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Rupra RS, Daneshi K, Liyanage D, Ceccaroni A, Gentile A, Khajuria A. Publication Trends in Aesthetic Breast Surgery: A Bibliometric Analysis. Aesthet Surg J Open Forum 2024; 6:ojae045. [PMID: 39015114 PMCID: PMC11249954 DOI: 10.1093/asjof/ojae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024] Open
Abstract
Background Aesthetic breast surgery (ABS) encompasses breast augmentation, breast reduction, mastopexy, and mastopexy augmentation. This topic has seldom been assessed as a bibliometric study. This analysis aims to address this gap and identify trends in ABS literature to guide future research areas. Bibliometrics, the quantitative analysis of publications, particularly scholarly literature, offers valuable insights into research trends and impact. Objectives This analysis aims to address this gap and identify trends in ABS literature to guide future research areas. Methods The 100 most-cited publications in ABS were identified on Web of Science (Clarivate Analytics, Philadelphia, PA), across all available journal years (from 1953 to 2024). Study details, including the citation count, main content focus, and outcome measures, were extracted and tabulated from each publication. The Oxford Centre for Evidence Based Medicine and levels of evidence (LOE) of each study were assessed. Results The 100 most-cited publications in ABS were cited by a total of 11,522 publications. Citations per publication ranged from 46 to 1211 (mean 115.2 ± 135.7), with the highest-cited study being the Pusic BREAST-Q paper (n = 1211). A majority of publications were LOE 4 (n = 30), representative of the large number of case series. The number of publications for LOE 5, 3, 2, and 1 was 12, 28, 21, and 9, respectively. The main content focus was "outcomes" in 52 publications, followed by "nonoperative management" (n = 12) and "surgical technique" (n = 12). Patient-reported outcome measures (PROMs) were used in 29 publications, and 53 publications reported aesthetic outcome measures. Conclusions This analysis highlights that research methodologies in ABS studies should be improved. This necessary improvement would be facilitated by vigorous, high-quality research, and the implementation of validated ABS-specific PROMs enhancing patient satisfaction, particularly in aesthetic procedures, such as BREAST-Q. Level of Evidence 4
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Affiliation(s)
| | | | | | | | | | - Ankur Khajuria
- Corresponding Author: Dr Ankur Khajuria, Ayrton Rd, South Kensington, London SW7 5NH, UK. E-mail: ; Twitter (X): @akhajuria1
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Feng Y, Li J, Zhang D, Yang H, Qiu M, Zhou J, Qin X, Liu X, Liang F, Du Z. Three-Pedicle Reduction Mammaplasty Technique in the Treatment of Greater Breast Hypertrophy Patients With or Without Breast Cancer: Surgical and Patient-reported outcomes. Aesthetic Plast Surg 2023; 47:2221-2231. [PMID: 36820864 DOI: 10.1007/s00266-023-03285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/04/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Reduction mammoplasty (RM) is an important procedure in the management of symptomatic greater breast hypertrophy with or without early-stage breast cancer. We aim to introduce a new procedure: the three-pedicle reduction mammaplasty technique. METHODS A prospectively maintained database was reviewed, and two prospectively registered clinical studies were included of all breast hypertrophy patients with or without breast cancer who underwent three-pedicle RM with inverted T incision at West China Hospital or the Fourth People's Hospital of Sichuan Province from 2018 to 2022. Patient demographics, patient-reported cosmetic results, quality of life (QoL), surgical outcomes and complications were assessed. RESULTS During a median period of 22.5 months, 101 reduction mammaplasties were performed (Mage= 35.80; MBMI= 27.05). Mean reduction weight was 880.9 g ranging from 423-1630 g per breast. The nipple-to-sternal notch distance (N-SN) at post-operation was significantly shorter than preoperatively (left, 34.51 cm; right, 34.69 cm). Major complications and minor complications were 1.9% (1/52 patients) and 13.5% (7/52 patients), respectively. Multivariate logistic regression analyses showed that BMI > 30 was independent risk factors for a complication. Except for sexual and physical well-being at 1-month post-operation, patients gave a higher score on the BREAST-Q (breast satisfaction, physical well-being, psychosocial well-being) after the operation than before the operation (P<0.001). CONCLUSIONS The three-pedicle RM technique was demonstrated to be an effective and safe RM procedure for moderate to severe breast hypertrophy patients with or without breast cancer, with the advantages of removing the lesions, reducing hypertrophic breasts and accomplishing mammoplasty. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.
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Affiliation(s)
- Yu Feng
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Juan Li
- Department of Breast Surgery, Sichuan Academy of Medical Sciences, Sichuan Province People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Donglin Zhang
- Department of General Surgery, The Fourth People's Hospital of Sichuan Province, Chengdu, 610016, Sichuan, People's Republic of China
| | - Huanzuo Yang
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Mengxue Qiu
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jiao Zhou
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiangquan Qin
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xinran Liu
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Faqing Liang
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zhenggui Du
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China.
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Stocco C, Cazzato V, Renzi N, Manara M, Ramella V, Scomersi S, Fezzi M, Bortul M, Arnez ZM, Papa G. Central Mound Technique in Oncoplastic Surgery: A Valuable Technique to Save Your Bacon. Clin Breast Cancer 2023; 23:e77-e84. [PMID: 36717320 DOI: 10.1016/j.clbc.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/01/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Breast-conserving surgery (BCS) is a valid method for the reconstruction of partial breast defects, however, there is a great variety of final aesthetic outcomes depending on the location of the tumor in the breast and also on the initial breast volume and the degree of ptosis. Specifically, defects affecting the upper inner/central quadrant represent a reconstructive challenge with not always satisfactory final results. For this purpose, the authors investigated the use of the central mound technique in breast-conserving surgery. The aim of the study was to apply the central mound as an oncoplastic technique and assess the satisfaction rate of the patients. MATERIALS AND METHODS This was a retrospective study that involved 40 patients (80 breast) underwent breast conserving surgery and contextual bilateral breast remodeling with central mound technique. A pre- and postoperative Breast-Q questionnaire (breast conserving therapy module) was given to all the patients before the surgery, 3 months and 9 months after. The statistical analysis with chi-square test was performed. RESULTS After 9 months the author found a major increase of all BREAST-Q parameters; the most valuable increments concerned the "Satisfaction with breast" and "Psychosocial well-being." None of the patients experienced a decreased in the quality of life related to the surgical procedure. CONCLUSION The authors believe that this technique has useful functional and aesthetic results particularly appreciated by patients with upper pole lesion who have a slightly or moderately breast ptosis and a small cup size.
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Affiliation(s)
- Chiara Stocco
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Vito Cazzato
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
| | - Nadia Renzi
- Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
| | - Mariastella Manara
- Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
| | - Vittorio Ramella
- Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
| | - Serena Scomersi
- Department of General Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
| | - Margherita Fezzi
- Department of General Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
| | - Marina Bortul
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; Department of General Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
| | - Zoran Marj Arnez
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
| | - Giovanni Papa
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste University Hospital, Trieste, Italy
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Tramm T, Kaidar-Person O. Optimising post-operative radiation therapy after oncoplastic and reconstructive procedures. Breast 2023; 69:366-374. [PMID: 37023565 PMCID: PMC10119683 DOI: 10.1016/j.breast.2023.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/16/2023] [Accepted: 03/25/2023] [Indexed: 03/30/2023] Open
Abstract
Surgical techniques for breast cancer have been refined over the past decades to deliver an aesthetic outcome as close as possible to the contralateral intact breast. Current surgery further allows excellent aesthetic outcome even in case of mastectomy, by performing skin sparing or nipple sparing mastectomy in combination with breast reconstruction. In this review we discuss how to optimise post-operative radiation therapy after oncoplastic and breast reconstructive procedures, including dose, fractionation, volumes, surgical margins, and boost application.
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Lee A, Kwasnicki RM, Khan H, Grant Y, Chan A, Fanshawe AEE, Leff DR. Outcome reporting in therapeutic mammaplasty: a systematic review. BJS Open 2021; 5:zrab126. [PMID: 34894122 PMCID: PMC8665419 DOI: 10.1093/bjsopen/zrab126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/05/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Therapeutic mammaplasty (TM) is an oncological procedure which combines tumour resection with breast reduction and mastopexy techniques. Previous systematic reviews have demonstrated the oncological safety of TM but reporting of critically important outcomes, such as quality of life, aesthetic and functional outcomes, are limited, piecemeal or inconsistent. This systematic review aimed to identify all outcomes reported in clinical studies of TM to facilitate development of a core outcome set. METHODS Medline, EMBASE, CINAHL and Web of Science were searched from inception to 5 August 2020. Included studies reported clinical outcomes following TM for adult women. Two authors screened articles independently for eligibility. Data were extracted regarding the outcome definition and classification type (for example, oncological, quality of life, etc.), time of outcome reporting and measurement tools. RESULTS Of 5709 de-duplicated records, 148 were included in the narrative synthesis. The majority of studies (n = 102, 68.9 per cent) reported measures of survival and/or recurrence; approximately three-quarters (n = 75, 73.5 per cent) had less than 5 years follow-up. Aesthetic outcome was reported in half of studies (n = 75, 50.7 per cent) using mainly subjective, non-validated measurement tools. The time point at which aesthetic assessment was conducted was highly variable, and only defined in 48 (64.0 per cent) studies and none included a preoperative baseline for comparison. Few studies reported quality of life (n = 30, 20.3 per cent), functional outcomes (n = 5, 3.4 per cent) or resource use (n = 28, 18.9 per cent). CONCLUSION Given the oncological equivalence of TM and mastectomy, treatment decisions are often driven by aesthetic and functional outcomes, which are infrequently and inconsistently reported with non-validated measurement tools.
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Affiliation(s)
- Alice Lee
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Hasaan Khan
- Faculty of Medicine, Imperial College London, London, UK
| | - Yasmin Grant
- Department of BioSurgery, Imperial College London, London, UK
| | - Abigail Chan
- Faculty of Medicine, Imperial College London, London, UK
| | - Angela E E Fanshawe
- Department of Breast Surgery, Charing Cross Hospital, Imperial College NHS Trust, London, UK
| | - Daniel R Leff
- Department of Surgery and Cancer, Imperial College London, London, UK
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Teh MS, Teoh LY, Jamaris S, Lai LL, See MH. Outcomes of Asian Women Treated With Grisotti Flap Reconstruction for Centrally Located Breast Cancers: 5-Years Single Institutional Experience. Ann Plast Surg 2021; 87:132-135. [PMID: 33675629 DOI: 10.1097/sap.0000000000002631] [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: 11/25/2022]
Abstract
INTRODUCTION Breast conserving surgeries were previously contraindicated for central breast cancers because of poor cosmetic outcomes of central mastectomy without oncoplastic surgery. Grisotti flap is a breast-conserving surgery incorporating oncoplastic surgery technique for centrally located breast cancers. We present our experience and outcome from Breast Surgery Unit, University Malaya Medical Center. MATERIALS AND METHODS A prospective analysis of 15 patients with central retroareolar breast cancer operated from 2012 to 2018 in University Malaya Medical Center. We assessed postoperative complications, margins, locoregional recurrence, and survival outcome. All patients received postoperative radiotherapy. Patients were followed-up 1 week, 1 month, 3 monthly for 1 year and 6 monthly for 5 years. RESULTS Mean age of patients is 62 years. Mean follow-up is 51 months (15-84 months). All tumors were less than 5 cm (1-2.5 cm). Majority of the patients are stage 1 (6 patients/40%) and stage 2 (8 patients/ 53.3%). 2 patients had surgical site infection resolved with antibiotics. One patient had hematoma. None require reoperation. Tumor margins were clear in all patients. No locoregional recurrence. Overall survival is 100%. All are satisfied with their cosmetic outcomes. CONCLUSIONS Grisotti flap is a volume displacement technique, which provides satisfactory cosmetic outcome for centrally located breast cancer. This evolutionary thinking leads us to changes in existing techniques with the purpose of achieving oncological safety while reaching for better esthetic results. Our 5 years' experience in Asian population showed that this technique is oncologically safe with good cosmetic outcomes and could be used selectively. It provides a good alternative in patients who are otherwise subjected for mastectomy. This relatively simple technique is a worthwhile endeavor and should be offered when feasible.
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Affiliation(s)
- Mei-Sze Teh
- From the Department of Surgery, University of Malaya Medical Centre, Malaysia
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Lee A, Kwasnicki RM, Leff DR. Outcomes and outcome measures reported in clinical studies of therapeutic mammaplasty: a systematic review protocol. BMJ Open 2021; 11:e046438. [PMID: 34135045 PMCID: PMC8211071 DOI: 10.1136/bmjopen-2020-046438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 06/09/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Therapeutic mammaplasty (TM) is an oncological procedure which combines tumour resection with breast reduction and mastopexy techniques. Previous systematic reviews have demonstrated oncological safety of TM, but poor and inconsistent reporting of quality-of-life, aesthetic and functional outcomes, often with non-validated measurement tools. Moreover, there is a paucity of patient-reported outcome measures. Standardisation of outcome reporting is required to enable study results to be compared and combined, for example, through core outcome set (COS) development. This systematic review aims to comprehensively describe the outcomes reported in clinical studies of TM, their respective outcome measures and the time points at which they were evaluated. The overall objective is to facilitate the development of a COS for TM. METHODS AND ANALYSIS A systematic review of clinical studies evaluating outcomes following TM will be completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following electronic databases have been searched from inception to 5 August 2020: Ovid MEDLINE, Embase, CINAHL and Web of Science. Primary outcomes will include the number of reported outcomes of various types (clinical, aesthetic, functional, quality-of-life and cost-effectiveness), whether these are patient-reported or clinician-reported, how outcomes are defined and the outcome measurement tool(s) used. The time point(s) at which outcomes were measured will be a secondary outcome. No studies will be excluded on the basis of methodological quality in order to generate a comprehensive list of reported outcomes and outcome measures; hence, risk of bias assessment is not required. The data will be described narratively. This protocol has been reported in line with PRISMA-Protocols. ETHICS AND DISSEMINATION This study does not involve human or animal participants, hence ethical approval is not required. The findings will be published in a peer-reviewed journal and presented at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42020200365.
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Affiliation(s)
- Alice Lee
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Daniel R Leff
- Department of Surgery and Cancer, Imperial College London, London, UK
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Savioli F, Seth S, Morrow E, Doughty J, Stallard S, Malyon A, Romics L. Extreme Oncoplasty: Breast Conservation in Patients with Large, Multifocal, and Multicentric Breast Cancer. BREAST CANCER (DOVE MEDICAL PRESS) 2021; 13:353-359. [PMID: 34079367 PMCID: PMC8164874 DOI: 10.2147/bctt.s296242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/22/2021] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Extreme Oncoplastic Breast Conservation Surgery (EOBCS) is offered in selected patients with multifocal or multicentric breast cancer (MFMC). Recent evidence has suggested that EOBCS may be a valuable resource for patients with MFMC who may avoid the risk associated with mastectomy in favour of the benefits of breast conservation without risking their oncological outcomes. Our study examined the practice of EOBCS in two regional breast units in Glasgow, United Kingdom. MATERIALS AND METHODS A prospectively collected database of 50 patients treated with EOBC in two breast units in Glasgow between 2007 and 2018 were evaluated, and clinical outcomes were observed. RESULTS Fifty patients (median age 55) underwent EOBCS, of which 43 (86%) had invasive disease. Median tumour size was 55mm (50-90) and multifocal disease was identified in 22 (44%) patients. Nine patients (18%) were found to have positive margins and underwent a second procedure, with 6 (12%) proceeding to mastectomy. Five-year disease free survival rate was 91.5%, while cancer-specific survival was 95.7%. CONCLUSION EOBCS is oncologically safe in short-term follow-up. Large scale studies are required to confirm these preliminary results, in order to offer EOBCS as a valid option to patients with advanced or multifocal breast cancer.
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Affiliation(s)
- Francesca Savioli
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Subodh Seth
- Department of Breast Surgery, Forth Valley Royal Hospital, Larbert, UK
| | - Elizabeth Morrow
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
| | - Julie Doughty
- Department of Breast Surgery, Gartnavel General Hospital, Glasgow, UK
| | - Sheila Stallard
- Department of Breast Surgery, Gartnavel General Hospital, Glasgow, UK
| | - Andy Malyon
- Canniesburn Department of Plastic Surgery, Glasgow Royal Infirmary, Glasgow, UK
| | - Laszlo Romics
- Academic Unit of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK
- Department of Breast Surgery, New Victoria Hospital, Glasgow, UK
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Abstract
OPINION STATEMENT Oncoplastic surgery (OPS) expands the indications and possibilities of breast-conserving surgery (BCS) by allowing for a wider cancer resection than lumpectomy. Ongoing investigation and reporting of OPS outcomes along with improvements in comprehensive training in breast surgical oncology will impact on awareness and lead to increased adoption of these techniques. Indications for OPS include concern about clear margins, poor tumor location (upper inner pole and lower quadrant), multifocality, need for skin excision, and poor candidacy for mastectomy and reconstruction. OPS has been proven to be oncological safe with comparable rates of complications, positive margins, and re-excisions with BCS. Additionally, OPS has a positive impact on the quality of life and self-esteem when compared with those patients that underwent BCT.
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10
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Emiroglu M, Karaali C, Oztop MB, Gulluoglu BM. National Consensus on Oncoplastic Breast Conserving Surgery in Turkey: Position Paper for the Standardization of Surgical Practice. Turk J Surg 2020; 36:271-277. [PMID: 33778382 DOI: 10.47717/turkjsurg.2020.4639] [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: 10/09/2019] [Accepted: 02/27/2020] [Indexed: 11/23/2022]
Abstract
Objectives The algorithms that define most of the application of oncoplastic breast conserving surgery (OBCS) in breast cancer patients are not clearly defined. Therefore, a consensus survey was conducted between the leading and experienced breast surgeons and oncoplastic breast surgeons in Turkey on the controversial areas of oncoplastic breast surgery. Material and Methods This consensus survey was carried out on-line through the Consensus software program (www.consensuss.com) under the roof of Turkish Federation of National Societies for Breast Diseases (TFNSBD). After finalizing each proposition, web-based remote access consensus process was performed on the Likert scale using Delphi method with the Consensus (www.consensuss.com) software program. Through the related software, an invitation was sent to 111 people who had at least 5 years of general surgery expertise in Turkey, and who devoted more than 50% of their daily clinical practice to the treatment and surgery of breast diseases. Results Sixty-two out of 111 people accepted to participate in the panel and made an on-line evaluation. According to the consensus results; Lumpectomy area should be done by placing the clips on at least four walls of the cavity, if the margin of the tumor is clear in central tumors, the distance between the tumor and the nipple is not significantly important, oncoplastic techniques may be used in patients with locally advanced breast cancer after neoadjuvant chemotherapy, in patients who have macromastia with ductal carcinoma in situ or breast cancer, OBCS techniques can be performed, and OBCS should be evaluated in terms of breast aesthetics. After OBCS, re-excision can be performed at a re-do setting in cases with involved surgical margins. Conclusion Our consensus results may provide a basis for the development of some standards in OBCS.
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Affiliation(s)
- Mustafa Emiroglu
- Izmir Tepecik Education And Research Hospital, General Surgery, İzmir, Turkey
| | - Cem Karaali
- Izmir Tepecik Education And Research Hospital, General Surgery, İzmir, Turkey
| | - Mehmet B Oztop
- Izmir Provincial Health Directorate, Health Directorate, İzmir, Turkey
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Potter S, Trickey A, Rattay T, O'Connell RL, Dave R, Baker E, Whisker L, Skillman J, Gardiner MD, Macmillan RD, Holcombe C. Therapeutic mammaplasty is a safe and effective alternative to mastectomy with or without immediate breast reconstruction. Br J Surg 2020; 107:832-844. [PMID: 32073654 DOI: 10.1002/bjs.11468] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 10/14/2019] [Accepted: 11/17/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Therapeutic mammaplasty (TM) may be an alternative to mastectomy, but few well designed studies have evaluated the success of this approach or compared the short-term outcomes of TM with mastectomy with or without immediate breast reconstruction (IBR). Data from the national iBRA-2 and TeaM studies were combined to compare the safety and short-term outcomes of TM and mastectomy with or without IBR. METHODS The subgroup of patients in the TeaM study who underwent TM to avoid mastectomy were identified, and data on demographics, complications, oncology and adjuvant treatment were compared with those of patients undergoing mastectomy with or without IBR in the iBRA-2 study. The primary outcome was the percentage of successful breast-conserving procedures in the TM group. Secondary outcomes included postoperative complications and time to adjuvant therapy. RESULTS A total of 2916 patients (TM 376; mastectomy 1532; mastectomy and IBR 1008) were included in the analysis. Patients undergoing TM were more likely to be obese and to have undergone bilateral surgery than those having IBR. However, patients undergoing mastectomy with or without IBR were more likely to experience complications than the TM group (TM: 79, 21·0 per cent; mastectomy: 570, 37·2 per cent; mastectomy and IBR: 359, 35·6 per cent; P < 0·001). Breast conservation was possible in 87·0 per cent of patients who had TM, and TM did not delay adjuvant treatment. CONCLUSION TM may allow high-risk patients who would not be candidates for IBR to avoid mastectomy safely. Further work is needed to explore the comparative patient-reported and cosmetic outcomes of the different approaches, and to establish long-term oncological safety.
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Affiliation(s)
- S Potter
- Population Health Sciences, Bristol Medical School, Bristol, UK.,Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
| | - A Trickey
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - T Rattay
- Cancer Research Centre, University of Leicester, Leicester Royal Infirmary, Leicester, UK
| | | | - R Dave
- Nightingale Breast Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - E Baker
- Department of Breast Surgery, Airedale General Hospital, Keighley, UK
| | - L Whisker
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J Skillman
- Department of Plastic Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - M D Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK.,Department of Plastic Surgery, Frimley Health NHS Foundation Trust, Slough, UK
| | - R D Macmillan
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Liverpool, UK
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Barellini L, Marcasciano M, Lo Torto F, Fausto A, Ribuffo D, Casella D. Intraoperative Ultrasound and Oncoplastic Combined Approach: An Additional Tool for the Oncoplastic Surgeon to Obtain Tumor-Free Margins in Breast Conservative Surgery-A 2-Year Single-Center Prospective Study. Clin Breast Cancer 2019; 20:e290-e294. [PMID: 32144083 DOI: 10.1016/j.clbc.2019.10.004] [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: 09/24/2019] [Revised: 10/17/2019] [Accepted: 10/19/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND The main goal of oncoplastic breast-conserving surgery (OBCS) is to obtain tumor-free resection margins after cancer excision with satisfactory cosmetic results. Positive tumor margins are associated with high rates of tumor recurrence requiring reoperation. The aim of this prospective clinical trial was to demonstrate the reliability of intraoperative ultrasound (IOUS) to obtain tumor-free resection margins in OBCS. PATIENTS AND METHODS Between December 2016 and March 2018, data from 130 patients with by T1-2 breast cancer, either invasive or in situ, who underwent OBCS were prospectively collected. The oncoplastic surgeon performed IOUS in the operating theater to localize the lesion and mark its skin projection. Then specimens were examined to assess the presence of the lesion and margin adequacy. Definitive histologic reports were reviewed, with a focus on margin status. RESULTS All patients experienced oncoplastic approaches, and lesions were always found on the specimen at the histologic report. In 126 cases (97%), margins were considered adequate. In 17 cases (13%), IOUS showed positive margins, and resection was contextually enlarged. In 12 of these (9%), the pathologic report confirmed the need for enlarged resection. This study shows that IOUS-guided surgery can obtain a high percentage of tumor-free resection margins in OBCS without scheduling conflicts between radiology, nuclear, and surgery departments. Full cooperation between radiologists and oncoplastic surgeons is required to achieve high-standard oncologic and reconstructive outcomes. CONCLUSION IOUS represent an additional tool for the breast surgeon to improve margin-free management of neoplastic lesions, preventing reoperations in patients undergoing oncoplastic surgery.
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Affiliation(s)
- Leonardo Barellini
- Unità di Oncologia Chirurgica Ricostruttiva della Mammella, "Spedali Riuniti" di Livorno, Breast Unit Integrata di Livorno, Livorno, Italia
| | - Marco Marcasciano
- Unità di Oncologia Chirurgica Ricostruttiva della Mammella, "Spedali Riuniti" di Livorno, Breast Unit Integrata di Livorno, Livorno, Italia; Department of Surgery "P. Valdoni," Unit of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Rome, Italy.
| | - Federico Lo Torto
- Department of Surgery "P. Valdoni," Unit of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Alfonso Fausto
- Department of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Diego Ribuffo
- Department of Surgery "P. Valdoni," Unit of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Rome, Italy
| | - Donato Casella
- Unità di Oncologia Chirurgica Ricostruttiva della Mammella, "Spedali Riuniti" di Livorno, Breast Unit Integrata di Livorno, Livorno, Italia; Department of Surgery "P. Valdoni," Unit of Plastic and Reconstructive Surgery, "Sapienza" University of Rome, Rome, Italy
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13
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Kelemen P, Pukancsik D, Újhelyi M, Kovács E, Stamatiou A, Ivády G, Kenessey I, Kovács T, Smanykó V, Rubovszky G, Mátrai Z. Evaluation of the central pedicled, modified Wise‐pattern technique as a standard level II oncoplastic breast‐conserving surgery: A retrospective clinicopathological study of 190 breast cancer patients. Breast J 2019; 25:922-926. [DOI: 10.1111/tbj.13371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 12/16/2018] [Accepted: 12/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Péter Kelemen
- Department of Breast and Sarcoma Surgery National Institute of Oncology Budapest Hungary
| | - Dávid Pukancsik
- Department of Breast and Sarcoma Surgery National Institute of Oncology Budapest Hungary
| | - Mihály Újhelyi
- Department of Breast and Sarcoma Surgery National Institute of Oncology Budapest Hungary
| | - Eszter Kovács
- Department of Radiological Diagnostics National Institute of Oncology Budapest Hungary
| | | | - Gabriella Ivády
- Department of Surgical and Molecular Pathology National Institute of Oncology Budapest Hungary
| | - István Kenessey
- National Cancer Registry National Institute of Oncology Budapest Hungary
- 2nd Department of Pathology Semmelweis University Budapest Hungary
| | - Tibor Kovács
- Department of Breast Surgery Guy's and St Thomas' Hospitals NHS Foundation Trust London UK
| | - Viktor Smanykó
- Department of Radiotherapy National Institute of Oncology Budapest Hungary
| | - Gábor Rubovszky
- Department of Oncological Internal Medicine National Institute of Oncology Budapest Hungary
| | - Zoltán Mátrai
- Department of Breast and Sarcoma Surgery National Institute of Oncology Budapest Hungary
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14
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Vella Baldacchino R, Bellizzi A, Madada-Nyakauru RN, Kazzazi F, Oni G, Forouhi P, Malata CM. Assessment of breast symmetry in breast cancer patients undergoing therapeutic mammaplasty using the Breast Cancer Conservation Therapy cosmetic results software (BCCT.core). Gland Surg 2019; 8:218-225. [PMID: 31328100 DOI: 10.21037/gs.2018.09.06] [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
Background Therapeutic mammaplasty (TM) is a standard oncoplastic technique utilising aesthetic breast reduction principles to facilitate tumour resection and breast reshaping. Simultaneous contralateral mammaplasties are often performed to maintain symmetry. BCCT.core software, which principally assesses breast symmetry, has been previously employed for evaluating cosmetic results after standard breast conservation therapy and latterly TMs for upper pole tumours. The purpose of this study was to validate this novel tool for TMs in all breast zones. Methods Standardised photographs of 20 consecutive patients who underwent TM were evaluated for symmetry using BCCT.core versus a plastic surgical panel completing a visual analogue scale. Results were rated as (excellent/good/fair/poor). Outcomes between the two methods were compared. Results Twenty patients aged 37 to 63 years with a median 36G bra size had 22 TMs (18 unilateral, 2 bilateral). Indications were invasive breast cancer (87%) and ductal carcinoma in situ (DCIS) (13%). The median (range) tumour size was 22.5 mm (6-90 mm) with a resection weight of 245.8 g (16-1,079 g). Primary nipple pedicles were superomedial (63%), inferior (21%) and superolateral (16%). Five patients required a secondary glandular pedicle for volume redistribution to maintain breast shape. The BCCT.core software vs. panel symmetry assessments were 37% vs. 39% (excellent), 63% vs. 50% (good) and 0% vs. 11% (fair). Wilcoxon matched-pairs sign rank tests and Spearman rank correlations found the pairings to be statistically significant (P<0.05). Conclusions Despite small patient numbers, BCCT.core gave comparable findings with the panel and is thus useful for objectively assessing cosmesis of TMs in all breast zones.
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Affiliation(s)
| | - Annalise Bellizzi
- Mater Dei Hospital, Malta Medical School, University of Malta, Msida, Malta
| | - Rudo N Madada-Nyakauru
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Fawz Kazzazi
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Georgette Oni
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Parto Forouhi
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Charles M Malata
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Anglia Ruskin School of Medicine, Anglia Ruskin University, Chelmsford and Cambridge, UK
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15
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Benson JR, Jatoi I, Toi M. Surgical management of multiple ipsilateral breast cancers. Future Oncol 2019; 15:1185-1191. [PMID: 30924355 DOI: 10.2217/fon-2019-0028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- John R Benson
- Cambridge Breast Unit, Addenbrookes Hospital, Anglia Ruskin School of Medicine & University of Cambridge, Cambridge CB2 0QQ, UK
| | - Ismail Jatoi
- Division of Surgical Oncology, Dale H Dorn Chair in Surgery, University of Texas Health Science Center, San Antonio, TX 78229, USA
| | - Masakazu Toi
- Department of Surgery, Kyoto University Hospital, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
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16
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Comment optimiser le bilan préopératoire d’un cancer du sein éligible à un traitement oncoplastique ? IMAGERIE DE LA FEMME 2019. [DOI: 10.1016/j.femme.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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17
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Winters ZE, Bernaudo L. Evaluating the current evidence to support therapeutic mammoplasty or breast-conserving surgery as an alternative to mastectomy in the treatment of multifocal and multicentric breast cancers. Gland Surg 2018; 7:525-535. [PMID: 30687626 DOI: 10.21037/gs.2018.07.01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The oncological safety of treating multiple ipsilateral breast cancers (MIBCs) with types of breast conserving surgery (BCS) compared to mastectomy remains uncertain. This is predicated on the absence of any randomised controlled trials or high-quality protocol defined prospective cohort studies. A single recently published systematic review by the first author, reports its summarised results in this review. Fundamentally the important question is the evaluation of clinical safety following BCS compared to mastectomy for treating MIBC, which is reported in only six studies. Consequently, current evidence doesn't support the latest St Gallen consensus suggesting the possibility of using BCS to treat all MIBC. There is minimal comparative outcomes data on multicentric (MC) cancers compared to multifocal (MF) cancers comparing BCS or mastectomy. There is also poor evidence of clinical outcomes following therapeutic mammoplasty (TM) for MIBC compared to mastectomy. The potential recommendation of two potential radiotherapy boosts to separate lumpectomy sites following BCS for MC cancers remains a novel treatment concept whose feasibility will be evaluated in the forthcoming NIHR funded randomised feasibility trial called MIAMI. This is a world first attempt to assess the feasibility of a randomised trial design alongside the on-going Alliance registry study (ACOSOG, American College of Surgeons Oncology Group Z11102) in the USA, in which there is no comparative evaluation of mastectomy outcomes. The MIAMI trial aims to assess the clinical safety of multiple lumpectomies combined with TM compared to the standard of mastectomy in MIBC stratified by MF or MC cancers. There is limited evidence on the impacts of inter-tumoral heterogeneity relating to breast cancer subtypes in relation to individualised treatments and recommendations for types of breast surgery. Recent studies have highlighted the potential contributions of stromal epigenetic changes that are currently poorly understood regarding their contributions to either clinical unifocal or MF cancers.
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Affiliation(s)
- Zoe Ellen Winters
- Breast Cancer Surgery, Patient-Centred and Clinical Outcomes Research Group, Surgical and Interventional Trials Unit, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, London, UK
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18
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O'Connell RL, Baker E, Trickey A, Rattay T, Whisker L, Macmillan RD, Potter S. Current practice and short-term outcomes of therapeutic mammaplasty in the international TeaM multicentre prospective cohort study. Br J Surg 2018; 105:1778-1792. [PMID: 30132807 DOI: 10.1002/bjs.10959] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/12/2018] [Accepted: 06/21/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Therapeutic mammaplasty, which combines breast reduction and mastopexy techniques with tumour excision, may extend the boundaries of breast-conserving surgery and improve outcomes for patients, but current practice is unknown and high-quality outcome data are lacking. This prospective multicentre cohort study aimed to explore the practice and short-term outcomes of the technique. METHODS Consecutive patients undergoing therapeutic mammaplasty at participating centres between 1 September 2016 and 30 June 2017 were recruited to the study. Demographic, preoperative, operative, oncological and complication data were collected. The primary outcome was unplanned reoperation for complications within 30 days of surgery. Secondary outcomes included re-excision rates and time to adjuvant therapy. RESULTS Overall, 880 patients underwent 899 therapeutic mammaplasty procedures at 50 centres. The most common indications were avoidance of poor cosmetic outcomes associated with standard breast-conserving surgery (702 procedures, 78·1 per cent) or avoidance of mastectomy (379, 42·2 per cent). Wise-pattern skin incisions were the most common (429 of 899, 47·7 per cent), but a range of incisions and nipple-areola pedicles were used. Immediate contralateral symmetrization was performed in one-third of cases (284 of 880, 32·3 per cent). In total, 205 patients (23·3 per cent) developed a complication, but only 25 (2·8 per cent) required reoperation. Median postoperative lesion size was 24·5 (i.q.r. 16-38) mm. Incomplete excision was seen in 132 procedures (14·7 per cent), but completion mastectomy was required for only 51 lesions (5·7 per cent). Median time to adjuvant therapy was 54 (i.q.r. 42-66) days. CONCLUSION Therapeutic mammaplasty is a safe and effective alternative to mastectomy or standard breast-conserving surgery. Further work is required to explore the impact of the technique on quality of life, and to establish cost-effectiveness.
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Affiliation(s)
- R L O'Connell
- Department of Breast Surgery, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - E Baker
- Department of Breast Surgery, Airedale General Hospital, Keighley, UK
| | - A Trickey
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - T Rattay
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - L Whisker
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - R D Macmillan
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Potter
- Population Health Sciences, Bristol Medical School, Bristol, UK.,Bristol Breast Care Centre, North Bristol NHS Trust, Bristol, UK
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19
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Romics L, Macaskill EJ, Fernandez T, Simpson L, Morrow E, Pitsinis V, Tovey S, Barber M, Masannat Y, Stallard S, Weiler-Mithoff E, Malyon A, Mansell J, Campbell EJ, Doughty J, Dixon JM. A population-based audit of surgical practice and outcomes of oncoplastic breast conservations in Scotland – An analysis of 589 patients. Eur J Surg Oncol 2018; 44:939-944. [DOI: 10.1016/j.ejso.2018.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/21/2018] [Accepted: 04/05/2018] [Indexed: 01/15/2023] Open
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20
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Habibi M, Broderick KP, Sebai ME, Jacobs LK. Oncoplastic Breast Reconstruction: Should All Patients be Considered? Surg Oncol Clin N Am 2018; 27:167-180. [PMID: 29132559 DOI: 10.1016/j.soc.2017.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Oncoplastic surgery of the tissue defect from partial mastectomy should be considered for all patients. It can result in in significant asymmetries from scar contraction, skin tethering, and alterations in the nipple areolar complex location. Indications, risks, and benefits are discussed. Optimal procedures are described, considering resected specimen volume, primary tumor location, tumor to breast size ratio, and the impact on the nipple areolar complex. Indications for plastic surgery consultation and joint surgery are discussed. Surgical management includes incision planning, preservation of the nipple areolar complex pedicle and position, patient positioning, incision location, and recovery.
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Affiliation(s)
- Mehran Habibi
- Department of Surgery, Johns Hopkins University, 4940 Eastern Avenue, Room A-562, Baltimore, MD 21224, USA
| | - Kristen P Broderick
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, 4940 Eastern Avenue, Suite A 520, Baltimore, MD 21224, USA
| | - Mohamad E Sebai
- Department of Surgery, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Building A 5th Floor-Room 562, Baltimore, MD 21224, USA
| | - Lisa K Jacobs
- Department of Surgery, Johns Hopkins University, Blalock 607, Baltimore, MD 21287, USA.
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21
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Winters ZE, Horsnell J, Elvers KT, Maxwell AJ, Jones LJ, Shaaban AM, Schmid P, Williams NR, Beswick A, Greenwood R, Ingram JC, Saunders C, Vaidya JS, Esserman L, Jatoi I, Brunt AM. Systematic review of the impact of breast-conserving surgery on cancer outcomes of multiple ipsilateral breast cancers. BJS Open 2018; 2:162-174. [PMID: 30079385 PMCID: PMC6069349 DOI: 10.1002/bjs5.53] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/11/2018] [Indexed: 01/16/2023] Open
Abstract
Background The clinical effectiveness of treating ipsilateral multifocal (MF) and multicentric (MC) breast cancers using breast‐conserving surgery (BCS) compared with the standard of mastectomy is uncertain. Inconsistencies relate to definitions, incidence, staging and intertumoral heterogeneity. The primary aim of this systematic review was to compare clinical outcomes after BCS versus mastectomy for MF and MC cancers, collectively defined as multiple ipsilateral breast cancers (MIBC). Methods Comprehensive electronic searches were undertaken to identify complete papers published in English between May 1988 and July 2015, primarily comparing clinical outcomes of BCS and mastectomy for MIBC. All study designs were included, and studies were appraised critically using the Newcastle–Ottawa Scale. The characteristics and results of identified studies were summarized. Results Twenty‐four retrospective studies were included in the review: 17 comparative studies and seven case series. They included 3537 women with MIBC undergoing BCS; breast cancers were defined as MF in 2677 women, MC in 292, and reported as MIBC in 568. Six studies evaluated MIBC treated by BCS or mastectomy, with locoregional recurrence (LRR) rates of 2–23 per cent after BCS at median follow‐up of 59·5 (i.q.r. 56–81) months. BCS and mastectomy showed apparently equivalent rates of LRR (risk ratio 0·94, 95 per cent c.i. 0·65 to 1·36). Thirteen studies compared BCS in women with MIBC versus those with unifocal cancers, reporting LRR rates of 2–40 per cent after BCS at a median follow‐up of 64 (i.q.r. 57–73) months. One high‐quality study reported 10‐year actuarial LRR rates of 5·5 per cent for BCS in 300 women versus 6·5 per cent for mastectomy among 887 women. Conclusion The available studies were mainly of moderate quality, historical and underpowered, with limited follow‐up and biased case selection favouring BCS rather than mastectomy for low‐risk patients. The evidence was inconclusive, weakening support for the St Gallen consensus and supporting a future randomized trial.
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Affiliation(s)
- Z E Winters
- Patient-Reported and Clinical Outcomes Research Group Surgical and Interventional Trials Unit (SITU) London UK
| | - J Horsnell
- Department of Breast Surgery Royal Surrey County Hospital NHS Foundation Trust Guildford UK
| | - K T Elvers
- Patient-Centred and Clinical Outcomes Research Group University of Bristol, Southmead Hospital Bristol UK
| | - A J Maxwell
- Nightingale Centre Wythenshawe Hospital Manchester UK
| | | | - A M Shaaban
- Department of Histopathology Queen Elizabeth Hospital Birmingham and University of Birmingham Birmingham UK
| | - P Schmid
- Centre for Experimental Cancer Medicine, Barts Cancer Institute Queen Mary University of London London UK
| | - N R Williams
- SITU, Division of Surgery and Interventional Science, Faculty of Medical Sciences University College London London UK
| | - A Beswick
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School University of Bristol, Southmead Hospital Bristol UK
| | - R Greenwood
- Research Design Service South West University Hospitals Bristol NHS Foundation Trust Bristol UK
| | - J C Ingram
- Research Design Service South West University Hospitals Bristol NHS Foundation Trust Bristol UK
| | - C Saunders
- Division of Surgery, Harry Perkins Institute of Medical Research, Fiona Stanley Hospital University of Western Australia Murdoch Western Australia Australia
| | - J S Vaidya
- SITU, Division of Surgery and Interventional Science, Faculty of Medical Sciences University College London London UK
| | - L Esserman
- University of California San Francisco Carol Franc Buck Breast Care Centre San Francisco California USA
| | - I Jatoi
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery University of Texas Health Science Centre San Antonio Texas USA
| | - A M Brunt
- Cancer Centre University Hospitals of North Midlands and Keele University Stoke-on-Trent UK
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22
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Catsman CJLM, Beek MA, Voogd AC, Mulder PGH, Luiten EJT. The COSMAM TRIAL a prospective cohort study of quality of life and cosmetic outcome in patients undergoing breast conserving surgery. BMC Cancer 2018; 18:456. [PMID: 29688847 PMCID: PMC5914027 DOI: 10.1186/s12885-018-4368-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 04/12/2018] [Indexed: 11/23/2022] Open
Abstract
Background Cosmetic result in breast cancer surgery is gaining increased interest. Currently, some 30–40% of the patients treated with breast conserving surgery (BCS) are dissatisfied with their final cosmetic result. In order to prevent disturbing breast deformity oncoplastic surgical techniques have been introduced. The extent of different levels of oncoplastic surgery incorporated in breast conserving surgery and its value with regard to cosmetic outcome, patient satisfaction and quality of life remains to be defined. The aim of this prospective cohort study is to investigate quality of life and satisfaction with cosmetic result in patients with breast cancer, undergoing standard lumpectomy versus level I or II oncoplastic breast conserving surgery. Methods Female breast cancer patients scheduled for BCS, from 18 years of age, referred to our outpatient clinic from July 2015 are asked to participate in this study. General, oncologic and treatment information will be collected. Patient satisfaction will be scored preceding surgery, and at 1 month and 1 year follow up. Photographs of the breast will be used to score cosmetic result both by the patient, an independent expert panel and BCCT.Core software. Quality of life will be measured by using the BREAST-Q BCT, EORTC-QLQ and EQ-5D-5 L questionnaires. Discussion The purpose of this prospective study is to determine the clinical value of different levels of oncoplastic techniques in breast conserving surgery, with regard to quality of life and cosmetic result. Analysis will be carried out by objective measurements of the final cosmetic result in comparison with standard breast conserving surgery. The results of this study will be used to development of a clinical decision model to guide the use oncoplastic surgery in future BCS. Trial registration Central Commission of Human Research (CCMO), The Netherlands: NL54888.015.15. Medical Ethical Commission (METC), Maxima Medical Centre, Veldhoven, The Netherlands: 15.107. Dutch Trial Register: NTR5665, retrospectively registered, 02-25-2016. Electronic supplementary material The online version of this article (10.1186/s12885-018-4368-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Coriene J L M Catsman
- Department of Surgery, Amphia Hospital, Molengracht 21, 4818, CK, Breda, The Netherlands.
| | - Martinus A Beek
- Department of Surgery, Amphia Hospital, Molengracht 21, 4818, CK, Breda, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Paul G H Mulder
- Department of Surgery, Amphia Hospital, Molengracht 21, 4818, CK, Breda, The Netherlands
| | - Ernest J T Luiten
- Department of Surgery, Amphia Hospital, Molengracht 21, 4818, CK, Breda, The Netherlands
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23
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Winters ZE, Benson JR. Surgical treatment of multiple ipsilateral breast cancers. Br J Surg 2018; 105:466-468. [DOI: 10.1002/bjs.10738] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 01/03/2023]
Abstract
Abundant research
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Affiliation(s)
- Z E Winters
- Surgical and Interventional Trials Unit, Division of Surgery and Interventional Science, Faculty of Medical Sciences, University College London, 1 Euston Square, 40 Melton Street, London NW1 2FD, UK
| | - J R Benson
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge, UK
- School of Medicine, Anglia Ruskin University, Cambridge and Chelmsford, UK
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24
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Campbell EJ, Romics L. Oncological safety and cosmetic outcomes in oncoplastic breast conservation surgery, a review of the best level of evidence literature. BREAST CANCER (DOVE MEDICAL PRESS) 2017; 9:521-530. [PMID: 28831273 PMCID: PMC5552002 DOI: 10.2147/bctt.s113742] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Oncoplastic breast conservation surgery (OBCS) is increasingly becoming part of routine breast cancer surgical management. OBCS may be viewed as an extension of standard breast conservation surgery for resecting tumors of larger sizes without compromising on cosmetic outcome, or as an alternative to mastectomy. High quality evidence to support the oncological safety and benefits of OBCS is lacking. This review will focus on the best available level of evidence and address key issues regarding oncological safety in OBCS, such as tumor resection margins and re-excision rates, local recurrence and patient outcome, postoperative complications and adjuvant therapy delivery, and briefly discuss cosmetic outcome in OBCS. Comparative observational studies and systematic review report no poorer outcomes compared with standard breast conservation surgery. More evidence needs to be generated to support the oncological safety and improved aesthetic outcome. Prospective data collection will significantly contribute to the generation of stronger evidence.
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Affiliation(s)
| | - Laszlo Romics
- Department of Surgery, New Victoria Hospital Glasgow
- Department of Academic Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, UK
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25
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Standard wide local excision or bilateral reduction mammoplasty in large-breasted women with small tumours: Surgical and patient-reported outcomes. Eur J Surg Oncol 2017; 43:636-641. [DOI: 10.1016/j.ejso.2016.10.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 10/11/2016] [Accepted: 10/31/2016] [Indexed: 11/19/2022] Open
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26
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Bilateral mammoplasty for cancer: Surgical, oncological and patient-reported outcomes. Eur J Surg Oncol 2017; 43:68-75. [DOI: 10.1016/j.ejso.2016.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/10/2016] [Accepted: 08/10/2016] [Indexed: 11/22/2022] Open
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27
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Ho W, Stallard S, Doughty J, Mallon E, Romics L. Oncological Outcomes and Complications After Volume Replacement Oncoplastic Breast Conservations-The Glasgow Experience. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2016; 10:223-228. [PMID: 28008267 PMCID: PMC5170883 DOI: 10.4137/bcbcr.s41017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 10/30/2016] [Accepted: 10/31/2016] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Oncoplastic breast conservation surgery (OBCS) combines the principles of surgical oncology and plastic surgery. OBCS has now become a growing option for the treatment of breast cancer and forms a part of breast-conserving therapy (BCT). We sought to investigate and report our experience in two breast units in Glasgow (Victoria Infirmary and Western Infirmary) on volume replacement OBCS. MATERIALS AND METHODS Details of patients treated with volume replacement OBCS were identified from a prospectively recorded database from November 2010 to October 2015. The clinical records included in the oncoplastic dataset were analyzed for demographics, tumor, treatment characteristics, and recurrences. The data were analyzed for follow-up to determine the pattern and timing of recurrence up to April 2016. The primary outcome of this study was tumor-free margin resection rates, and the secondary outcomes were locoregional and distant recurrence rates as these correlate with the overall oncological safety of volume replacement oncoplastic breast surgery (OPBS). RESULTS A total of 30 volume replacement oncoplastic breast conservation procedures have been carried out in this time period. The mean age of the former group was 51 years. Twice as many patients presented symptomatically than had tumors detected on screening. The mean preoperative tumor size on radiology was 25.4 mm. Patients underwent 13 thoracoepigastric flaps, 5 lateral intercostal artery perforator (LICAP) flaps, 2 thoracodorsal artery perforator (TDAP) flaps, 1 lateral thoracic artery perforator (LTAP) flap, 1 crescent flap volume replacement surgery, and 8 matrix rotations. Two patients had neoadjuvant chemotherapy. Fourteen patients had adjuvant chemotherapy, and all patients were treated with adjuvant radiotherapy. Twenty-two patients were treated with hormonal therapy and four patients were treated with Herceptin. The rate of incomplete excision was 10%. Median follow-up time was 48.5 months. Only one regional recurrence was detected. Eight patients encountered some form of complication. CONCLUSION This study continues to show the relative oncological safety of volume replacement oncoplastic conservations as an option for reconstruction in breast cancer patients. Further research is urgently needed to build robust evidence supporting the long-term oncological safety.
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Affiliation(s)
- Weiguang Ho
- The New Victoria Infirmary, Glasgow, Scotland, UK
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Baker E, Kim B, Rattay T, Williams K, Ives C, Remoundos D, Holcombe C, Gardiner MD, Jain A, Sutton R, Achuthan R, Turton P, Fairbrother P, Brock L, Aggarwal S, Basu N, Murphy J, Trickey A, Macmillan RD, Potter S. The TeaM ( Th er apeutic Mammaplasty) study: Protocol for a prospective multi-centre cohort study to evaluate the practice and outcomes of therapeutic mammaplasty. Int J Surg Protoc 2016; 1:3-10. [PMID: 31851757 PMCID: PMC6913574 DOI: 10.1016/j.isjp.2016.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 08/20/2016] [Accepted: 08/20/2016] [Indexed: 11/15/2022] Open
Abstract
Multicentre prospective study involving breast and plastic surgical units across the UK. Will produce valuable data regarding the practice and outcomes of therapeutic mammaplasty. Will inform decision-making and lead to future definitive study. Will strengthen the collaborative network to facilitate the delivery of future projects. Will increase awareness of the techniques among trainees such that participation is educational.
Introduction Wide local excision and adjuvant radiotherapy is the standard of care for early breast cancer. For large tumours, however, mastectomy is frequently recommended as conventional breast-conserving techniques often result in poor cosmetic outcomes. Therapeutic mammaplasty (TM) may extend the boundaries of breast-conserving surgery by combining breast reduction and mastopexy techniques with tumour excision, preserving a natural breast shape and avoiding the need for mastectomy. The prevalence of this operative option among surgeons in the UK and its success rate are unknown. The TeaM study is a multicentre prospective study that aims to investigate the practice and outcomes of TM. Methods and analysis Breast centres performing TM will be invited to participate through the research collaborative network and the professional associations. All patients undergoing TM between September 2016 and March 2017 will be included. Demographic, operative, oncological and complication data within 30-days of surgery will be collected. The primary outcome will be unplanned re-operation for complications. Secondary outcomes will include unplanned readmission, re-excision rates and time to adjuvant therapy. Prospective data on 500 patients from 50 centres are anticipated. Exploratory analyses will identify predictors for complications and inform the design of a definitive study. Ethics and dissemination Research ethics approval is not required for this study. This has been confirmed by the on-line Health Research Authority decision tool. This study will provide novel information regarding the practice and outcomes of TM in the UK. This will inform decision-making for patients and surgeons and inform future research. Dissemination of the study protocol will be via the Mammary Fold Academic and Research Collaborative, the Reconstructive Surgery Trials Network and the professional associations, the Association of Breast Surgery and British Association of Plastic, Reconstructive and Aesthetic Surgeons. Results will be presented at relevant surgical conferences and published in peer-reviewed journals.
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Affiliation(s)
- Elizabeth Baker
- Breast Unit, Bradford Teaching Hospitals, Duckworth Lane, Bradford BD9 6RJ, UK
| | - Baek Kim
- Department of Breast Surgery, St. James's University Hospital, Beckett Street, Leeds LS9 7TF, UK
| | - Tim Rattay
- Department of Cancer Studies, Clinical Sciences Building, University of Leicester, Leicester LE2 2LX, UK
| | - Kathryn Williams
- Nightingale Breast Unit, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK
| | - Charlotte Ives
- Torbay and South Devon NHS Foundation Trust, Newton Road, Torquay, Devon TQ2 7AA, UK
| | - Dennis Remoundos
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Chris Holcombe
- Linda McCartney Centre, Royal Liverpool and Broadgreen University Hospital, Prescot Street, Liverpool L7 8XP, UK
| | - Matthew D Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7HE, UK.,Department of Surgery and Cancer, Imperial College London, SW7 2AZ, UK
| | - Abhilash Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7HE, UK.,Imperial College London NHS Trust, London SW7 2AZ, UK
| | - Richard Sutton
- Royal United Hospital NHS Foundation Trust, Combe Park, Bath, Avon BA1 3NG, UK
| | - Rajgopal Achuthan
- Breast Unit, Bradford Teaching Hospitals, Duckworth Lane, Bradford BD9 6RJ, UK
| | - Philip Turton
- Breast Unit, Bradford Teaching Hospitals, Duckworth Lane, Bradford BD9 6RJ, UK
| | | | - Lisa Brock
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham NG5 1PB, UK
| | - Shweta Aggarwal
- Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, London E11 1NR, UK
| | - Naren Basu
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK
| | - John Murphy
- Nightingale Breast Unit, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK
| | - Adam Trickey
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol BS8 2PS, UK
| | - R Douglas Macmillan
- Nottingham Breast Institute, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham NG5 1PB, UK
| | - Shelley Potter
- Bristol Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Clifton, Bristol BS8 2PS, UK
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Jeevan R, Mennie JC, Mohanna PN, O'Donoghue JM, Rainsbury RM, Cromwell DA. National trends and regional variation in immediate breast reconstruction rates. Br J Surg 2016; 103:1147-56. [PMID: 27324317 DOI: 10.1002/bjs.10161] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/18/2015] [Accepted: 02/16/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Previous studies have identified variation in immediate reconstruction (IR) rates following mastectomy for breast cancer across English regions during a period of service reorganization, a national audit and changing guidelines. This study analysed current variations in regional rates of IR in England. METHODS Patient-level data from Hospital Episode Statistics were used to define a cohort of women who underwent primary mastectomy for invasive or in situ breast carcinoma in English National Health Service (NHS) hospitals between April 2000 and March 2014. A time series of IR rates was calculated nationally and within regions in 28 cancer networks. Regional IR rates before and after the national audit were compared, using logistic regression to adjust for patient demographics, tumour type, co-morbidity and year of mastectomy. RESULTS Between 2000 and 2014, a total of 167 343 women had a mastectomy. The national IR rate was stable at around 10 per cent until 2005; it then increased to 23·3 per cent by 2013-2014. Preaudit (before January 2008), adjusted cancer network-level IR rates ranged from 4·3 to 22·6 per cent. Postaudit (after April 2009) adjusted IR rates ranged from 13·1 to 36·7 per cent, with 20 networks having IR rates between 15 and 24 per cent. The degree of change was not greatest amongst those that started with the lowest IR rates, with four networks with the largest absolute increase also starting with relatively high IR rates. CONCLUSION The national IR rate increased throughout the study period. Substantial regional variation remains, although considerable time has elapsed since a period of service reorganization, guideline revision and a national audit.
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Affiliation(s)
- R Jeevan
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Regional Paediatric Burns and Plastic Surgery Service, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - J C Mennie
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Plastic Surgery Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - P N Mohanna
- Plastic Surgery Service, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - J M O'Donoghue
- Plastic and Reconstructive Surgery Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - R M Rainsbury
- Department of Breast Surgery, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Winchester, UK
| | - D A Cromwell
- Clinical Effectiveness Unit, The 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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Current Practice of Therapeutic Mammaplasty: A Survey of Oncoplastic Breast Surgeons in England. Int J Surg Oncol 2016; 2016:1947876. [PMID: 27110398 PMCID: PMC4821971 DOI: 10.1155/2016/1947876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/03/2016] [Indexed: 11/21/2022] Open
Abstract
Introduction. Therapeutic mammaplasty (TM) is a useful technique in the armamentarium of the oncoplastic breast surgeon (OBS). There is limited guidance on patient selection, technique, coding, and management of involved margins. The practices of OBS in England remain unknown. Methods. Questionnaires were sent to all OBS involved with the Training Interface Group. We assessed the number of TM cases performed per surgeon, criteria for patient selection, pedicle preference, contralateral symmetrisation, use of routine preoperative MRI, management of involved margins, and clinical coding. Results. We had an overall response rate of 43%. The most common skin resection technique utilised was wise pattern followed by vertical scar. Superior-medial pedicle was preferred by the majority of surgeons (62%) followed by inferior pedicle (34%). Twenty percent of surgeons would always proceed to a mastectomy following an involved margin, whereas the majority would offer reexcision based on several parameters. The main absolute contraindication to TM was tumour to breast ratio >50%. One in five surgeons would not perform TM in smokers and patients with multifocal disease. Discussion. There is a wide variation in the practice of TM amongst OBS. Further research and guidance would be useful to standardise practice, particularly management of involved margins and coding for optimal reimbursement.
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Kabir SA, Stallard S, Weiler-Mithoff E, Mansell J, Mallon E, Doughty JC, Romics L. Six-year follow-up of patients treated with oncoplastic reduction mammoplasty: A cohort study. Int J Surg 2016; 26:38-42. [DOI: 10.1016/j.ijsu.2016.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/11/2015] [Accepted: 01/01/2016] [Indexed: 12/01/2022]
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Holt R, Murphy J. PICO™ incision closure in oncoplastic breast surgery: a case series. Br J Hosp Med (Lond) 2015; 76:217-23. [PMID: 25853353 DOI: 10.12968/hmed.2015.76.4.217] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Single-use negative pressure wound therapy (PICO™) has been used on high-risk surgically incised wounds with encouraging results, but there is no evidence for its use in oncoplastic breast surgery. This article reports a case series with closed incisions in oncoplastic breast procedures following the introduction of PICO™.
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Affiliation(s)
- Rachel Holt
- ST8 Trainee in Plastic Surgery, University Hospital South Manchester NHS Foundation Trust, Manchester M23 9LT
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33
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Therapeutic mammoplasty allows for clear surgical margins in large and multifocal tumours without delaying adjuvant therapy. Breast 2015; 24:171-4. [DOI: 10.1016/j.breast.2015.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 12/22/2014] [Accepted: 01/08/2015] [Indexed: 10/24/2022] Open
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Emiroğlu M, Sert İ, İnal A. The Role of Oncoplastic Breast Surgery in Breast Cancer Treatment. THE JOURNAL OF BREAST HEALTH 2015; 11:1-9. [PMID: 28331682 PMCID: PMC5351526 DOI: 10.5152/tjbh.2014.2215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 07/01/2014] [Indexed: 11/22/2022]
Abstract
The aim of this study is to discuss indications, advantages, disadvantages, oncologic and aesthetic results of Oncoplastic Surgery (OBS). Pubmed and Medline database were searched for articles published between 1998 and 2014 for keywords: oncoplastic breast surgery, therapeutic mammoplasty, oncoplastic breast reduction, synchrenous reconstructions. Role of OBS in breast cancer surgery, its aspects to be considered, its value and results have been interpreted. This technique has advantages by providing more extensive tumourectomy, yielding better aesthetic results compared with breast conserving surgery, allowing oncoplastic reduction in breast cancer patients with macromastia, with higher patient satisfaction and quality of life and by being inexpensive due to single session practice. As for its disadvantages are: re-excision is more difficult, risk for mastectomy is higher, it is depent on the Surgeron's experience, it has a risk for delay in adjuvant therapies and its requirement for additional imaging studies during management. Main indications are patients with small tumour/breast volume, macromastia, multifocality, procedures which can disrupt breast cosmesis such as surgeries for upper inner breas tquadrient tumours. Contraindications are positive margin problems after wide excision, diffuse malign microcalsifications, inflammatory breast cancer, history of radiotherapy and patients' preferences. Despite low evidence level, Oncoplastic Breast Surgery seems to be both reliable and acceptable in terms of oncologic and aesthetic aspects. Oncoplastic Breast Surgery increase the application rate of breast conserving surgery by obviating practical limitations and improve the results of breast conserving surgery. Correct patient and technique choice in OBS is vital for optimization of post surgical.
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Affiliation(s)
- Mustafa Emiroğlu
- Clinic of General Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
| | - İsmail Sert
- Clinic of General Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Abdullah İnal
- Clinic of General Surgery, Bursa Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
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35
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Mansfield L, Agrawal A, Cutress RI. Oncoplastic breast conserving surgery. Gland Surg 2014; 2:158-62. [PMID: 25083477 DOI: 10.3978/j.issn.2227-684x.2013.08.04] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 08/28/2013] [Indexed: 11/14/2022]
Abstract
Oncoplastic breast conserving surgery is a fundamental component of the repertoire for the management of breast cancer. It facilitates removal of large volumes of breast tissue, and can improve cosmetic outcomes and patient satisfaction whilst maintaining good oncological principles, reducing re-excision and mastectomy rates and assisting in adjuvant radiotherapy planning. We review the various techniques for oncoplastic breast conserving surgery that have emerged over recent years and describe their utilisation in excising tumours from various locations within the breast, and the pertinent patient specific factors that must be considered in technique selection. Finally complications and the evidence for the oncological safety specific to this type of surgery are discussed.
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Affiliation(s)
- Lucy Mansfield
- 1 Portsmouth Breast Care Centre, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK ; 2 Southampton Breast Unit, Princess Anne Hospital, Southampton, SO16 5YA, UK
| | - Avi Agrawal
- 1 Portsmouth Breast Care Centre, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK ; 2 Southampton Breast Unit, Princess Anne Hospital, Southampton, SO16 5YA, UK
| | - Ramsey I Cutress
- 1 Portsmouth Breast Care Centre, Queen Alexandra Hospital, Portsmouth, PO6 3LY, UK ; 2 Southampton Breast Unit, Princess Anne Hospital, Southampton, SO16 5YA, UK
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Surgical strategy, methods of reconstruction, surgical margins and postoperative complications in oncoplastic breast surgery. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014; 37:205-214. [PMID: 24659858 PMCID: PMC3950564 DOI: 10.1007/s00238-013-0922-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/19/2013] [Indexed: 01/10/2023]
Abstract
Background Oncoplastic breast surgery is an evolving discipline in the surgical treatment of breast cancer aimed to improve the outcome. Methods Oncoplastic breast surgery was performed between January 2008 and December 2010 on 72 women with 74 breast cancers selected from a population of 1,018 primary breast cancer patients. Careful preoperative planning revealed the possibility of partial breast reconstruction with volume reduction, volume displacement or volume replacement depending on breast size as well as tumour size and location. Data were registered consecutively. Results The surgical plan was successful in all but one case, where a mastectomy had to be performed during the primary surgery. In 53 cases, a contralateral mammoplasty was performed during the operation to achieve symmetry. During the follow-up period until November 2011, only one patient needed corrective surgery. Final histopathological examination indicated that seven cases required extended resection and three cases required a mastectomy. Five patients experienced delayed wound healing, although complications requiring further surgery occurred for the reconstructed breast in four cases, the contralateral breast in three cases and the axilla after exaeresis in two cases because of haematoma. Such complications led to slight delay in adjuvant therapy for four patients. Conclusions This study demonstrates that it is feasible to implement oncoplastic breast surgery into daily clinical practice as a supplement to conventional breast cancer surgery. As such, oncoplastic breast surgery may provide a markedly better outcome than breast-conserving surgery in terms of shape and symmetry without compromising the surgical margins. Level of Evidence: Level IV, prognostic/risk study.
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Therapeutic mammaplasty – Impact on the delivery of chemotherapy. Int J Surg 2014; 12:51-5. [DOI: 10.1016/j.ijsu.2013.10.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/22/2013] [Accepted: 10/25/2013] [Indexed: 11/20/2022]
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Quality of information reporting in studies of standard and oncoplastic breast-conserving surgery. Breast 2013; 23:104-11. [PMID: 24388734 DOI: 10.1016/j.breast.2013.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 11/30/2013] [Accepted: 12/07/2013] [Indexed: 11/20/2022] Open
Abstract
The aim of this systematic review was to establish the completeness of reporting of key patient, tumour, treatment, and outcomes information in the randomized-controlled trials (RCTs) of standard breast-conserving surgery (sBCS) considered to be the 'gold-standard', and to compare this with the reporting of the same key criteria for all published studies of oncoplastic breast-conserving surgery (oBCS). Pubmed (1966 to 1st April 2013), Ovid MEDLINE (1966 to 1st April 2013), EMBASE (1980 to 1st April 2013), and the Cochrane Database of Systematic Reviews (Issue 4, 2013) were searched separately for the following terms: (i) 'oncoplastic AND breast AND surgery'; and (ii) 'therapeutic AND mammaplasty'. Only English language and full text articles were reviewed. Following a pilot evaluation of all studies, key reporting criteria were identified. 16 RCTs of sBCS (n = 11,767 patients) were included, and 53 studies met the inclusion criteria for oncoplastic BCS (n = 3236 patients), none of which were RCTs. No study reported all of the criteria identified, with a mean of 64% of key criteria (range, 55-75%) reported in studies of sBCS, and 54% of criteria (range, 10-85%) reported in studies of oBCS. It is therefore evident that there is much room for improvement in the quality of reporting is BCS studies. Standards are proposed to give future studies of BCS a framework for reporting key information and outcomes.
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Hicks G, Turton P, Rajan S, Nunn A, Sharma N, Achuthan R. The role of magnetic resonance imaging in preoperative planning for patients undergoing therapeutic mammoplasty. ISRN ONCOLOGY 2013; 2013:260260. [PMID: 24455305 PMCID: PMC3877648 DOI: 10.1155/2013/260260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 11/12/2013] [Indexed: 11/17/2022]
Abstract
Background. Assessment of the ratio between tumour volume and breast volume in therapeutic mammoplasty is paramount. Traditionally based on clinical assessment and conventional breast imaging, the role of breast magnetic resonance imaging (MRI) in this context has not been established. Methods. Data was collected from all women undergoing therapeutic mammoplasty (TM) between 2006 and 2011. Each case was discussed at an MDT where MRI was considered to facilitate surgical planning. The contribution of MRI to disease assessment and surgical outcome was then reviewed. Results. 35 women underwent TM, 15 of whom had additional MRI. 33% of patients within the MRI subgroup had abnormalities not seen on either mammography or USS. Of those undergoing MRI, 1/15 patients required completion mastectomy versus 3 patients requiring completion mastectomy and 1 patient requiring further wide local excision (4/20) in the conventional imaging group. No statistical difference was seen between size on MRI and size on mammography versus final histological size, but a general trend for greater correlation between size on MRI and final histological size was seen. Conclusion. MRI should be considered in selected patients undergoing therapeutic mammoplasty. Careful planning can identify those who are most likely to benefit from MRI, potentially reducing the need for further surgery.
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Affiliation(s)
- Gareth Hicks
- Breast Unit, St. James' University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Philip Turton
- Breast Unit, St. James' University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Sree Rajan
- Breast Unit, St. James' University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - April Nunn
- Breast Unit, St. James' University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Nisha Sharma
- Breast Unit, St. James' University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
| | - Raj Achuthan
- Breast Unit, St. James' University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK
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Currie A, Chong K, Davies GL. Using therapeutic mammoplasty to extend the role of breast-conserving surgery in women with larger or ptotic breasts. Ann R Coll Surg Engl 2013; 95:192-5. [PMID: 23827290 DOI: 10.1308/003588413x13511609958091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The equivalence of breast-conserving surgery followed by postoperative radiotherapy against mastectomy is now firmly established in patients with early breast cancer. The results of surgery in large-breasted women can be poor, with radiation-induced fibrosis, chronic pain and poor cosmesis contributing to long-term psychological and physical morbidity. Therapeutic mammoplasty offers an alternative management strategy to both enhance the role of breast-conserving surgery and provide better outcomes. METHODS A retrospective note review was undertaken of all patients undergoing therapeutic mammoplasty for breast malignancy between 2007 and 2011. All cases were performed using a Wise pattern-reduction technique. Histology and pathological outcomes were assessed. Postoperative outcomes reviewed included wound infection, seroma and need for further intervention. RESULTS During the study period, 20 patients underwent therapeutic mammoplasty with a mean follow-up duration of 36 months. The mean weight of the lumpectomy specimen was 330g. The average cancer size was 34mm, with a mean margin clearance of 7mm. There was one episode of wound infection and three of delayed wound healing at the T-junction. One patient required a mastectomy for involved margins. There were no recurrences at the most recent follow-up visit. CONCLUSIONS Therapeutic mammoplasty offers a tailored approach to women with larger breasts and early breast cancers with good cosmetic results and oncological outcomes.
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Affiliation(s)
- A Currie
- Department of Breast Surgery, Kingston Hospital, Galsworthy Road, Kingston upon Thames, Surrey KT2 7QB, UK.
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Romics L, Barrett S, Stallard S, Weiler-Mithoff E. [Intraoperative, postoperative and long-term oncosurgical safety of therapeutic mammaplasty]. Orv Hetil 2013; 154:1291-6. [PMID: 23933607 DOI: 10.1556/oh.2013.29660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION (Pre)malignant lesion in the breast requiring mastectomy conventionally may be treated with breast conservation by using oncoplastic breast surgical techniques, which is called therapeutic mammaplasty. However, no reliable data has been published so far as regards the oncological safety of this method. AIM The aim of the authors was to analyse the oncological safety of therapeutic mammaplasty in a series of patients. METHOD 99 patients were treated with therapeutic mammaplasty and data were collected in a breast surgical database prospectively. Results were analysed with respect to intraoperative, postoperative and long-term oncological safety. RESULTS Incomplete resection rate was 14.1%, which correlated with tumour size (p = 0.023), and multifocality (p = 0.012). Time between surgery (therapeutic mammaplasty) and chemotherapy was similar to time between conventional breast surgeries (wide excision, mastectomy, mastectomy with immediate reconstruction) and chemotherapy (mean 29-31 days; p<0.05). Overall recurrence rate was 6.1%, locoregional recurrence rate was 2% during 27 month (1-88) mean follow-up. CONCLUSIONS Since literature data are based on relatively short follow-up and low patient number, it is highly important that all data on therapeutic mammaplasty is collected in a prospectively maintained breast surgical database in order to determine true recurrence after long-follow-up.
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Affiliation(s)
- László Romics
- Victoria Infirmary Glasgow Langside Road Glasgow G49 9TY Egyesült Királyság.
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Abstract
Recent studies have shown that the number of women undergoing risk-reducing mastectomy has increased rapidly in the USA in the past 15 years. Although a small rise in the number of bilateral risk-reducing procedures has been noted in high-risk gene mutation carriers who have never had breast cancer, this number does not account for the overall increase in procedures undertaken. In patients who have been treated for a primary cancer and are judged to be at high risk of a contralateral breast cancer, contralateral risk-reducing mastectomy is often, but not universally, indicated. However, many patients undergoing contralateral risk-reducing mastectomy might not be categorised as high risk and therefore any potential benefit from this procedure is unproven. At a time when breast-conserving surgery has become more widely used, this sharp increase in contralateral risk-reducing mastectomy is surprising. We have reviewed the literature in an attempt to establish what is driving the increase in this procedure in moderate-to-low-risk populations and to assess its justification in terms of risk-benefit analysis.
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Khan J, Barrett S, Forte C, Stallard S, Weiler-Mithoff E, Doughty JC, Romics L. Oncoplastic breast conservation does not lead to a delay in the commencement of adjuvant chemotherapy in breast cancer patients. Eur J Surg Oncol 2013; 39:887-91. [PMID: 23746877 DOI: 10.1016/j.ejso.2013.05.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/11/2013] [Accepted: 05/08/2013] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION There is hardly any evidence that oncoplastic breast conservation surgery (OBCS) does not lead to a delay in the commencement of adjuvant chemotherapy. Although this is an integral part of overall oncological safety, no controlled studies have been published so far. Therefore, our aim was to determine whether OBCS led to a delay when compared to simple wide local excision (WLE), mastectomy (Ms) or mastectomy with immediate reconstruction (MsIR). METHODS Breast cancer patients who required adjuvant chemotherapy after OBCS, WLE, Ms and MsIR were identified from prospectively maintained institutional databases. Time between multidisciplinary team decision to offer chemotherapy and delivery of first cycle of chemotherapy was measured and compared among the four groups of patients. RESULTS time to chemotherapy of breast cancer patients (n = 169) treated with OBCS (n = 31) were 29 [16-58] days, while it was 29.5 [15-105] days after WLE (n = 66), 29 [15-57] days after Ms (n = 56) and 31 [15-58] days after MsIR (n = 16). A combined analysis involving all four groups demonstrated no statistically significant difference (p = 0.524). Similarly, inter-group analysis revealed no significant differences in between patients treated with OBCS compared to any of the three control groups (OBCS to WLE: p = 0.433; OBCS to Ms: p = 0.800; OBCS to MsIR: p = 0.405). CONCLUSION OBCS seems as safe as WLE, Ms or MsIR in terms of delivery of adjuvant chemotherapy, and, therefore, should not adversely affect breast cancer outcome in this respect.
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Schaverien MV, Raine C, Majdak-Paredes E, Dixon JM. Therapeutic mammaplasty--extending indications and achieving low incomplete excision rates. Eur J Surg Oncol 2013; 39:329-33. [PMID: 23375468 DOI: 10.1016/j.ejso.2013.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 12/18/2012] [Accepted: 01/09/2013] [Indexed: 11/28/2022] Open
Abstract
AIMS The aim of this study was to report the outcomes of the first 50 consecutive therapeutic mammaplasty procedures at the Edinburgh Breast Unit. METHODS A retrospective case-notes analysis was performed. In addition a validated patient satisfaction and outcomes questionnaire was sent to all patients. RESULTS Fifty therapeutic mammaplasty procedures were performed in 48 patients, with contralateral synchronous breast reduction performed in 42 of these patients. The median age was 58 years (range, 34-81). The median total tumour size was 28 mm (range, 7-83 mm) and 11 patients had multifocal tumours. The median wide local excision weight was 119 g (range, 15-815) and the median total excision weight was 354 g (range, 20-1725). Neoadjuvant letrozole was used in 16 patients and neoadjuvant chemotherapy was given in six. Incomplete excision (DCIS) occurred in only one patient who underwent reexcision. Complications occurred in 19 breasts overall, delaying adjuvant chemotherapy in one patient. Median reported patient satisfaction with appearance was 9.5 out of ten, with 33 of 35 respondents reporting that they definitely or probably would choose the same operation again. CONCLUSIONS Therapeutic mammaplasty can be performed with a low rate of incomplete excision and complications, and high patient satisfaction, even with large tumours and multifocal disease. In this study the use of neoadjuvant letrozole in selected oestrogen receptor positive tumours, intraoperative radiographic imaging of specimens, and targeting further excision to around the tumour bed, was associated with a very low rate of incomplete excision.
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Affiliation(s)
- M V Schaverien
- Department of Plastic Surgery, Ninewells Hospital, Dundee DD1 9SY, UK.
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Denewer A, Elnahas W, Hussein O, Khater A, El-sadda W, Abouelkher KM. Evaluation of Inferior Pedicle Therapeutic Mammoplasty as a Primary Procedure for Upper Quadrants Early Breast Cancer. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/abcr.2013.23015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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