM (22·6 versus 14·0 per cent respectively). The higher overall complication rate was due to the rate of nipple necrosis in the NSM group (15·0 per cent). Conclusion In carefully selected cases, NSM is a viable choice for women with breast cancer who need to have a mastectomy. More research is needed to help further refine which surgical approaches to NSM optimize outcomes.
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Affiliation(s)
- R A Agha
- Department of Plastic Surgery, Royal Free NHS Foundation Trust London UK
| | - Y Al Omran
- Department of Plastic Surgery University Hospitals of North Midlands Stoke-on-Trent UK
| | - G Wellstead
- Ear, Nose and Throat Department, Norfolk and Norwich University Hospitals NHS Foundation Trust Norwich UK
| | - H Sagoo
- GKT School of Medical Education, King's College London London UK
| | - I Barai
- Imperial College School of Medicine London UK
| | - S Rajmohan
- Imperial College School of Medicine London UK
| | - M R Borrelli
- Division of Plastic Surgery, Stanford University Stanford California USA
| | - M Vella-Baldacchino
- Department of Orthopaedics, Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - D P Orgill
- Division of Plastic Surgery, Brigham and Women's Hospital Boston Massachusetts USA
| | - J E Rusby
- Breast Surgical Unit, The Royal Marsden NHS Foundation Trust Sutton UK
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Oncoplastic Breast Consortium consensus conference on nipple-sparing mastectomy. Breast Cancer Res Treat 2018; 172:523-537. [PMID: 30182349 PMCID: PMC6245050 DOI: 10.1007/s10549-018-4937-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 08/22/2018] [Indexed: 11/24/2022]
Abstract
Purpose Indications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion. Methods The panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative process in question development, voting, and wording of the recommendations followed the modified Delphi methodology. Results Consensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference. Conclusions In case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest and most efficacious reconstruction techniques. Electronic supplementary material The online version of this article (10.1007/s10549-018-4937-1) contains supplementary material, which is available to authorized users.
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Yoon-Flannery K, DeStefano LM, De La Cruz LM, Fisher CS, Lin LY, Coffua LS, Mustafa RE, Sataloff DM, Tchou JC, Brooks AD. Quality of life and sexual well-being after nipple sparing mastectomy: A matched comparison of patients using the breast Q. J Surg Oncol 2018; 118:238-242. [DOI: 10.1002/jso.25107] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/28/2018] [Indexed: 01/12/2023]
Affiliation(s)
- Kahyun Yoon-Flannery
- Sidney Kimmel Comprehensive Breast Center; Jefferson Health New Jersey; Sewell New Jersey
| | | | - Lucy M. De La Cruz
- Division of Endocrine and Oncologic Surgery, Department of Surgery; University of Pennsylvania; Philadelphia Pennsylvania
| | - Carla S. Fisher
- Department of Surgery; Indiana University School of Medicine; Indianapolis Indiana
| | - Lisa Y. Lin
- Division of Endocrine and Oncologic Surgery, Department of Surgery; University of Pennsylvania; Philadelphia Pennsylvania
| | - Lauren S. Coffua
- Philadelphia College of Osteopathic Medicine; Philadelphia Pennsylvania
| | | | - Dahlia M. Sataloff
- Division of Endocrine and Oncologic Surgery, Department of Surgery; University of Pennsylvania; Philadelphia Pennsylvania
| | - Julia C. Tchou
- Division of Endocrine and Oncologic Surgery, Department of Surgery; University of Pennsylvania; Philadelphia Pennsylvania
| | - Ari D. Brooks
- Division of Endocrine and Oncologic Surgery, Department of Surgery; University of Pennsylvania; Philadelphia Pennsylvania
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Du Z, Zhou Y, Chen J, Long Q, Lü Q. Retrospective observational study of breast reconstruction with extended latissimus dorsi flap following skin-sparing mastectomy. Medicine (Baltimore) 2018; 97:e10936. [PMID: 30075492 PMCID: PMC6081160 DOI: 10.1097/md.0000000000010936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The study was aimed to evaluate oncological safety and patient satisfaction in relatively late stage breast cancer patients who was treated with skin-sparing mastectomy (SSM) followed by breast reconstruction with an extended latissimus dorsi (LD) flap. Oncological safety, postoperative complications, and cosmetic results were retrospectively analyzed in patients who underwent extended LD flap breast reconstruction following SSM between October 2011 and August 2014. A total of 62 patients who underwent 63 breast reconstructions were enrolled in the study. Local recurrence rate was 1.6% over a median follow-up of 63 months. On final aesthetic assessment, 37 reconstructions were rated excellent, 19 good, 5 fair, and 2 poor. Reconstruction-related complications occurred in 22 patients (34.9%); these patients' satisfaction scores were significantly lower than those of patients without complications (P < .05). Five patients developed shoulder movement limitation, and 2 had minor twitching and pain in the reconstructed breast. However, these patients did not find their problems disabling and were able to live normally. SSM followed by breast reconstruction with extended LD flap can improve patients' postoperative quality of life and is as oncologically safe as total mastectomy even in patients with tumors of relatively late stage.
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Affiliation(s)
- Zhenggui Du
- Department of Breast Surgery Laboratory of Breast Disease, West China Hospital, Sichuan University, Chengdu, China
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Mitchell SD, Willey SC, Beitsch P, Feldman S. Evidence based outcomes of the American Society of Breast Surgeons Nipple Sparing Mastectomy Registry. Gland Surg 2018; 7:247-257. [PMID: 29998074 DOI: 10.21037/gs.2017.09.10] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background The American Society of Breast Surgeons (ASBrS) Nipple Sparing Mastectomy Registry (NSMR) is a prospective, non-randomized, IRB approved, multi-institutional registry. The purpose of this Registry is to provide a large, prospective, non-randomized database of patient characteristics, tumor characteristics, surgical technique, and outcome (both aesthetic and oncologic) of the nipple sparing mastectomy (NSM). Methods Data is entered into the ASBrS NSMR, housed within the Mastery of Surgery Program, after patients consent to participation. Each investigator routinely offers NSM in their practice has obtained IRB approval and completed forms of agreement to participate in the ASBrS NSMR. Results This data set represents a total of 1,935 NSMs performed on 1,170 patients by 98 investigators from 70 institutions/sites. Of the 1,935 NSMs: 833 were performed for an indication of cancer [594 invasive carcinoma and 239 for ductal carcinoma in situ (DCIS)] and 1,102 were prophylactic. Of the 1,170 total patients, 352 underwent a unilateral and 818 underwent a bilateral NSM. Recurrence at a mean follow-up of 31 months/median follow-up of 27 months, with a range of 9.7 to 58.3 months since surgery was 1.4% with no recurrences at the nipple or nipple areola complex (NAC). Cancer occurrence (0.3%) also did not involve the nipple/NAC. Overall patient satisfaction of excellent/good: 94.9% and overall cosmesis (surgeon rated) of excellent/good was 96.4%. Overall infection rates included flap infection of 4.4%, NAC complication rate of 4.5% (defined as necrosis/other or ischemia/epidermolysis requiring surgery), and a 10% rate of NAC epidermolysis with full recovery. Conclusions NSMs were performed on breasts with a variety of sizes and degrees of ptosis, via multiple incisions, dissection and reconstruction techniques with low complication rates and high patient satisfaction and surgeon rated cosmesis.
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Dorfman RG, Mioton L, Stone E, Yan W, Qiu C, Marla S, Kim JY. The Effect of Implant Type on Nipple Position Geometry and Aesthetics Following Tissue Expander Reconstruction After Nipple Sparing Mastectomy. Aesthet Surg J 2018; 38:605-613. [PMID: 29267860 DOI: 10.1093/asj/sjx210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND While recent studies have reported modest to no difference in breast aesthetics for shaped and round implant types in breast augmentations, the anatomy and biomechanics in the setting of breast reconstruction is different. OBJECTIVES Accordingly, we endeavored to evaluate whether two implant types impacted nipple position and aesthetic features in prosthetic breast reconstruction. METHODS A retrospective chart review was carried out on patients who underwent nipple-sparing mastectomy (NSM) with immediate tissue expander breast reconstruction. Patients were divided into two cohorts: smooth round implants and textured shaped implants. Postoperative photographs were evaluated to assess nipple displacement vis-à-vis a vector of maximal projection and aesthetic outcome for features of breast shape. RESULTS Of 102 breasts meeting the inclusion criteria, 41 had tissue expander-implant reconstruction with anatomical shaped implants, and 61 had reconstruction with smooth round implants. The shaped implant cohort had less nipple deviation from the point of maximal projection (3.69 ± 6.24 vs 7.52 ± 10.50; P < 0.0001). Graded semi-quantitative aesthetic scores were also higher (4.04 ± 0.67 vs 3.72 ± 0.93; P = 0.0044) in the shaped implants than in the round cohort. CONCLUSIONS Unlike breast augmentation, there is a paucity of overlying breast tissue and larger dissected spaces in prosthetic breast reconstruction. Our analysis suggests that in this setting, textured anatomic implants result in less nipple deviation from the point of maximum projection and improved aesthetic outcomes compared to round implants. When considering implant choice in NSM reconstruction, the manifold risks of shaped textured implants must thus be informed by potential aesthetic benefits with respect to shape and enhanced nipple sensation. LEVEL OF EVIDENCE 4
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Affiliation(s)
- Robert G Dorfman
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lauren Mioton
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Emily Stone
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Wenhui Yan
- Department of Breast Surgery, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Cecil Qiu
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sekhar Marla
- Department of Surgery, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - John Y Kim
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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Bernier J. Postoperative radiotherapy after nipple- or skin-sparing mastectomy: a review of recent institutional and pooled data. Ecancermedicalscience 2018; 12:834. [PMID: 29910831 PMCID: PMC5985754 DOI: 10.3332/ecancer.2018.834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Indexed: 11/13/2022] Open
Abstract
The increasing use of nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) in the treatment of nonmetastatic breast cancer is justified by considerations linked to their therapeutic index. In selected patients, efficacy results tend to be similar to those observed after radical modified mastectomy and at the same time, subcutaneous mastectomies preserve the patient’s body image. Yet the oncologic safety of the two former surgical approaches is still a matter of debate, also in consideration of the almost complete absence of clinical studies directed to prospective, controlled comparisons between subcutaneous and radical modified mastectomies. In addition, no clear statement—and consequently no consensus—emerges from the rather rare reports addressing the issue of whether or not there exist robust algorithms for guiding decision-making in delivering postoperative radiotherapy after NSM or SSM. The objective of the present review article is to revisit the dataset recently provided by the literature, which might help oncology teams optimise local treatment in this patient population.
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Affiliation(s)
- Jacques Bernier
- Genolier Cancer Center, Clinique de Genolier, Genolier 1272, Switzerland
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Evolution in Monitoring of Free Flap Autologous Breast Reconstruction after Nipple-Sparing Mastectomy. Plast Reconstr Surg 2018; 141:1086-1093. [DOI: 10.1097/prs.0000000000004271] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Albright EL, Schroeder MC, Foster K, Sugg SL, Erdahl LM, Weigel RJ, Lizarraga IM. Nipple-Sparing Mastectomy is Not Associated with a Delay of Adjuvant Treatment. Ann Surg Oncol 2018; 25:1928-1935. [PMID: 29671138 DOI: 10.1245/s10434-018-6446-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND High-volume single-institution studies support the oncologic safety of nipple sparing mastectomy (NSM). Concerns remain regarding the increased potential for complications, recurrence, and delays to subsequent adjuvant therapy. A national database was used to examine treatment and outcomes for NSM patients. METHODS Women undergoing unilateral NSM or skin sparing mastectomy (SSM) for stage 0-4 breast cancer from 2004 to 2013 were identified from the National Cancer Database. Demographic and oncologic characteristics, short-term outcomes and time to local and systemic treatment were compared. RESULTS NSM was performed on 8173 patients: 8.7% were node positive, and for stage 1-4 disease, 10.6% were triple negative (TN) and 15.3% were HER2-positive. NSM patients were less likely than SSM patients to receive chemotherapy [CT] (37.4 vs. 43.4%) or radiation [PMRT] (15.6 vs. 16.9%), and were also more likely to present with clinically early-stage disease. NSM patients with high-risk features were more likely to receive CT in the neoadjuvant [NCT] than adjuvant setting [AC] (OR 3.76, 1.81, and 1.99 for clinical N2/3, TN, and HER2-positive disease, all p < 0.001). On multivariate analysis, NSM patients had a higher rate of pathologic complete response [pCR] (OR 1.41, p < 0.001). Readmission rate, positive margin rate and time to CT, PMRT or hormonal therapy were not increased for NSM compared to SSM patients. CONCLUSIONS Over one third of NSM patients received chemotherapy and/or radiation. NSM patients with high-risk features were more likely to receive NAC and obtain a pCR. NSM patients did not experience worse outcomes or delayed adjuvant therapy compared to SSM.
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Huang J, Mo Q, Zhuang Y, Qin Q, Huang Z, Mo J, Tan Q, Lian B, Cao Y, Qin S, Wei C. Oncological safety of nipple-sparing mastectomy in young patients with breast cancer compared with conventional mastectomy. Oncol Lett 2018; 15:4813-4820. [PMID: 29541245 PMCID: PMC5835917 DOI: 10.3892/ol.2018.7913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 12/12/2017] [Indexed: 02/06/2023] Open
Abstract
Although nipple-sparing mastectomy (NSM) is being used more frequently, the oncological safety of NSM remains unclear, particularly in young patients (<35 years). The aim of the present study was to compare the rates of local recurrence (LR), disease-free survival (DFS) and overall survival (OS) in young patients with breast cancer who had undergone NSM or conventional mastectomy (CM). The clinicopathological data of young patients with stage 0-IIB breast cancer who had undergone NSM (163 cases) or CM (194 cases) between 2007 and 2016 were retrospectively analyzed. The log-rank test was used to analyze the differences in the LR, DFS and OS rates between the two groups and multivariate analysis was used to analyze the patient prognostic factors for DFS. The median follow-up time was 49 months. Patients who had undergone CM were more likely to exhibit stage II disease (68.4 vs. 58.3%; P=0.015) and positive lymph nodes (45.9 vs. 33.1%; P=0.014). In the NSM group, LR occurred in 7 (4.3%) cases, systemic recurrence in 15 (9.2%) cases and mortality in 9 (5.5%) cases. In the CM group, LR occurred in 6 (3.1%) cases, systemic recurrence in 27 (13.9%) cases and mortality in 15 (7.7%) cases. There were no statistical differences in the LR, DFS and OS rates between the two groups (P>0.05). Following adjustment for clinical stage, the LR and DFS rates between the two groups exhibited no significant differences. Analysis of the prognostic factors demonstrated that clinical stage, lymph node status, estrogen and progesterone receptor status and human epidermal growth factor receptor 2 status were associated with DFS (P<0.05). NSM is safe for young patients with early-stage breast cancer and provides patients with an improved cosmetic outcome. Furthermore, nipple-areola complex preservation does not increase the risk of recurrence.
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Affiliation(s)
- Jiapeng Huang
- Second Department of Breast Surgery, Guangxi Medical University Affiliated Tumor Hospital, Nanning, Guangxi 530021, P.R. China
| | - Qinguo Mo
- Second Department of Breast Surgery, Guangxi Medical University Affiliated Tumor Hospital, Nanning, Guangxi 530021, P.R. China
| | - Yaqiang Zhuang
- Second Department of Breast and Thyroid Surgery, Liuzhou People's Hospital, Liuzhou, Guangxi 545006, P.R. China
| | - Qinghong Qin
- Second Department of Breast Surgery, Guangxi Medical University Affiliated Tumor Hospital, Nanning, Guangxi 530021, P.R. China
| | - Zhen Huang
- Second Department of Breast Surgery, Guangxi Medical University Affiliated Tumor Hospital, Nanning, Guangxi 530021, P.R. China
| | - Junyang Mo
- First Department of Breast and Thyroid Surgery, Liuzhou People's Hospital, Liuzhou, Guangxi 545006, P.R. China
| | - Qixing Tan
- Second Department of Breast Surgery, Guangxi Medical University Affiliated Tumor Hospital, Nanning, Guangxi 530021, P.R. China
| | - Bin Lian
- Second Department of Breast Surgery, Guangxi Medical University Affiliated Tumor Hospital, Nanning, Guangxi 530021, P.R. China
| | - Yiming Cao
- Second Department of Breast and Thyroid Surgery, Liuzhou People's Hospital, Liuzhou, Guangxi 545006, P.R. China
| | - Shuting Qin
- First Department of Breast and Thyroid Surgery, Liuzhou People's Hospital, Liuzhou, Guangxi 545006, P.R. China
| | - Changyuan Wei
- Second Department of Breast Surgery, Guangxi Medical University Affiliated Tumor Hospital, Nanning, Guangxi 530021, P.R. China
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Machida Y, Shimauchi A, Igarashi T, Hoshi K, Fukuma E. Preoperative breast MRI: reproducibility and significance of findings relevant to nipple–areolar complex involvement. Breast Cancer 2018; 25:456-463. [DOI: 10.1007/s12282-018-0845-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 02/07/2018] [Indexed: 02/07/2023]
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Cil TD, McCready D. Modern Approaches to the Surgical Management of Malignant Breast Disease: The Role of Breast Conservation, Complete Mastectomy, Skin- and Nipple-Sparing Mastectomy. Clin Plast Surg 2017; 45:1-11. [PMID: 29080650 DOI: 10.1016/j.cps.2017.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The armamentarium of the modern breast surgeon includes the time-tested procedures of modified radical mastectomy and lumpectomy with sentinel lymph node biopsy with postoperative radiation, but has evolved to include several options that produce excellent oncologic endpoints and improved cosmesis. These options include skin- and nipple-sparing mastectomies with immediate reconstruction as well as oncoplastic procedures that allow larger excisions and better postoperative breast shape. This article provides an overview of these modern surgical approaches for breast cancer treatment.
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Affiliation(s)
- Tulin D Cil
- Department of Surgery, University of Toronto, Women's College Hospital, Room 8331, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada.
| | - David McCready
- Breast Surgical Oncology, University of Toronto, Princess Margaret Cancer Centre, University Health Network, Room 3-130, 610 University Avenue, Toronto, Ontario M5G2M9, Canada
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