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Pagliara D, Schiavone L, Garganese G, Bove S, Montella RA, Costantini M, Rinaldi PM, Bottosso S, Grieco F, Rubino C, Salgarello M, Ribuffo D. Predicting Mastectomy Skin Flap Necrosis: A Systematic Review of Preoperative and Intraoperative Assessment Techniques. Clin Breast Cancer 2023; 23:249-254. [PMID: 36725477 DOI: 10.1016/j.clbc.2022.12.021] [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: 12/04/2022] [Revised: 12/31/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023]
Abstract
Mastectomy skin-flap necrosis (MSFN) is one of the most feared complications of immediate implant-based breast reconstruction (IIBR). Traditionally, mastectomy skin-flap viability was based only on surgeons' clinical experience. Even though numerous studies have already addressed the patients' risk factors for MSFN, few works have focused on assessing quality of breast envelope. This review investigates mastectomy's flap viability-assessment methods, both preoperative (PMFA) and intraoperative (IMFA), to predict MSFN and its sequalae. Between June and November 2022, we conducted a systematic review of Pubmed/MEDLINE and Cochrane electronic databases. Only English studies regarding PMFA and IMFA applied to IIBR were selected. The use of digital mammography, ultrasound, magnetic resonance imaging, and a combination of several methods before surgery was shown to be advantageous by several authors. Indocyanine performed better than other IMFA, however both thermal imaging and spectroscopy demonstrated novel and promising results. Anyway, the best prediction comes when preoperative and intraoperative values are combined. Particularly in prepectoral reconstruction, when mastectomy flaps are essential to determine a successful breast reconstruction, surgeons' clinical judgment is insufficient in assessing the risk of MSFN. Preoperative and intraoperative assessment techniques play an emerging key role in MSFN prediction. However, although there are several approaches to back up the surgeon's processing choice, there is still a dearth of pertinent literature on the subject, and more research is required.
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Affiliation(s)
- Domenico Pagliara
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy.
| | - Laurenza Schiavone
- Department of Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Roma, Italy
| | - Giorgia Garganese
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Sonia Bove
- Gynecology and Breast Care Center, Mater Olbia Hospital, Olbia, Italy
| | - Rino Aldo Montella
- Radiology Unit, Mater Olbia Hospital, Mater Olbia Hospital, Olbia, Italy
| | - Melania Costantini
- Radiology Unit, Mater Olbia Hospital, Mater Olbia Hospital, Olbia, Italy
| | | | - Stefano Bottosso
- Department of Medical, Surgical and Health Sciences, Plastic Surgery Unit, University of Trieste, Ospedale di Cattinara, ASUGI, Trieste, Italy
| | - Federica Grieco
- Department of Medical, Surgical and Experimental Sciences, Plastic Surgery Unit, University of Sassari, Sassari University Hospital Trust, Sassari, Italy
| | - Corrado Rubino
- Department of Medical, Surgical and Experimental Sciences, Plastic Surgery Unit, University of Sassari, Sassari University Hospital Trust, Sassari, Italy
| | - Marzia Salgarello
- Department of Woman and Child Health and Public Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Diego Ribuffo
- Department of Surgery "P.Valdoni", Unit of Plastic and Reconstructive Surgery, Sapienza University of Rome, Roma, Italy
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O'Neill AC. Achieving consistent and equitable access to post mastectomy breast reconstruction. Gland Surg 2020; 9:1082-1085. [PMID: 32953621 DOI: 10.21037/gs.2020.02.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anne C O'Neill
- Division of Plastic Surgery, Department of Surgery and Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada
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Nègre G, Balcaen T, Dast S, Sinna R, Chazard E. Breast reconstruction in France, observational study of 140,904 cases of mastectomy for breast cancer. ANN CHIR PLAST ESTH 2019; 65:36-43. [PMID: 31383624 DOI: 10.1016/j.anplas.2019.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/17/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES In France, there are few up-to-date epidemiological data on breast reconstruction after mastectomy for breast cancer. The objective of the present study was to measure immediate and delayed breast reconstruction (IBR and DBR, respectively) rates and thus the proportion of patients not benefiting from any reconstruction. METHODS We performed an observational study by assessing data from the French nationwide discharge summary database (Programme de Médicalisation des Systèmes d'Information) for the period 2008-2014. All women having undergone a total mastectomy for breast cancer during this period were included. We then searched for reconstructive surgery during the initial or subsequent hospital stays, and recorded the time interval between mastectomy and reconstruction. RESULTS Among the 140,904 mastectomies included, the IBR rate was 16.1% on average, and increased over the study period. The time interval between mastectomy and DBR was≤3 years in 92% of cases. For patients included in 2008 and 2009, the DBR rate was 17.8%, and the non-reconstruction rate was 66.4%. CONCLUSION The high proportion of women not undergoing breast reconstruction after mastectomy suggests that access to this procedure should be improved.
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Affiliation(s)
- G Nègre
- Department of plastic reconstructive and aesthetic surgery, Amiens University Hospital, 80080 Amiens, France; Department of plastic reconstructive and aesthetic surgery, Saint-Quentin Hospital, 02321 Saint-Quentin, France
| | - T Balcaen
- CERIM EA2694, Lille University, 59000 Lille, France; Public Health Department, Lille University Hospital, 59000 Lille, France; Medical Information Department, Saint-Quentin Hospital, 02321 Saint-Quentin, France
| | - S Dast
- Department of plastic reconstructive and aesthetic surgery, Amiens University Hospital, 80080 Amiens, France
| | - R Sinna
- Department of plastic reconstructive and aesthetic surgery, Amiens University Hospital, 80080 Amiens, France.
| | - E Chazard
- CERIM EA2694, Lille University, 59000 Lille, France; Public Health Department, Lille University Hospital, 59000 Lille, France
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Abstract
BACKGROUND The purpose of this systematic review was to comprehensively summarize barriers of access to breast reconstruction and evaluate access using the Penchansky and Thomas conceptual framework based on the six dimensions of access to care. METHODS The authors performed a systematic review that focused on (1) breast reconstruction, (2) barriers, and (3) breast cancer. Eight databases (i.e., EMBASE, MEDLINE, PsycINFO, CINHAL, ePub MEDLINE, ProQuest, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials) were searched. English peer-reviewed articles published between 1996 and 2016 were included. RESULTS The authors' search retrieved 4282 unique articles. Two independent reviewers screened texts, selecting 99 articles for inclusion. All studies were observational and qualitative in nature. The availability of breast reconstruction was highest in teaching hospitals, private hospitals, and national cancer institutions. Accessibility affected access, with lower likelihood of breast reconstruction in rural geographic locations. Affordability also impacted access; high costs of the procedure or poor reimbursement by insurance companies negatively influenced access to breast reconstruction. Acceptability of the procedure was not universal, with unfavorable physician attitudes toward breast reconstruction and specific patient and tumor characteristics correlating with lower rates of breast reconstruction. Lastly, lack of patient awareness of breast reconstruction reduced the receipt of breast reconstruction. CONCLUSIONS Using the access-to-care framework by Penchansky and Thomas, the authors found that barriers to breast reconstruction existed in all six domains and interplayed at many levels. The authors' systematic review analyzed this complex relationship and suggested multiprong interventions aimed at targeting breast reconstruction barriers, with the goal of promoting equitable access to breast reconstruction for all breast cancer patients.
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Rimareix F, Sarfati B, Leymarie N, Alkhashnam H, Honart JF, Tran De Frémicourt K, Conversano A, Struk S, Schaff JB, Bennis Y, Mazouni C, Delaloge S, Rivera S, Kolb F. [Mastectomy and immediate reconstruction: Indications, techniques and decision algorithm]. ANN CHIR PLAST ESTH 2018; 63:542-544. [PMID: 30144962 DOI: 10.1016/j.anplas.2018.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 01/22/2023]
Abstract
Immediate breast reconstruction indications extend to infiltrating carcinomas, due to new matrix implant coverage techniques and the development of perforator flaps. These techniques allow adjuvant treatments. However, the decision of immediate reconstruction must be discussed with the oncological multidisciplinary team and the benefits/risks must also be evaluated in relation to the morphology of the patients and their co-morbidities. The chosen type of mastectomy: conventional or skin sparing and/or nipple sparing depends on the shape and volume of the breast, the localization of the tumor in the breast and the distance from the nipple areola complex (NAC). We describe an algorithm to allow, in the case of therapeutic mastectomy with or without adjuvant radiotherapy, an immediate reconstruction with implants or free or pedicled flaps.
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Affiliation(s)
- F Rimareix
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - B Sarfati
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - N Leymarie
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - H Alkhashnam
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - J F Honart
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - K Tran De Frémicourt
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - A Conversano
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - S Struk
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - J-B Schaff
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - Y Bennis
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - C Mazouni
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - S Delaloge
- Département d'oncologie médicale, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - S Rivera
- Département de radiothérapie, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - F Kolb
- Département de chirurgie plastique, Gustave-Roussy, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
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Kamali P, Curiel D, van Veldhuisen CL, Bucknor AEM, Lee BT, Rakhorst HA, Lin SJ. Trends in immediate breast reconstruction and early complication rates among older women: A big data analysis. J Surg Oncol 2017; 115:870-877. [PMID: 28409847 DOI: 10.1002/jso.24595] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 02/08/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although approximately 57% of breast cancer (BC) diagnoses are in older patients (>60 years), only 4.1-14% receives breast reconstruction (BR). This has been attributed to physician concerns about operative complications. This paper aims to: 1) analyze the 30-day complication rates in the older patient population undergoing immediate breast reconstruction (IBR); and 2) analyze links between complication type and category of reconstruction. METHODS Using the ACS-NSQIP database (2005-2014), all women older than 60 years of age diagnosed with BC and DCIS were identified. IBR and complication rates were plotted for all ages. Patients were divided into those with and those without complications. Patient demographics and co-morbidities were compared. Complications within each type of reconstruction were analyzed. RESULTS Of the 4450 BC and 1104 DCIS patients, 22.3% (BC) and 20.9% (DCIS) had complications. IBR decreased significantly with increased age (P < 0.00 in both cohorts), while complication rates remained stable across all ages (P = 0.32 in BC, P = 0.69 in DCIS patients). Patients were well matched in terms of demographics. CONCLUSIONS The rates of breast reconstruction decrease with increasing age. Despite increasing age, associated complication rates in IBR patients remained stable.
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Affiliation(s)
- Parisa Kamali
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniel Curiel
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Charlotte L van Veldhuisen
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Alexandra E M Bucknor
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Bernard T Lee
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Hinne A Rakhorst
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.,Division of Plastic- Reconstructive and Hand Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Samuel J Lin
- Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Jeevan R, Browne JP, Gulliver-Clarke C, Pereira J, Caddy CM, van der Meulen JHP, Cromwell DA. Association between age and access to immediate breast reconstruction in women undergoing mastectomy for breast cancer. Br J Surg 2017; 104:555-561. [PMID: 28176303 DOI: 10.1002/bjs.10453] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/05/2016] [Accepted: 11/04/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND National guidelines state that patients with breast cancer undergoing mastectomy in England should be offered immediate breast reconstruction (IR), unless precluded by their fitness for surgery or the need for adjuvant therapies. METHODS A national study investigated factors that influenced clinicians' decision to offer IR, and collected data on case mix, operative procedures and reconstructive decision-making among women with breast cancer having a mastectomy with or without IR in the English National Health Service between 1 January 2008 and 31 March 2009. Multivariable logistic regression was used to examine the relationship between whether or not women were offered IR and their characteristics (tumour burden, functional status, planned radiotherapy, planned chemotherapy, perioperative fitness, obesity, smoking status and age). RESULTS Of 13 225 women, 6458 (48·8 per cent) were offered IR. Among factors the guidelines highlighted as relevant to decision-making, the three most strongly associated with the likelihood of an offer were tumour burden, planned radiotherapy and performance status. Depending on the combination of their values, the probability of an IR offer ranged from 7·4 to 85·1 per cent. A regression model that included all available factors discriminated well between whether or not women were offered IR (c-statistic 0·773), but revealed that increasing age was associated with a fall in the probability of an IR offer beyond that expected from older patients' tumour and co-morbidity characteristics. CONCLUSION Clinicians are broadly following guidance on the offer of IR, except with respect to patients' age.
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Affiliation(s)
- R Jeevan
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.,Mersey Regional Burns, Plastic and Reconstructive Surgery Unit, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - J P Browne
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - C Gulliver-Clarke
- Integrated Breast Service, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital, Worthing, UK
| | - J Pereira
- Department of General Surgery, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - C M Caddy
- Department of Plastic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - J H P van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - D A Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Chan SWW, Cheung C, Chan A, Cheung PSY. Surgical options for Chinese patients with early invasive breast cancer: Data from the Hong Kong Breast Cancer Registry. Asian J Surg 2016; 40:444-452. [PMID: 27209473 DOI: 10.1016/j.asjsur.2016.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/28/2016] [Accepted: 02/01/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Breast conserving surgery (BCS) is preferred for suitable candidates, while mastectomy (MTX) with reconstruction (MTX + R) is considered a better option for patients requiring MTX. In Hong Kong, the rates of BCS and breast reconstruction are relatively low. This paper aims to study the surgical options and their predictors among Hong Kong breast cancer patients. METHODS Data is retrieved from the Hong Kong Breast Cancer Registry (HKBCR) from 2007 to 2013. A total of 4519 Stage I-II breast cancer patients who had surgical treatments were included in this retrospective study. RESULTS Our multivariate logistic regression shows that people who were younger (age < 40 years: OR, 1.5; 95% CI, 1.1-2.1; p = 0.010), more educated (undergraduate/postgraduate: OR, 2.8; 95% CI, 1.7-4.4; p < 0.0001), never married (OR, 1.5; 95% CI, 1.1-1.9; p = 0.002), had regular mammography screening (OR, 1.5; 95% CI, 1.3-1.8; p < 0.0001), had screen-detected cancers (OR, 1.3; 95% CI, 1.0-1.6; p = 0.031), and who underwent surgery at a private medical service facility (OR, 1.8; 95% CI, 1.6-2.2; p < 0.0001) were more likely to receive BCS. In addition, people who were younger (age < 40 years: OR, 15.9; 95% CI, 6.5-39.2; p < 0.0001), more educated (undergraduate/postgraduate: OR, 26.8; 95% CI, 3.6-201.4; p = 0.001), had regular mammography screening (OR, 1.6; 95% CI, 1.1-2.3; p = 0.008), had screen-detected cancers (OR, 2.1; 95% CI, 1.4-3.3; p = 0.001), and had smaller tumor (≤ 2.0 cm: OR, 0.39; 95% CI, 0.20-0.76; p = 0.005) were more likely to have reconstruction after MTX. CONCLUSION Chinese patients have lower BCS and breast reconstruction rate. Besides cultural difference, patient-related factors such as age, education, marital status, mammography screening, the use of private medical facilities, and clinical characteristics including smaller tumor size and peripherally located tumor were significant predictors for type of surgical treatments in Chinese women with early breast cancer.
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Affiliation(s)
- Sharon W W Chan
- Kowloon East Cluster Breast Centre, Department of Surgery, United Christian Hospital, Hong Kong, China.
| | | | - Amy Chan
- Hong Kong Breast Cancer Foundation, Hong Kong, China
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Rococo E, Mazouni C, Or Z, Mobillion V, Koon Sun Pat M, Bonastre J. Variation in rates of breast cancer surgery: A national analysis based on French Hospital Episode Statistics. Eur J Surg Oncol 2016; 42:51-8. [DOI: 10.1016/j.ejso.2015.09.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/17/2015] [Accepted: 09/21/2015] [Indexed: 11/25/2022] Open
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10
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Burnier P, Hudry D, See LA, Duvernay A, Roche M, Loustalot C, Zwetyenga N, Coutant C. Patient age and breast resection weight affect immediate postmastectomy breast reconstruction in ductal carcinoma in situ. J Plast Reconstr Aesthet Surg 2015; 69:37-41. [PMID: 26576701 DOI: 10.1016/j.bjps.2015.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 05/02/2015] [Accepted: 09/27/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Mastectomy is necessary for 40% of the ductal carcinoma in situ. If immediate breast reconstruction (IBR) is systematically proposed, 81% of the patients would choose immediate versus delayed breast reconstruction, but the actual IBR rate is only approximately 50% of them. Therefore, the aim of this study was to identify objective characteristics that distinguish the patients who actually underwent IBR from those who did not. METHODS Several criteria of 248 patients who have undergone mastectomy for ductal carcinoma were analyzed. Factors studied were age, body mass index, diabetes, tobacco use, and weight of the specimen of resection. RESULTS The rate of IBR was 43%. An increase in age and weight of the resection specimen, irrespective of the body mass index, was associated with a lower rate of IBR. Thus, an increase of 100 g in the weight of the breast induces a significant reduction of the IBR (33%). CONCLUSIONS In our series, older patients or patients with larger breasts (irrespective of the body mass index) were less likely to undergo IBR. In order to be in line with the patient's desire, the surgeons of our unit should broaden their indications of IBR. The lack of reconstruction of large breasts should certainly be compensated in part with the recent development of free tissue transfers in our unit. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Pierre Burnier
- Department of Plastic, Reconstructive and Aesthetic Surgery, 14 Rue Paul Gaffarel, Dijon, Côte d'Or, France; Department of Oncologic Surgery, Georges-François Leclerc Cancer Institute, 1 Rue du Professeur Marion, Dijon, Côte d'Or, France.
| | - Delphine Hudry
- Department of Oncologic Surgery, Georges-François Leclerc Cancer Institute, 1 Rue du Professeur Marion, Dijon, Côte d'Or, France; Dijon Univeristy, 7 Boulevard Jeanne d'Arc, Dijon, Côte d'Or, France
| | - Leslie-Ann See
- Department of Plastic, Reconstructive and Aesthetic Surgery, 14 Rue Paul Gaffarel, Dijon, Côte d'Or, France; Department of Oncologic Surgery, Georges-François Leclerc Cancer Institute, 1 Rue du Professeur Marion, Dijon, Côte d'Or, France; Dijon Univeristy, 7 Boulevard Jeanne d'Arc, Dijon, Côte d'Or, France
| | - Alain Duvernay
- Department of Oncologic Surgery, Georges-François Leclerc Cancer Institute, 1 Rue du Professeur Marion, Dijon, Côte d'Or, France
| | - Matthieu Roche
- Department of Oncologic Surgery, Georges-François Leclerc Cancer Institute, 1 Rue du Professeur Marion, Dijon, Côte d'Or, France
| | - Catherine Loustalot
- Department of Oncologic Surgery, Georges-François Leclerc Cancer Institute, 1 Rue du Professeur Marion, Dijon, Côte d'Or, France
| | - Narcisse Zwetyenga
- Department of Plastic, Reconstructive and Aesthetic Surgery, 14 Rue Paul Gaffarel, Dijon, Côte d'Or, France; Dijon Univeristy, 7 Boulevard Jeanne d'Arc, Dijon, Côte d'Or, France
| | - Charles Coutant
- Department of Oncologic Surgery, Georges-François Leclerc Cancer Institute, 1 Rue du Professeur Marion, Dijon, Côte d'Or, France; Dijon Univeristy, 7 Boulevard Jeanne d'Arc, Dijon, Côte d'Or, France
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Whom Should We SPY? A Cost Analysis of Laser-Assisted Indocyanine Green Angiography in Prevention of Mastectomy Skin Flap Necrosis during Prosthesis-Based Breast Reconstruction. Plast Reconstr Surg 2014; 133:448e-454e. [DOI: 10.1097/prs.0000000000000025] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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12
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DCIS and LCIS are confusing and outdated terms. They should be abandoned in favor of ductal intraepithelial neoplasia (DIN) and lobular intraepithelial neoplasia (LIN). Breast 2013; 22:431-5. [PMID: 23643807 DOI: 10.1016/j.breast.2013.04.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 04/03/2013] [Indexed: 11/22/2022] Open
Abstract
The terms ductal and lobular intraepithelial neoplasia (DIN and LIN) were introduced by Tavossoli 15 years ago, who proposed they should replace, respectively, ductal and lobular carcinoma in situ (DCIS and LCIS). This proposal has been slowly gaining ground. We argue that DCIS and LCIS should now be definitively abandoned. Bringing together 'in situ' and other entities into the simpler and more logical DIN/LIN framework--as has been done with intraepithelial neoplasias of cervix, vagina, vulva, prostate, and pancreas--would eliminate the artificial and illogical distinctions between 'not cancers' (e.g. flat epithelial atypia, atypical ductal hyperplasia--now classified as low grade DIN) and 'cancers' (e.g. DCIS--now considered medium-high grade DIN). Elimination of the term 'carcinoma' from entities that cannot metastasize will reduce confusion among health professionals and patients, and contribute to reducing the risk of overtreatment, as well as reducing adverse psychological reactions in patients.
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