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Orsaria P, Grasso A, Caggiati L, Ippolito E, Pantano F, Piccolo C, Altomare V. Life after oncoplastic surgery (IRONY) trial: Preliminary results. Surg Oncol 2025; 59:102205. [PMID: 40088639 DOI: 10.1016/j.suronc.2025.102205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 01/29/2025] [Accepted: 03/04/2025] [Indexed: 03/17/2025]
Abstract
BACKGROUND Today partial reconstruction in breast cancer (BC) surgery involves displacement or replacement procedures to improve cosmesis without compromising safety. However, patient satisfaction should be compared among several options, in order to get additional criteria for a personalized approach. The aim is evaluate oncological, aesthetic and functional results after monolateral (reshaping or replacement) or bilateral (mammoplasty with contralateral pexy or reduction) conserving strategies. MATERIALS AND METHODS The protocol provides for the enrollment of a prospective sample of 250 patients in a time frame of 3 years. The first 108 cases (range 18-85 years) with BC diagnosis, and suitable for type 1-2 oncoplastic surgery who gave informed consent, were selected Data analysis was focused on radicality, complications, cosmetic and functional results related to quality of life, comparing monolateral (ML) and bilateral (BL) groups. RESULTS Tumor size (p = 0.01), multifocality (p = 0.05), multicentricity (p = 0.01) and estimated resection volume (p = 0.000) were higher in the BL group. There was a comparable re-excision rate for positive margins (p = 0.72), and after 2.3 years, no difference in local recurrences were recorded. No early (p > 0.05), but late complications were more common in the BL (p = 0.07). The overall satisfaction with cosmesis and well-being were characterized by similar proportions of good results (p>0.05), with some details more related to each procedure. CONCLUSION The proposed techniques represent effective solutions for reshaping that follows BC excision, achieving comparable early complications, low re-interventions with good aesthetic results and social functioning. However, is crucial a careful patient selection and surgical plan while predicting any sequel or delayed complication during follow-up.
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Affiliation(s)
- Paolo Orsaria
- Department of Breast Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro Del Portillo, 200, 00128, Roma, Italy.
| | - Antonella Grasso
- Department of Breast Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro Del Portillo, 200, 00128, Roma, Italy
| | - Lorenza Caggiati
- Department of Breast Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro Del Portillo, 200, 00128, Roma, Italy
| | - Edy Ippolito
- Department of Radiation Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro Del Portillo, 200, 00128, Roma, Italy
| | - Francesco Pantano
- Department of Medical Oncology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro Del Portillo, 200, 00128, Roma, Italy
| | - Claudia Piccolo
- Department of Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro Del Portillo, 200, 00128, Roma, Italy
| | - Vittorio Altomare
- Department of Breast Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro Del Portillo, 200, 00128, Roma, Italy
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Ku GDLC, Desai A, Singhal M, Mallouh M, King C, Rojas AN, Persing S, Homsy C, Chatterjee A, Nardello S. Oncoplastic Surgery with Volume Replacement versus Mastectomy with Implant-Based Breast Reconstruction: Early Postoperative Complications in Patients with Breast Cancer. J Reconstr Microsurg 2024. [PMID: 39608763 DOI: 10.1055/a-2491-3110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2024]
Abstract
BACKGROUND Two common surgical approaches for breast cancer are breast-conserving surgery and mastectomy with implant-based breast reconstruction (MIBR). However, for large tumors, an alternative to MIBR is oncoplastic surgery with volume replacement (OPSVR). We performed a comprehensive analysis comparing OPSVR with MIBR, with our aim to focus on the 30-day postoperative complications between these two techniques. METHODS We conducted a retrospective cohort study using the National Surgical Quality Improvement Program (NSQIP) database from 2005 to 2020. Only breast cancer patients were included and were divided according to the surgical technique: OPSVR and MIBR. Logistic regression analysis was used to assess independent risk factors for total, surgical, and wound complications. RESULTS A cohort of 8,403 breast cancer patients was analyzed. A total of 683 underwent OPSVR and 7,720 underwent MIBR. From 2005 to 2020, the adoption of OPSVR gradually increased over the years (p < 0.001), whereas MIBR decreased. OPSVR patients were older (57.04 vs. 51.89 years, p < 0.001), exhibited a higher body mass index (31.73 vs. 26.93, p < 0.001), had a greater prevalence of diabetes mellitus (11.0 vs. 5.0%, p < 0.001). They also had a higher ASA classification (2.33 vs. 2.15, p < 0.001), shorter operative time (173.39 vs. 216.20 minutes, p < 0.001), and a higher proportion of outpatient procedures (83.7 vs. 39.5%, p < 0.001). Outcome analysis demonstrated fewer total complications in the OPSVR patients (4.2 vs. 10.9%, p < 0.001), including lower rates of surgical complications (2.2 vs. 8.0%, p < 0.001) and wound complications (1.9 vs. 4.8%, p = 0.005) compared with MIBR patients. Multivariate analysis identified OPSVR as an independent protective factor for total, surgical, and wound complications. CONCLUSION OPSVR has become a favorable technique for patients with breast cancer. Even in patients with higher comorbidities, OPSVR demonstrates safe and better outcomes when compared with MIBR. It should be considered a reasonable and safe breast surgical option in the appropriate patient.
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Affiliation(s)
- Gabriel De La Cruz Ku
- Universidad Cientifica del Sur, Lima, Peru
- Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Anshumi Desai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Medical School, Miami, Florida
| | - Meera Singhal
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts
| | | | - Caroline King
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Alexis N Rojas
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Medical School, Miami, Florida
| | - Sarah Persing
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Christopher Homsy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Abhishek Chatterjee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts
- Division of Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Salvatore Nardello
- Division of Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, Massachusetts
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Hu JJ, Qin C, Liu S, Zhu M, Xia X, Liang C, Mao J, Zhang F, Yu Y. Oncoplastic Breast-Conserving Surgery for Upper Inner Quadrant Breast Cancer Using Pedicled Pectoralis Major Myofascial Flap. Cancer Manag Res 2024; 16:1747-1752. [PMID: 39678040 PMCID: PMC11645960 DOI: 10.2147/cmar.s472263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 10/25/2024] [Indexed: 12/17/2024] Open
Abstract
Background Oncoplastic breast-conserving surgery (OBCS) has emerged as a pivotal approach in the management of breast cancer, ensuring both oncological safety and aesthetic outcomes. However, challenges persist, particularly in upper inner quadrant (UIQ) tumors, where achieving satisfactory cosmetic results while preserving oncological integrity remains intricate. Methods 15 patients with UIQ breast cancer received OBCS using a pedicled pectoralis major myofascial flap (PMMF). All medical records, preoperative imaging findings, and post-operative data were gathered retrospectively. Results This study showed good cosmetic outcomes after OBCS of the upper inner pole and the patients were satisfied with the results. There were no recurrences or metastases in any of the patients. Conclusion PMMF as a technique is reliable blood supply, easy to master, no need for additional incision, and minimal surgical trauma and functional impact.
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Affiliation(s)
- Jie Jie Hu
- Breast Cancer Department, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, People’s Republic of China
| | - Chengdong Qin
- Breast Cancer Department, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, People’s Republic of China
| | - Siyuan Liu
- Breast Cancer Department, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, People’s Republic of China
- Postgraduate Training Base Alliance of Wenzhou Medical University, Hangzhou, Zhejiang, 310022, People’s Republic of China
| | - Meizhen Zhu
- Breast Cancer Department, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, People’s Republic of China
| | - Xianghou Xia
- Breast Cancer Department, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, People’s Republic of China
| | - Chenlu Liang
- Breast Cancer Department, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, People’s Republic of China
| | - Jiefei Mao
- Breast Cancer Department, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, People’s Republic of China
| | - Fanrong Zhang
- Breast Cancer Department, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, People’s Republic of China
| | - Yang Yu
- Breast Cancer Department, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, People’s Republic of China
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Ahmed AS, Mohamed MA, Mostafa HS, El Naggar ANM, Ali AHM, Ahmed AS, Ibrahim MF. Comparison of Oncological and Aesthetic Outcomes between Tissue Rearrangement Technique and Pedicled Latissimus Dorsi Flap Reconstruction in Cases of Upper Outer Quadrant Breast Cancer. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6065. [PMID: 39188964 PMCID: PMC11346860 DOI: 10.1097/gox.0000000000006065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 06/21/2024] [Indexed: 08/28/2024]
Abstract
Background Emerging as an adjunct to breast-conserving surgery, oncoplastic breast surgery seeks to improve the cosmetic and functional outcomes for breast cancer surgery. The objective was to assess the potential advantages of using the latissimus dorsi (LD) flap, in comparison with local tissue rearrangement, in terms of aesthetic results and postoperative problems. Methods This study compared the outcomes of patients with a malignant tumor removed from the upper outer quadrant of the breast using a comparative nonrandomized control approach. Participants were split into two groups: reconstruction using local tissue rearrangement was performed on 20 patients (group A), and a pedicled LD flap was used to treat the same number of patients (group B). All patients were examined in the clinics' outpatient setting. Every 3 months, the medical oncology team would do a thorough clinical assessment. Results Better aesthetic outcomes were significantly higher among patients with an LD flap. The LD flap was able to maintain breast shape in 90%, breast volume in 85%, and the nipple-areola complex direction in 90% of patients. Surgeons' evaluation of both techniques reported significantly higher satisfaction for LD flap than local tissue replacement. Patient satisfaction was significantly higher among patients with an LD flap. With regard to the postoperative complications, there were no significant differences between either group. Conclusions Oncoplastic breast surgery with reconstruction using the pedicled LD flap provides maintenance of the shape of female breasts with better aesthetic outcomes and patient and surgeon satisfaction than reconstruction using local tissue rearrangement, with a comparable complication rate.
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Affiliation(s)
- Ahmed S. Ahmed
- From the General Surgery Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Mohamed A.K. Mohamed
- From the General Surgery Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Hesham S. Mostafa
- From the General Surgery Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | | | - Abdel Halim M.A. Ali
- From the General Surgery Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed Safaa Ahmed
- From the General Surgery Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Mostafa F. Ibrahim
- From the General Surgery Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
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5
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Schwartz JCD. Combining Wise-pattern Volume Displacement and Autologous Volume Replacement to Facilitate Oncoplastic Breast Conservation. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5710. [PMID: 38596588 PMCID: PMC11000776 DOI: 10.1097/gox.0000000000005710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/12/2024] [Indexed: 04/11/2024]
Abstract
Background Oncoplastic breast conservation has been classically divided into volume displacement (VD) or volume replacement (VR) techniques. There have been few descriptions of merging these two approaches. This report describes our experience combining Wise-pattern VD and autologous VR to repair extensive partial mastectomy defects in patients with ptosis. Methods A retrospective chart review was performed for patients who underwent combined Wise-pattern VD surgery and autologous VR by the author from June 2017 to June 2023, with at least 6 months follow-up. Patient demographics, oncological and intraoperative details, and complications were recorded. Results Forty patients underwent Wise-pattern VD surgery combined with a medial intercostal artery perforator flap (five patients), lateral thoracic artery perforator/lateral intercostal artery perforator flap (18 patients), anterior intercostal artery perforator flap (five patients), or muscle-sparing latissimus dorsi flap (12 patients). The average tumor size was 4.0 cm (range, 1.5-9.1 cm), and specimen weight was 152 g (range, 33-415 g). Six patients (15%) required re-operation for positive margins. There was delayed healing of three (7.5%) donor sites. There were no flap failures. Two (5%) patients had clinically apparent fat necrosis without requirement for surgical revision. Conclusions This report demonstrates the feasibility of combining Wise-pattern VD and autologous VR. We propose that oncoplastic breast-conserving surgery be no longer divided into two mutually exclusive approaches and that surgeons make liberal use of combining these approaches to address challenging cases of breast-conserving surgery.
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Korayem IM, Ramadan R, Fayed H. Feasibility and early cosmetic outcome of modified lateral intercostal artery perforator flap after breast conservative surgery. BMC Surg 2024; 24:75. [PMID: 38431543 PMCID: PMC10908061 DOI: 10.1186/s12893-024-02367-6] [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: 12/16/2023] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The lateral intercostal artery perforator (LICAP) flap aims at replacing the excised breast lump with axillary tissue rich blood supply. The purpose of this study is to report the initial results of a modification LICAP flap technique in terms of intraoperative technical feasibility and short-term cosmetic outcomes in the early postoperative period. METHODS Modified LICAP flap technique was performed on 36 female patients with pathologically proven BC located in the outer half of the breast in the period from June 1, 2021, to April 30, 2022. RESULTS The LICAP flap modification enabled performing the procedure with the patient in supine position without repositioning. The majority of the patients (90%) had satisfactory early cosmetic results as reported by the patients and oncoplastic independent surgeon. CONCLUSION Modified LICAP flap reconstruction is feasible to be performed with the patient in supine position without repositioning and it has satisfactory early cosmetic outcomes.
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Affiliation(s)
- Islam M Korayem
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Rabie Ramadan
- Department of Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Haytham Fayed
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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7
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Chou HY, Tseng LM, Ma H, Perng CK, Huang CC, Tsai YF, Lin YS, Lien PJ, Feng CJ. Clinical outcomes and patient-reported outcomes after oncoplastic breast surgery in breast cancer patients: A matched cohort study. J Chin Med Assoc 2024; 87:320-327. [PMID: 38252489 DOI: 10.1097/jcma.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Surgery is the recommended treatment for breast cancer, the most common cancer in women in Taiwan and the leading cause of cancer-related deaths. Although breast-conserving surgery (BCS) has good prognosis, in some cases, BCS may cause more significant deformities and interfere with the patient's psychosocial well-being. Oncoplastic breast surgery (OBS) is the treatment option in these cases. This study aimed to determine the outcomes of OBS and BCS regardless of clinical and patient-reported esthetic outcomes. METHODS Between 2015 and 2020, 50 patients who underwent OBS at our hospital after complete treatment were enrolled. With 1:2 matched ratios, 100 patients were enrolled in the BCS control group. Clinical outcomes were analyzed. The BREAST-Q questionnaire was then assessed 6 months after the completion of treatment for subjective patient-reported outcomes. RESULTS Due to the matching process, no difference was noted between the two groups in terms of demographic data such as age, comorbidities, or tumor characteristics. There were no significant differences in the local recurrence rate, disease-free survival, overall survival, positive margin rate, rewide excision rate, conversion to mastectomy rate, or complication rate (major or minor) between both groups. However, the OBS group showed higher satisfaction with breasts in the BREAST-Q questionnaire ( p < 0.001). The mean follow-up time was 38.77 ± 14.70 months in the BCS group and 29.59 ± 14.06 months in the OBS group. CONCLUSION OBS seems to be a safe and feasible surgery in breast cancer patients because clinical outcomes are compatible with BCS. Moreover, the OBS group had better patient-reported outcomes in terms of satisfaction.
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Affiliation(s)
- Hsuan-Yu Chou
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan, ROC
| | - Ling-Ming Tseng
- Comprehensive Breast Health Center & Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsu Ma
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Surgery, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Cherng-Kang Perng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chi-Cheng Huang
- Comprehensive Breast Health Center & Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Fang Tsai
- Comprehensive Breast Health Center & Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yen-Shu Lin
- Comprehensive Breast Health Center & Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pei-Ju Lien
- Comprehensive Breast Health Center & Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chin-Jung Feng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Comprehensive Breast Health Center & Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Mustață LM, Peltecu G, Gică N, Botezatu R, Iancu G, Gheoca GD, Cigăran R, Iordăchescu DA. Evaluation of quality of life and socio-emotional impact of oncological treatment among patients with breast cancer. J Med Life 2024; 17:341-352. [PMID: 39044938 PMCID: PMC11262597 DOI: 10.25122/jml-2024-0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/29/2024] [Indexed: 07/25/2024] Open
Abstract
Breast cancer is the most frequent cancer in women worldwide. Quality of life (QoL) is significantly affected by both surgical and oncological treatment. The aim of this study was to assess and compare QoL, resilience and depression scores among women who had breast cancer treatment. We assessed 170 patients diagnosed with breast cancer in a non-experimental, descriptive study through anonymized questionnaires from January to March 2024. Patients were invited to fill in the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Breast Cancer Module (EORTC QLQ-BR23) questionnaire, the Depression Anxiety Stress Scale, the CD-RISC 10 questionnaire, and the MOS Social Support Survey. Clinical information and demographical data were obtained and statistical analysis was conducted to evaluate factors that affect QoL, resilience and depression scores. QoL was significantly influenced by chemotherapy and surgery. Women with higher resilience scores had lower anxiety and depression scores and reported a better QoL. Women with strong social support and high resilience reported a better QoL during and after breast cancer treatment. The results of our study show that breast cancer surgery and chemotherapy have an important impact on patients' QoL. Moreover, the results reflect the importance of both medical treatment and social support as resilience-building strategies in managing and improving the QoL of patients.
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Affiliation(s)
| | - Gheorghe Peltecu
- Department of Gynecology, Filantropia Clinical Hospital, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Nicolae Gică
- Department of Gynecology, Filantropia Clinical Hospital, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Radu Botezatu
- Department of Gynecology, Filantropia Clinical Hospital, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - George Iancu
- Department of Gynecology, Filantropia Clinical Hospital, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Ruxandra Cigăran
- Department of Gynecology, Filantropia Clinical Hospital, Bucharest, Romania
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Noguchi M, Morioka E, Yokoi-Noguchi M, Haba Y, Inokuchi M, Hisano M. Oncoplastic breast surgery to prevent "Bird's beak" deformity in the breast: a comparative retrospective study. Surg Today 2024; 54:14-22. [PMID: 37157037 DOI: 10.1007/s00595-023-02690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/06/2023] [Indexed: 05/10/2023]
Abstract
PURPOSES Breast deformity occurring in the lower pole after breast conserving surgery (BCS) is known as bird's beak (BB) deformity. This retrospective study evaluated the outcomes in breasts reconstructed with a conventional closing procedure (CCP) and a downward-moving procedure (DMP), respectively, after BCS. METHODS In CCP, the inferomedial and inferolateral portions of breast tissues were reapproximated toward the midline after wide excision to repair the breast defect. In DMP, the retro-areolar breast tissue was detached from the nipple-areolar complex after wide excision, and the upper pole breast tissue was moved downward to refill the breast defect. RESULTS CCP was performed in 20 patients (Group A), and DMP was performed in 28 patients (Group B). Although retraction of the lower part of the breast was postoperatively observed in 13 (72%) of 18 patients from Group A, it was observed in 7 (28%) of 25 patients in Group B (p < 0.05). The downward pointing of the nipple was observed in 8 (44%) of 18 patients from Group A and in 4 (16%) of 25 patients in Group B (p < 0.05). CONCLUSIONS DMP is more useful for preventing BB deformity than CCP.
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Affiliation(s)
- Masakuni Noguchi
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, 920-0293, Japan.
- Breast Center, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, Japan.
| | - Emi Morioka
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, 920-0293, Japan
- Breast Center, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, Japan
| | - Miki Yokoi-Noguchi
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, 920-0293, Japan
- Breast Center, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, Japan
| | - Yusuke Haba
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, 920-0293, Japan
- Breast Center, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, Japan
| | - Masafumi Inokuchi
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, 920-0293, Japan
- Breast Center, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, Japan
| | - Machiko Hisano
- Breast Center, Kanazawa Medical University Hospital, Daigaku 1-1, Uchinada-Kahoku, Ishikawa, Japan
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10
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Russell Pinto T, Mora H, Peleteiro B, Magalhães A, Gonçalves D, Fougo JL. Chest wall perforator flaps for partial breast reconstruction after conservative surgery: Prospective analysis of safety and reliability. Surg Oncol 2023; 51:102015. [PMID: 38016381 DOI: 10.1016/j.suronc.2023.102015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 11/06/2023] [Accepted: 11/18/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Breast-conserving surgery associated with adjuvant radiotherapy is the state of the art in the surgical treatment of breast cancer. Oncoplastic surgery through dermo-adipose flaps based in perforating arteries (muscle sparing flaps) for partial reconstruction is increasingly used as a good option for avoiding musculocutaneous flaps. In this study we evaluate the outcomes of the use of chest wall perforator flaps in the replacement of partial breast volume. METHODS A prospective cohort study of female patients that underwent a conservative oncoplastic surgery procedure with partial breast reconstruction using a dermo-adipose flap of perforating arteries of the chest wall was conducted between November 2020 and March 2022 at our centre. Primary outcomes were surgical morbidity, positive margins and reoperation rates. Characteristics associated with the occurrence of complications were further identified. RESULTS Forty-five patients underwent the procedure of interest during the study period. The mean age was 55 years. The median larger dimension of the tumor was 23 mm. Lateral intercostal artery perforator (LICAP), lateral thoracic artery perforator (LTAP), a combined flap and Anterior Intercostal Artery Perforator/Medial Intercostal Artery Perforator (AICAP)/(MICAP) were performed in 22, 16, 2 and 5 patients, respectively. The mean operative time was 126 min. A total of 9 (20.0%) patients required a reoperation after definitive diagnosis, 4 due to positive margins and 5 due to immediate/early surgical morbidity. CONCLUSIONS Local perforator flaps in oncoplastic breast-conserving surgery are a good option for immediate reconstruction after conservative surgery, showing low morbidity and favourable outcomes.
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Affiliation(s)
| | - Henrique Mora
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal; Breast Center, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Bárbara Peleteiro
- Faculty of Medicine, University of Porto, Portugal; Breast Center, Centro Hospitalar Universitário São João, Porto, Portugal; EPI Unit, Institute of Public Health, University of Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health, University of Porto, Portugal
| | - André Magalhães
- Laboratory for Integrative and Translational Research in Population Health, University of Porto, Portugal
| | - Diana Gonçalves
- Breast Center, Centro Hospitalar Universitário São João, Porto, Portugal
| | - José Luís Fougo
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal; Breast Center, Centro Hospitalar Universitário São João, Porto, Portugal
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11
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An YY, Hwang H, Suh YJ. What Should We Know in Postoperative Surveillance Imaging After Oncoplastic Breast-Conserving Surgery with Pellet-Type Acellular Dermal Matrix? Acad Radiol 2023; 30 Suppl 2:S16-S24. [PMID: 37263859 DOI: 10.1016/j.acra.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 06/03/2023]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to evaluate the usual postoperative imaging findings among patients who underwent oncoplastic breast-conserving surgery (BCS) with acellular dermal matrix (ADM) and to assess the clinical utility of mammography (MG) and ultrasonography (US) in follow-ups. MATERIALS AND METHODS This retrospective review of our prospectively collected database of patients who underwent oncoplastic BCS with ADM was conducted with IRB approval and in HIPPA compliance. A total of 105 patients whose follow-up MG and US studies over 2years after surgery were available were included in this study. Postoperative imaging findings were analyzed based on sequential MG and US follow-ups. The clinical outcomes and pathological data were also reviewed. The diagnostic performance of MG and US for postoperative surveillance was assessed. RESULTS On MG, ADM presented as an oval (99/105, 94.3%), circumscribed/obscured (65/105, 61.9%), and high-density (56/105, 53.3%) mass with calcifications (54/105, 51.4%). On US, the ADM-filled cavity presented as an oval (93/105, 88.6%), circumscribed (70/105, 66.7%), heterogenous echoic (65/105, 61.9%) mass with marginal/posterior acoustic shadowing (95/105, 90.5%) on US. During the follow-up period (mean, 46.1months; range, 26-58 months), four tumor recurrences were diagnosed (4/105, 3.8%). One tumor recurrence detected on MG presented as microcalcifications (1/4, 25%), which were differentiated from benign postoperative calcifications due to their suspicious morphology and location. Two additional recurrences (2/4, 50%), which were MG-negative small masses or intraductal lesions, were detected on US. One tumor recurrence was missed on both MG+US and was detected by magnetic resonance imaging performed at clinician's request. The sensitivity and specificity of MG, US, and MG+US for postoperative surveillance were 25%, 50% and 75% and 100%, 98% and 98%, respectively. CONCLUSION Recognition and adequate interpretation of the usual findings after oncoplastic BCS with ADM insertion are important in postoperative imaging surveillance. The sole use of MG is not sufficient for the detection of mass-type tumor recurrence due to the density of inserted ADM fillers. Therefore, the combined use of MG+US could serve as a useful postoperative surveillance tool with increased sensitivity in this population.
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Affiliation(s)
- Yeong Yi An
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic Unversity of Korea, Suwon, Republic of Korea (Y.Y.A., H.H.)
| | - Hyejung Hwang
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic Unversity of Korea, Suwon, Republic of Korea (Y.Y.A., H.H.)
| | - Young Jin Suh
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic Unversity of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Republic of Korea (Y.J.S.).
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12
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Lin LS, Zhang JF, Zheng ZF, Li SQ, Jian CX. Midterm follow-up results of a novel technique: Contralateral breast overlapped reconstruction after mastectomy for unilateral breast cancer. Asian J Surg 2023; 46:254-259. [PMID: 35393222 DOI: 10.1016/j.asjsur.2022.03.073] [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: 09/07/2021] [Revised: 02/11/2022] [Accepted: 03/22/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The breasts of Oriental women are characterized by an obvious scar constitution and a relatively small mammary gland volume. Thus, plastic surgery, which is now popular in the West, is not suitable for most patients in China, and Chinese surgeons are searching for symmetrical plastic surgery options that are suitable for patients with breast tumors, unilateral breast implants and an obvious scar constitution. METHODS Between January 2016 and December 2019, 15 patients underwent contralateral breast overlapped reconstruction (COBOR) at the Affiliated Hospital of Putian University. We assessed their clinicopathological data, complications, cosmetic satisfaction and quality of life. RESULTS The mean age was 41.6 years (range, 31-54 years), the average BMI was 24.36 kg/m2 (range, 20.3-28.4 kg/m2), the most common tumor location was the upper outer quadrant (n = 9), the mean preoperative tumor size was 21.11 mm (range, 7-42 mm), and 4 patients underwent neoadjuvant chemotherapy. The cancer grades and histological types were as follows: G3 nonspecial type (NST), 3 cases; G2 NST, 6 cases; G2 lobular carcinoma, 1 case; and ductal carcinoma in situ (DCIS), 5 cases. The nipple margin was negative in all of these cases. Among them, there was 1 case of poor wound healing caused by subcutaneous fat liquefaction around the incision. In another case, partial nipple necrosis occurred on the affected side due to an insufficient nipple blood supply after the operation and healed after debridement and dressing changes. There were no cases of tumor recurrence during the mean follow-up of 22.53 months (range, 11-47 months). The BREAST-Q scores showed that COBOR provided good patient satisfaction. CONCLUSION For Oriental patients with small breasts, COBOR, which results in fewer scars, good symmetry and good satisfaction, is an effective and safe surgical method. However, larger studies with longer follow-up periods are needed to obtain more reliable postoperative results.
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Affiliation(s)
- Li-Sheng Lin
- Department of Breast Surgery, Affiliated Hospital of Putian University, Putian, Fujian, 351100, China.
| | - Jin-Fan Zhang
- Department of Breast Surgery, Affiliated Hospital of Putian University, Putian, Fujian, 351100, China.
| | - Zi-Fang Zheng
- Department of Minimally Invasive Surgery, Affiliated Hospital of Putian University, Putian, Fujian, 351100, China.
| | - Shuang-Qi Li
- Department of Breast Surgery, Affiliated Hospital of Putian University, Putian, Fujian, 351100, China.
| | - Chen-Xing Jian
- Department of Breast Surgery, Affiliated Hospital of Putian University, Putian, Fujian, 351100, China.
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13
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Orsaria P, Grasso A, Soponaru G, Carnevale F, Scorsone V, Ippolito E, Pantano F, Sammarra M, Piccolo C, Altomare M, Perrone G, Altomare V. Subaxillary Replacement Flap Compared with the Round Block Displacement Technique in Oncoplastic Breast Conserving Surgery: Functional Outcomes of a Feasible One Stage Reconstruction. Curr Oncol 2022; 29:9377-9390. [PMID: 36547150 PMCID: PMC9776519 DOI: 10.3390/curroncol29120736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND For selected women diagnosed with breast cancer (BC), partial reconstructive techniques involve displacement or replacement procedures to improve cosmesis without compromising oncological safety. This study aims to evaluate the surgical outcomes of the round block (RB) compared with the subaxillary flap (SF) technique for patients with upper outer tumor. PATIENTS AND METHODS Thirty-three patients treated with oncoplastic conserving surgery (15 RB and 18 SF) were enrolled in this retrospective study. After carrying out a comparison of baseline characteristics, all cases were recruited for postoperative evaluation of oncological and cosmetic parameters. Moreover, we investigated several scoring combinations to check whether they could discriminate surgeon and patient satisfaction according to different functional results. RESULTS Median age (p < 0.05), average tumor size (p > 0.05), estimated resection volume (p > 0.05), and nodal involvement (p > 0.05) were slightly higher in the SF group. A greater frequency of DCIS (p < 0.05) in the RB series correlated with reintervention for positive margins (p > 0.001). At a mean follow-up of 19 months, no locoregional recurrences were recorded and early and late complications were comparable (p > 0.05). The overall satisfaction with cosmesis was characterized by similar proportions of good results (p > 0.05), with some details more related to each procedure. CONCLUSION The proposed techniques represent effective solutions for reshaping that follows upper outer wide excision, achieving comparable complication rates, low reinterventions, and good aesthetic results in relation to technical and social functioning evaluations. However, it is crucial to establish a careful patient selection in order to manage correct surgical planning while predicting any potential sequelae or complication.
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Affiliation(s)
- Paolo Orsaria
- Department of Breast Surgery, Campus Bio-Medico University, 00159 Rome, Italy
| | - Antonella Grasso
- Department of Breast Surgery, Campus Bio-Medico University, 00159 Rome, Italy
| | - Georgeta Soponaru
- Department of Breast Surgery, Campus Bio-Medico University, 00159 Rome, Italy
| | - Francesca Carnevale
- Department of Breast Surgery, Campus Bio-Medico University, 00159 Rome, Italy
| | - Virginia Scorsone
- Department of Breast Surgery, Campus Bio-Medico University, 00159 Rome, Italy
| | - Edy Ippolito
- Department of Radiation Oncology, Campus Bio-Medico University, 00159 Rome, Italy
| | - Francesco Pantano
- Department of Medical Oncology, Campus Bio-Medico University, 00159 Rome, Italy
| | - Matteo Sammarra
- Department of Radiology, Campus Bio-Medico University, 00159 Rome, Italy
| | - Claudia Piccolo
- Department of Radiology, Campus Bio-Medico University, 00159 Rome, Italy
| | - Michele Altomare
- Department of Trauma and Acute Care, Metropolitano Niguarda Hospital, 20162 Milan, Italy
| | - Giuseppe Perrone
- Department of Anatomical Pathology, Campus Bio-Medico University, 00139 Rome, Italy
| | - Vittorio Altomare
- Department of Breast Surgery, Campus Bio-Medico University, 00159 Rome, Italy
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14
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An analysis of complication rates and the influence on patient satisfaction and cosmetic outcomes following oncoplastic breast surgery. J Plast Reconstr Aesthet Surg 2022; 75:4152-4159. [DOI: 10.1016/j.bjps.2022.06.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022]
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15
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Witmer TJK, Kouwenberg CAE, Bargon CA, de Leeuw DM, Koiter E, Siemerink EJM, Mureau MAM, Rakhorst HA. Comparing costs of standard Breast-Conserving Surgery to Oncoplastic Breast-Conserving Surgery and Mastectomy with Immediate two-stage Implant-Based Breast Reconstruction. J Plast Reconstr Aesthet Surg 2022; 75:2569-2576. [PMID: 35398000 DOI: 10.1016/j.bjps.2022.02.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Conventional breast-conserving surgery (C-BCS) has equal oncological outcomes and superior cosmetic and patient-reported outcomes compared to mastectomy with immediate two-stage implant-based breast reconstruction (M-IBR). Oncoplastic breast-conserving surgery (OP-BCS) is increasingly being used, as it often has better cosmetic results and it enables larger tumour resection. However, OP-BCS and M-IBR compared to C-BCS lengthens operative time and might lead to more complications and consequently to additional costs. Therefore, this study aimed to compare costs and complication rates of C-BCS, OP-BCS and M-IBR. METHODS This single-centre, retrospective cohort study, calculated costs for all patients who had undergone breast cancer surgery between January 2014 and December 2016. Patient-, tumour- and surgery-related data of C-BCS, OP-BCS and M-IBR patients were retrieved by medical record review. Treatment costs were calculated using hospital financial data. Differences in costs and complications were analysed. RESULTS A total of 220 patients were included: 74 patients in the C-BCS, 78 in the OP-BCS and 68 in the M-IBR group. From most expensive to least expensive, differences in total costs were found between C-BCS vs. OP-BCS and C-BCS vs. M-IBR (p=<0.01 and p=0.04, respectively). Costs of OP-BCS and M-IBR were comparable. Complication rates were 5.5% for C-BCS, followed by 17% for OP-BCS, and 34% for M-IBR (p<0.01). CONCLUSION Considering total treatment costs, OP-BCS was financially non-inferior to M-IBR, whereas complication rates were higher following M-IBR. Therefore, when considering other benefits of OP-BCS, such as higher patient-reported outcomes and similar oncological outcomes, a shift from M-IBR to BCS using oncoplastic techniques seems justified.
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Affiliation(s)
- Tom J K Witmer
- Department of Plastic and Reconstructive Surgery, Ziekenhuisgroep Twente, Hengelo, The Netherlands.
| | - Casimir A E Kouwenberg
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Claudia A Bargon
- Department of Plastic and Reconstructive Surgery, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Daniëlle M de Leeuw
- Department of Surgical Oncology, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | - Eveline Koiter
- Department of Radiotherapy, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Hinne A Rakhorst
- Department of Plastic and Reconstructive Surgery, Ziekenhuisgroep Twente, Hengelo, The Netherlands.
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16
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Forma A, Sitarz R, Baj J, Sołowiej K, Łukasiewicz S, Stanisławek A. Oncoplastic Surgery and the Clinical Features of Breast Cancer-Relevant Factors Associated with Reoperation in Breast Oncoplastic Surgery. J Clin Med 2022; 11:817. [PMID: 35160267 PMCID: PMC8836683 DOI: 10.3390/jcm11030817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/19/2022] [Accepted: 02/01/2022] [Indexed: 02/05/2023] Open
Abstract
Oncoplastic breast surgery slowly becomes a part of routine breast cancer surgical management but evidence with regard to oncological safety remains limited. The aim of this study was to compare relevant factors associated with the particular type of breast carcinoma and the applied surgical techniques either with or without oncoplastic surgery. This retrospective study enrolled the breast cancer female patients who underwent breast-conserving therapy alone or with the oncoplastic surgery in the Department of Surgical Oncology at the Center of Oncology of the Lublin Region St. Jana from Dukli in the years 2008-2011. The study involves 679 breast cancer patients who underwent oncoplasty (n = 81) and the control group (n = 598). There is a significant relationship between the histological type of breast cancer (p = 0.00000) along with the expression of estrogen and/or progesterone receptors (p = 0.01285) and the usage of oncoplastic surgery in breast cancer patients. Interestingly, in the majority of cases, there was no need to conduct a reoperation. Oncoplastic surgery is an effective and safe strategy that might be favorable especially for those patients who are potential candidates for more invasive surgical methods. High-quality evidence to support the oncological safety and benefits of oncoplastic breast surgery is lacking.
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Affiliation(s)
- Alicja Forma
- Department of Forensic Medicine, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Robert Sitarz
- Department of Human Anatomy, Medical University of Lublin, 20-090 Lublin, Poland;
- Department of Surgical Oncology, Center of Oncology of the Lublin Region St. Jana z Dukli, 20-091 Lublin, Poland; (K.S.); (S.Ł.); (A.S.)
| | - Jacek Baj
- Department of Human Anatomy, Medical University of Lublin, 20-090 Lublin, Poland;
| | - Krzysztof Sołowiej
- Department of Surgical Oncology, Center of Oncology of the Lublin Region St. Jana z Dukli, 20-091 Lublin, Poland; (K.S.); (S.Ł.); (A.S.)
| | - Sergiusz Łukasiewicz
- Department of Surgical Oncology, Center of Oncology of the Lublin Region St. Jana z Dukli, 20-091 Lublin, Poland; (K.S.); (S.Ł.); (A.S.)
| | - Andrzej Stanisławek
- Department of Surgical Oncology, Center of Oncology of the Lublin Region St. Jana z Dukli, 20-091 Lublin, Poland; (K.S.); (S.Ł.); (A.S.)
- Department of Oncology, Oncology and Environmental Health, Medical University of Lublin, 20-090 Lublin, Poland
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17
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Karadeniz Cakmak G. Innovative Standards in Oncoplastic Breast Conserving Surgery: From Radical Mastectomy to Extreme Oncoplasty. Breast Care (Basel) 2022; 16:559-573. [PMID: 35087359 DOI: 10.1159/000518992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/11/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Oncoplastic breast conserving surgery (OBCS), which is the current procedure of choice for eligible BC patients, describes a philosophy that prioritizes oncologic and cosmetic outcomes. However, knowledge gaps regarding training, acceptance, and practice preclude standardization and make it difficult to design algorithmic guidelines to optimize individualized management in the era of precision medicine. SUMMARY The harmony between patient expectations and oncologic goals creates the state of the art of OBCS. Nevertheless, to achieve these goals, multidisciplinary approach is a must. Surgical decisions require a comprehensive evaluation including patient factors, tumor biology, genetics, technical considerations, and adjunct therapies. Moreover, the quality-of-life (QOL) issues should be considered as the highest level of priority with a shared decision making instituted on realistic discussions with the patient. KEY MESSAGES The standardization in OBCS should be initiated via defining a breast surgeon who should gain theorical and practical competence on techniques via national or international educational programs. The algorithmic patient assessment with appropriate documentation before and after surgery should be established. A simple and safe global lexicon should be designed regarding techniques to be proposed and quality metrics to be considered. Additionally, international multicenter prospective trials should be instituted to overcome knowledge gaps. It is evident that OBCS is the perfect union of science with art. Nevertheless, at the very end, the question is not the nature of the surgeon/artist who would be the extremist, the innovator, or the conservative, but the patient's satisfaction, prognosis, and QOL that conclude the cascade of state of the art of OBCS.
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18
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Kollias V, Kollias J. Safety and efficacy of anterior intercostal artery perforator flaps in oncoplastic breast reconstruction. ANZ J Surg 2022; 92:1184-1189. [PMID: 35088519 DOI: 10.1111/ans.17496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/20/2021] [Accepted: 01/02/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Partial breast reconstruction based on the anterior intercostal artery perforators (AICAP) has been suggested to avoid the unsightly 'bird's beak' deformity for lower pole breast cancers. The aims of this study were to evaluate the initial clinical experience of AICAP flaps in terms of safety and efficacy in oncoplastic breast reconstruction. METHODS Between October 2013 and April 2020, AICAP flaps were offered to 30 patients with lower pole breast cancers. Hand-held Acoustic Doppler assessments were undertaken to confirm adequate perforators. Surgical results were evaluated in terms of safety and efficacy. Patients were invited to complete sections of the Breast-Q questionnaire at least 12 months postoperatively to assess patient satisfaction in terms of cosmetic outcome, physical and psychosocial wellbeing. RESULTS Median operating theatre time for AICAP flap harvesting and positioning was 20 min (range 15-28 min). The median weight of resected breast specimens was 41 g (range 10-127 g). Total tumour size ranged from 7 to 35 mm (median 16 mm; three cases exhibited multifocal disease). Clear radial resection margins were achieved in 29 cases (96.7%). The median post-operative stay was two days (range 2-3 days). There were two postoperative complications comprising delayed wound healing/fat necrosis, which resolved with monitoring and inadine dressings. Based on the Breast-Q results, patients reported high levels of satisfaction with the physical appearance of their reconstructed breast, psychosocial and physical wellbeing. CONCLUSION AICAP flaps appear to be safe in restoring breast contour after wide excision of lower pole breast cancers, with high levels of patient satisfaction reported postoperatively.
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Affiliation(s)
- Victoria Kollias
- Department of General Surgery, St Andrew's Hospital, Adelaide, South Australia, Australia.,Department of General Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - James Kollias
- Department of General Surgery, St Andrew's Hospital, Adelaide, South Australia, Australia.,Department of Surgery, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
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19
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Ahmed YS, Abd El Maksoud WM, Sultan MH, El-Bakoury EA. Immediate Lipo-Filling as a Novel Technique for Volume Replacement in Oncoplastic Breast Conservative Surgery. Aesthetic Plast Surg 2022; 46:1612-1621. [PMID: 35048152 DOI: 10.1007/s00266-021-02755-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 12/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND We aimed to evaluate the feasibility of immediate lipofilling as a volume replacement technique in breast conservative surgery (BCS) in terms of the volume of fat graft resorption after radiotherapy, patient satisfaction, and oncological safety. PATIENTS AND METHODS This was a prospective study that included female patients with breast cancer, with small- or medium-sized breasts. The patients underwent BCS followed by lipofilling into the deformed areas away from the tumor site that resulted from direct closure of the tumor cavity. They were followed up for early and late postoperative complications, including recurrence. Volumetric computed tomography was performed before and after radiotherapy to determine percentage fat resorption. Postoperative patient satisfaction was assessed using the Kyungpook National University Hospital Breast Reconstruction Satisfaction Questionnaire. RESULTS The study included 54 female patients with a mean age of 47.57 ± 9.26 years. The mean follow-up period was 31.02 ± 4.47 months. Local recurrence was observed in three patients (5.56%). The volume reduction of the injected fat graft ranged from 10.15% to 55.67%, with a mean of 29.27 ± 10.06%. Fifty-two patients (96.30%) reported postoperative satisfaction, and nine of them expressed satisfaction only after a second lipofilling session. CONCLUSIONS Immediate lipofilling as a volume replacement technique in BCS is a safe and simple technique without major complications. It has a locoregional recurrence rate similar to BCS alone, with an acceptable fat resorption percentage and high postoperative patient satisfaction. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Yasser S Ahmed
- Experimental Surgery Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Walid M Abd El Maksoud
- General Surgery Department, Faculty of Medicine, King Khalid University, P.O. 641, Abha, 61421, Saudi Arabia.
| | - Mohamed Hussein Sultan
- Experimental Surgery Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Eman A El-Bakoury
- Radiology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
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20
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Monib S, Elzayat I. Evaluation of the Surgical Outcomes of Breast Oncoplastic Techniques Carried Out by a General Surgical Oncologist. Cureus 2021; 13:e19226. [PMID: 34877204 PMCID: PMC8641256 DOI: 10.7759/cureus.19226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2021] [Indexed: 11/28/2022] Open
Abstract
Background With recent advances in different breast cancer treatment modalities, breast conservation surgery (BCS) has gained popularity and has become the mainstay for the treatment of early breast cancer. The model of dedicated breast surgeons working in breast units is standard in some but not all countries. We have aimed to define surgical outcomes of oncoplastic breast surgery carried out by one general surgical oncologist. Patients and methods We have conducted a prospective non-randomised case series analysis to assess the oncologic and aesthetic outcome of tissue displacement oncoplastic breast techniques in managing unifocal early-stage breast cancer from January 2019 to January 2020. One surgical oncologist with 23 years of surgical oncology experience carried out all operations. Results We have included 50 female patients treated with variant oncoplastic volume displacement techniques. We have used the round block technique in 20%, the batwing technique in 18%, lateral mammoplasty in 20%, and medial mammoplasty in 2%. We have also carried out wise pattern therapeutic mammoplasty with inferior pedicle in 20% (10 patients), and vertical mammoplasty with superior pedicle in 20% (10 patients). While 8% of our patients had Clavien-Dindo system grade I Immediate complications, including the surgical site infection and postoperative seroma and haematoma, 2% of patients had grade II complications in the form of partial areola and nipple complex necrosis leading to delayed wound healing requiring secondary suturing. No delayed complications or mortalities were recorded. Eight per cent of patients required re-excision to clear margins, 74% had excellent results, 24% had good results, and 2% had fair results. In addition, 64% were very satisfied with their results, 32% were satisfied, while 4% were not satisfied with aesthetic results. Conclusion Based on our limited number of patients, we have found that tissue displacement oncoplastic techniques carried out by a general surgical oncologist are safe and reliable in providing satisfactory oncological outcomes with a low risk of delaying adjuvant therapy and acceptable aesthetic outcomes.
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Affiliation(s)
- Sherif Monib
- Breast Surgery, West Hertfordshire Hospitals National Health Services (NHS) Trust, St. Albans and Watford General Hospitals, London, GBR
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21
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Jacobs JED, Al Shaer S, Schmidbauer U, de Leeuw DM, Rakhorst HA, Zöphel OT. The anterior LICAP flap: a design option for oncoplastic breast reconstruction. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2021; 8:158-163. [PMID: 34621915 PMCID: PMC8491666 DOI: 10.1080/23320885.2021.1986048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose was to describe the operation technique of an anterior lateral intercostal artery perforator (LICAP) flap and analyse outcomes and complications. An anterior LICAP flap is a good and safe alternative for direct oncoplastic breast reconstruction. It is a reliable flap that provides sufficient volume and good esthetic outcomes.
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Affiliation(s)
- Juliëtte E D Jacobs
- Department of Plastic, Reconstructive and Handsurgery, Ziekenhuis Groep Twente (ZGT), Hengelo, The Netherlands
| | - Sanharib Al Shaer
- Department of Surgery, Ziekenhuis Groep Twente (ZGT), Hengelo, The Netherlands
| | - Ute Schmidbauer
- Department of Plastic, Reconstructive and Handsurgery, Ziekenhuis Groep Twente (ZGT), Hengelo, The Netherlands
| | - Daniëlle M de Leeuw
- Department of Surgery, Ziekenhuis Groep Twente (ZGT), Hengelo, The Netherlands
| | - Hinne A Rakhorst
- Department of Plastic, Reconstructive and Handsurgery, Ziekenhuis Groep Twente (ZGT), Hengelo, The Netherlands
| | - Oliver T Zöphel
- Department of Plastic, Reconstructive and Handsurgery, Ziekenhuis Groep Twente (ZGT), Hengelo, The Netherlands
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22
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Kim MY, Suh YJ, An YY. Imaging surveillance for the detection of ipsilateral local tumor recurrence in patients who underwent oncoplastic breast-conserving surgery with acellular dermal matrix: abbreviated MRI versus conventional mammography and ultrasonography. World J Surg Oncol 2021; 19:290. [PMID: 34579740 PMCID: PMC8477561 DOI: 10.1186/s12957-021-02403-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the usefulness of surveillance-abbreviated magnetic resonance imaging (AB-MRI) for the detection of ipsilateral local tumor recurrence (LTR) in patients who underwent oncoplastic breast-conserving surgery (BCS) with acellular dermal matrix (ADM) by comparing its diagnostic performance with that of mammography (MG) and ultrasonography (US). METHODS The postoperative MG, US, and AB-MRI findings of the ipsilateral breast and pathological results of 324 patients who underwent oncoplastic BCS using ADM were reviewed. The cancer detection rate (CDR), sensitivity, specificity, positive predictive value (PPV) for biopsy, accuracy, and area under the curve (AUC) for each imaging modality were calculated. RESULTS A total of 8 ipsilateral LTRs were diagnosed, and most cancers (87.5%) were stage 0 or 1 (median size of invasive cancer, 1.44 cm; range, 0.7-2 cm). The CDRs of MG, US, MG + US, and AB-MRI were 0.009, 0.012, 0.015, and 0.025 per woman, respectively. Three cancers were detectable on only AB-MRI, and the additional CDR of AB-MRI was 0.010. The sensitivity and specificity of MG, US, MG + US, and AB-MRI were 37.5%, 50%, 62.5%, and 100% and 99.7%, 98.4%, 98.1%, and 97.8%, respectively. The PPVs for biopsy were 75%, 44.4%, 45.5%, and 53.3%, respectively. The AUC was significantly higher for AB-MRI (0.989) than for MG alone (0.686, P = 0.0009), US alone (0.742, P = 0.009), and MG + US (0.803, P = 0.04). A total of 66.7% of cancers visible on only AB-MRI were located at the deep posterior portion of the excision cavity, which might have been missed with MG or MG + US due to masking by the ADM filler. CONCLUSION AB-MRI can improve the detection of ipsilateral LTR despite postoperative changes caused by ADM fillers compared to conventional MG and US. Patients who undergo BCS with ADM can be candidates for AB-MRI surveillance considering improved cancer detection and high sensitivity.
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Affiliation(s)
- Mi Young Kim
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Young Jin Suh
- Department of Surgery, Division of Breast and Thyroid Surgical Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Yeong Yi An
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea.
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Can supine breast magnetic resonance imaging help hit the target in extreme oncoplastic surgery? Eur J Surg Oncol 2021; 47:2788-2796. [PMID: 34412958 DOI: 10.1016/j.ejso.2021.07.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/23/2021] [Accepted: 07/31/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To evaluate the clinical value of supine magnetic resonance imaging (MRI) for tumor localization in breast cancer patients with large or multifocal tumors detected by prone MRI, scheduled for oncoplastic breast conserving surgery (OBCS). Outcomes were compared with those of patients who underwent wide local excision (WLE) or OBCS without MRI guidance. METHODS Over a 2-year period, consecutive patients with large or multifocal disease scheduled for OBCS with MRI-only findings were invited to participate (Group-1). Supplementary supine MRI was performed, and tumor margins were marked in the surgical position. Consecutive patients with early, non-palpable breast cancer who underwent WLE (Group-2) or OBCS (Group-3) were included for comparisons. The primary outcome was reoperation due to an insufficient margin. Secondary outcomes included surgical complications and delayed adjuvant treatment. RESULTS Altogether, 102 breasts (98 patients) were analyzed. All preoperative demographic data were comparable among the three groups. Multifocality, tumor-to-breast volume ratio, and the volume of excised breast tissue were significantly greater in Group-1 than in Groups-2 and 3. Operation time was longer and the need for axillary clearance or surgery for both breasts was more common in Groups-1 and 3 than in Group-2. Adequate margins were achieved in all patients in Groups-1 and 2, and one patient underwent re-excision in Group-3. CONCLUSIONS Supine MRI in the surgical position is a new, promising method to localize multifocal, large tumors visible on MRI. Its short-term outcomes were comparable with those of conventional WLE and OBCS.
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Hussein O, Roshdy S, Hamdy O, Denewer A. Pectoralis major myo-parenchymal flap for local reconstruction of partial mastectomy defects. Description of a new technique. Breast Dis 2021; 41:31-36. [PMID: 34275886 DOI: 10.3233/bd-201042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Breast conservation is the standard of care treatment for early breast cancer. Several oncoplastic approaches have been described for the reconstruction of partial breast defects. The multiplicity of techniques indicates that the ideal reconstructive technique is yet to be identified. There has been a recent emphasis on minimizing the magnitude of surgery. In this report, we describe our experience of using the pectoralis major muscle to fill relatively large post-tumorectomy breast defects. PATIENTS AND TECHNIQUE Nine patients were operated on for malignant breast lesions. Tumorectomy resection with surgical margin rendered a 40-50% breast defect. The parenchymal defect was repaired with an advancement muscle flap of the ipsilateral pectoralis major muscle. RESULTS All patients experienced a non-eventful postoperative course. The early cosmetic outcome was excellent in four patients, good in another four, and fair in one patient. CONCLUSION The pectoralis major flap is useful for local repair of upper half partial breast defects in non-ptosed, cup A-B breasts.
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Affiliation(s)
- Osama Hussein
- Surgery Department, Mansoura University Oncology Center, Mansoura, Egypt
| | - Sameh Roshdy
- Surgery Department, Mansoura University Oncology Center, Mansoura, Egypt
| | - Omar Hamdy
- Surgery Department, Mansoura University Oncology Center, Mansoura, Egypt
| | - Adel Denewer
- Surgery Department, Mansoura University Oncology Center, Mansoura, Egypt
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Raufdeen F, Murphy J, Ahluwalia M, Coroneos CJ, Thoma A. Outcomes in volume replacement and volume displacement techniques in oncoplastic breast conserving surgery: A systematic review. J Plast Reconstr Aesthet Surg 2021; 74:2846-2855. [PMID: 34272177 DOI: 10.1016/j.bjps.2021.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 02/09/2021] [Accepted: 06/02/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Volume Replacement (VR-OBCS) and Volume Displacement Oncoplastic Breast Conserving Surgery (VD-OBCS) are commonly used in the management of breast cancer. Many studies summarize the individual postoperative outcomes of these two procedures; however, there is a lack of research that compares outcomes of these approaches. This review summarizes the available VR and VD-OBCS literature in terms of oncological, cosmetic, and clinical outcomes. METHODS An online literature search (MEDLINE, EMBASE, PubMed, and CINAHL) was performed. Studies were included if they were written in English, had more than 10 adult (18+) female patients who underwent VR-OBCS or VD-OBCS, and reported at least one well-described oncological, clinical, or cosmetic outcome RESULTS: Thirty-three studies (26 VR-OBCS and 7 VD-OBCS) were included in this review; VR-OBCS studies were separated based on the use of latissimus dorsi (LD) flaps. Studies utilizing VR-OBCS with LD flaps reported the highest rate of all oncological outcomes; VR-OBCS studies without LD flaps reported the lowest. Rates of hematoma, seroma, and wound dehiscence were highest in VR-OBCS with LD flaps; partial flap loss and fat necrosis were highest in VR-OBCS without LD flaps and infection was highest in VD-OBCS studies. Inconsistencies in methodology (cosmetic outcome measures, outcome definitions, and time horizons) were found in all procedural groups. CONCLUSION Differences in outcomes for both OBCS procedures may be due to the heterogeneity of patient populations. "Doers" and "Users" of breast oncoplastic research should consider tumor size, laterality of tumor, breast size, measurement scales, and defensible time horizons before the application of a study's conclusions.
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Affiliation(s)
- Fasna Raufdeen
- Department of Science, School of Interdisciplinary Science, McMaster University, Hamilton, ON, Canada
| | - Jessica Murphy
- Department of Surgery, Division of Surgery, McMaster University, Hamilton, ON, Canada
| | - Monish Ahluwalia
- Department of Science, School of Interdisciplinary Science, McMaster University, Hamilton, ON, Canada; Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christopher J Coroneos
- Department of Surgery, Division of Surgery, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Achilles Thoma
- Department of Surgery, Division of Surgery, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada.
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Magnetically Guided Localization Using a Guiding-Marker System ® and a Handheld Magnetic Probe for Nonpalpable Breast Lesions: A Multicenter Feasibility Study in Japan. Cancers (Basel) 2021; 13:cancers13122923. [PMID: 34208090 PMCID: PMC8230842 DOI: 10.3390/cancers13122923] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/31/2021] [Accepted: 06/08/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary In this multicenter feasibility study, non-palpable breast lesions in 89 patients were localized using a handheld cordless magnetic probe (TAKUMI) and a magnetic marker (Guiding-Marker System®). Additionally, a dye was injected subcutaneously under ultrasound guidance to indicate the extent of the tumor. Consequently, a magnetic marker was detected in all resected specimens, and the initial surgical margin was positive only in five (6.1%) of 82 patients. Thus, the magnetic guiding localization system with ultrasound guidance is useful for the detection and excision of non-palpable breast lesions. Abstract Accurate pre-operative localization of nonpalpable lesions plays a pivotal role in guiding breast-conserving surgery (BCS). In this multicenter feasibility study, nonpalpable breast lesions were localized using a handheld magnetic probe (TAKUMI) and a magnetic marker (Guiding-Marker System®). The magnetic marker was preoperatively placed within the target lesion under ultrasound or stereo-guidance. Additionally, a dye was injected subcutaneously to indicate the extent of the tumor excision. Surgeons checked for the marker within the lesion using a magnetic probe. The magnetic probe could detect the guiding marker and accurately localize the target lesion intraoperatively. All patients with breast cancer underwent wide excision with a safety margin of ≥5 mm. The presence of the guiding-marker within the resected specimen was the primary outcome and the pathological margin status and re-excision rate were the secondary outcomes. Eighty-seven patients with nonpalpable lesions who underwent BCS, from January to March of 2019 and from January to July of 2020, were recruited. The magnetic marker was detected in all resected specimens. The surgical margin was positive only in 5/82 (6.1%) patients; these patients underwent re-excision. This feasibility study demonstrated that the magnetic guiding localization system is useful for the detection and excision of nonpalpable breast lesions.
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Li JJ, Yang Y, Wan Q, Li H, Long QM, Zhang PR. Clinical observation of the regeneration process of defects after breast cancer resection. BMC WOMENS HEALTH 2021; 21:99. [PMID: 33676505 PMCID: PMC7936498 DOI: 10.1186/s12905-021-01219-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 02/10/2021] [Indexed: 11/11/2022]
Abstract
Background The present study aims to use two different kinds of filling materials, oxidized regenerated cellulose and gelatin sponge, to repair defects of breast-conserving surgery due to breast cancer, and compare the clinical efficacy, cosmetic effect and complication rate among groups. Methods A total of 125 patients, who had breast -conserving surgery due to breast cancer, were enrolled into the present study. Postoperative efficacy was assessed by a doctor and patient, according to the Harvard/NSABP/RTOG Breast Cosmetic Grading Scale. Results Among these patients, 41 patients received conventional breast-conserving surgery, and 84 patients received breast-conserving surgery plus filling implantation (41 patients in the oxidized regenerated cellulose group and 43 patients in the gelatin sponge group). All patients had small to medium sized breasts (cup size A and B). The average weight of tumor tissues was 56.61 ± 11.57 g in the conventional breast-conserving surgery group, 58.41 ± 8.53 g in the oxidized regenerated cellulose group, and 58.77 ± 9.90 g in the gelatin sponge group. The difference in pathological factors, average operation time, length of stay and local infection rate was not statistically significant among the three groups. 18 patients in the oxidized regenerated cellulose group and 15 patients in the gelatin sponge group were evaluated to have a good cosmetic effect by the surgeon and patient, while 12 patients in the conventional breast-conserving surgery group were evaluated to be have good cosmetic effect by the surgeon and patient. The cosmetic effects in the oxidized regenerated cellulose group and gelatin sponge group were comparable, and these were superior to those in the conventional breast-conserving surgery group. Conclusion The use of oxidized regenerated cellulose and gelatin sponge is a feasible approach for defect repair after breast-conserving surgery.
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Affiliation(s)
- Jun-Jie Li
- Department of Breast Surgery, Sichuan Cancer Hospital, South Renmin Road Chengdu, No. 55, Section 4, Chengdu, 610041, Sichuan, China
| | - Ye Yang
- Department of Medical Oncology, Sichuan Cancer Hospital, Chengdu, 610041, Sichuan, China
| | - Qi Wan
- Jinjiang Maternity and Child Health Hospital, Chengdu, 610065, Sichuan, China
| | - Hui Li
- Department of Breast Surgery, Sichuan Cancer Hospital, South Renmin Road Chengdu, No. 55, Section 4, Chengdu, 610041, Sichuan, China
| | - Qi-Ming Long
- Department of Breast Surgery, Sichuan Cancer Hospital, South Renmin Road Chengdu, No. 55, Section 4, Chengdu, 610041, Sichuan, China
| | - Pu-Rong Zhang
- Department of Breast Surgery, Sichuan Cancer Hospital, South Renmin Road Chengdu, No. 55, Section 4, Chengdu, 610041, Sichuan, China.
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Chu CK, Hanson SE, Hwang RF, Wu LC. Oncoplastic partial breast reconstruction: concepts and techniques. Gland Surg 2021; 10:398-410. [PMID: 33633998 DOI: 10.21037/gs-20-380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Immediate oncoplastic breast reconstruction performed at the time of breast conserving surgery for the treatment of breast cancer merges the therapeutic goals of complete oncologic extirpation with preservation of breast form and function. A constellation of surgical techniques that employs breast volume displacement and/or replacement methods of varying complexity levels have emerged, thus broadening the potential applications for breast conservation therapy to include cases with increased tumor-to-native breast-volume ratios, multicentric or multifocal disease, and/or previous margin-positive resections. This review describes the various reconstructive methods, including the use of local tissue rearrangement, oncoplastic reduction-mastopexy, and locoregional flaps. Classification of the surgical options into levels I and II volume-displacement and volume-replacing techniques is made. Additionally, we explore the oncologic safety and effectiveness of this treatment paradigm by summarizing existing supportive evidence regarding associated risk of surgical complications, rate of margin-positive resection, implications for radiographic surveillance, local recurrence rates, and patient-reported outcomes. In conclusion, surgeons may use a wide variety of oncoplastic techniques for partial breast reconstruction at the time of segmental mastectomy to deliver effective breast conserving treatment for women with breast cancer. A growing body of literature affirms the oncologic safety of this approach. Future directions for research include long-term follow-up data with emphasis on outcomes from patient perspectives.
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Affiliation(s)
- Carrie K Chu
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Summer E Hanson
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rosa F Hwang
- Department of Breast Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Liza C Wu
- Section of Plast Reconstr Surg, Department of Surgery, The University of Pennsylvania Health System, Philadelphia, PA, USA
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Kohli P, Penumadu P, Dharanipragada K, Friji MT. Lateral Thoracodorsal Flap Revisited: An Underappreciated Workhorse. World J Plast Surg 2020; 9:206-212. [PMID: 32934934 PMCID: PMC7482543 DOI: 10.29252/wjps.9.2.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Although, the lateral thoracodorsal flap is a well described technique, its utility seems to be lost in the ever evolving world of oncoplastic breast surgery. This study reviews the technique, its indications and limitations and the advantage of this technique. METHODS Between January 2016 and January 2018, data from 7 consecutive patients who underwent partial breast mastectomy with lateral thoracodorsal flap were enrolled. A wedge shaped flap was designed using the pinch test using the index finger and the thumb in small defects, while larger defects required a convex shaped incision with curved superior and inferior borders. Incision was made along the marked margins of the proposed flap and deepened to the underlying serratus anterior and latissimus dorsii muscle. The flap was transposed in the defect and the symmetry of mound between the two breasts confirmed in sitting and supine position. RESULTS All patients were satisfied by cosmetic outcomes on visual analog scale (VAS). Cosmetic results based on Harvard scale showed good to excellent scores. Evaluation by Breast Cancer Conservation Treatment (BCCT) core software illustrated good to excellent cosmetic outcomes. There was no delayed wound healing, marginal skin ornecrosis and no evidence of any fat necrosis in the follow up period. CONCLUSION The versatility of latissimus dorsii flap, good aesthetic and functional results and its simple execution made it an important option in the armamentarium of the oncoplastic breast surgeon. Also, morbidity of the donor site was minimized without sacrificing muscles or nerves.
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Affiliation(s)
- Pavneet Kohli
- Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Prasanth Penumadu
- Department of Surgical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Kadambari Dharanipragada
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - M T Friji
- Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Yang B, Ren G, Song E, Pan D, Zhang J, Wang Y, Liao N, Tang J, Wang X, Cui S, Jin F, Geng C, Sun Q, Li H, Fan Z, Cao X, Wang H, Wang S, Shao Z, Wu J. Current Status and Factors Influencing Surgical Options for Breast Cancer in China: A Nationwide Cross-Sectional Survey of 110 Hospitals. Oncologist 2020; 25:e1473-e1480. [PMID: 32333626 DOI: 10.1634/theoncologist.2020-0001] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 03/26/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There are limited nationwide data regarding breast cancer surgery in China. The Chinese Anti-Cancer Association's Committee of Breast Cancer Society and the Chinese Society of Breast Surgeons conducted a nationwide survey to examine the use of and barriers associated with surgical options among patients with breast cancer. METHODS Surveys were sent via e-mail to the directors of 110 centers that performed at least 200 breast cancer operations in 2017. The electronic questionnaire contained 183 questions and covered six aspects, including demographic information about the hospitals and surgeons, surgical practice, and application of breast reconstruction. RESULTS The selected hospitals were from 31 provinces or municipalities. The overall proportion of breast-conserving surgery (BCS) was 22%. Local gross domestic product was significantly related to the rate of BCS (p = .046). Sentinel lymph node biopsy was performed routinely in 76% of hospitals. Only 14.5% (16/110) of hospitals used the dual-tracer method, including radioisotopes. For patients with cN0 disease receiving BCS with one or two positive sentinel lymph nodes, 20% (22/110) of hospitals accepted omitting axillary lymph node dissection (ALND). For patients who underwent mastectomy, only 4% (4/110) of hospitals accepted omitting ALND. There was an obvious polarization trend in the proportion of oncoplastic breast-conserving surgery (OPS); 35/110 (32%) performed OPS in fewer than 10% of cases, whereas 36/110 (33%) performed OPS in more than 50% of cases. OPS was more likely to be performed in academic hospitals. Volume displacement was more commonly used than volume replacement (p < .001). Breast reconstruction was routinely performed in 96/110 (87%) of hospitals, 62% of which involved cooperation with the plastic surgery department. Factors influencing breast reconstruction after mastectomy included the establishment of a plastic surgery department, regional economy, and cooperation between the plastic and general surgery departments. Overall, the proportion of breast reconstruction procedures after mastectomy was 10.7%, with 70% being implant-based reconstruction, 17% autologous tissue reconstruction, and 13% a combination. Overall, 22% of the hospitals predominantly performed immediate breast reconstruction. For delayed reconstruction, two-stage implant-based breast reconstruction was the first choice for 46% of centers, whereas 20% of centers chose autologous reconstruction. Among the 96 centers that performed autologous-based reconstruction, 96% performed latissimus dorsi flap reconstruction, 65% performed transverse rectus abdominis musculocutaneous flap reconstruction, and 45% used deep inferior epigastric artery perforator flaps. CONCLUSION The results are of great value for promoting the implementation of a consensus on diagnostic and treatment standards, development of guidelines for breast cancer, and training of breast specialists. IMPLICATIONS FOR PRACTICE This study aimed to establish comprehensive baseline data on the status of current breast cancer treatment in China by presenting the statistics on clinical treatments and surgeries, the distribution of clinical stages, and the demographic characteristics of patients. This report is based on a survey conducted by the Chinese Anti-Cancer Association's Committee of Breast Cancer Society and the Chinese Society of Breast Surgeons, which examined the use of breast cancer surgical options in hospitals all over the country and the factors hindering the adoption of procedures and techniques. This study makes a significant contribution to the literature because there are limited nationwide data regarding breast cancer surgery in China.
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Affiliation(s)
- Benlong Yang
- Department of Breast Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Shanghai, People's Republic of China
| | - Guosheng Ren
- Department of Breast Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Erwei Song
- Breast Tumor Center, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Da Pan
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, People's Republic of China
| | - Jing Zhang
- Department of Breast Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Yongsheng Wang
- Department of Breast Cancer Center, Shandong Cancer Hospital, Jinan, People's Republic of China
| | - Ning Liao
- Department of Breast Cancer, Cancer Center, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - Jinhai Tang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Xiang Wang
- Department of Breast Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Shude Cui
- Department of Breast Cancer, Henan Cancer Hospital, Zhengzhou, People's Republic of China
| | - Feng Jin
- Department of Breast Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Cuizhi Geng
- Research Center and Tumor Research Institute, The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
- Breast Disease Diagnostic and Therapeutic Center, The Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Beijing, People's Republic of China
| | - Hongyuan Li
- Department of Breast Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Zhimin Fan
- Department of Breast Surgery, The First Hospital of Jilin University, Changchun, Jilin Province, People's Republic of China
| | - Xuchen Cao
- Department of Breast Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Haibo Wang
- Breast Center, Qingdao University Affiliated Hospital, Qingdao, Shandong Province, People's Republic of China
| | - Shu Wang
- Breast Disease Center, Peking University People's Hospital, Beijing, People's Republic of China
| | - Zhimin Shao
- Department of Breast Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Shanghai, People's Republic of China
| | - Jiong Wu
- Department of Breast Surgery, Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China
- Collaborative Innovation Center for Cancer Medicine, Shanghai, People's Republic of China
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Gwak H, Jeon YW, Lim ST, Park SY, Suh YJ. Volume replacement with diced acellular dermal matrix in oncoplastic breast-conserving surgery: a prospective single-center experience. World J Surg Oncol 2020; 18:60. [PMID: 32209100 PMCID: PMC7093974 DOI: 10.1186/s12957-020-01835-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/17/2020] [Indexed: 01/13/2023] Open
Abstract
Background Several studies have reported the use of acellular dermal matrix in breast reconstruction. However, the primary role of acellular dermal matrix in these studies was to support the implant; there are no reports on the use of acellular dermal matrix exclusively as volume replacement. Thus, we aimed to evaluate the safety and effectiveness of filling of the defect with acellular dermal matrix in oncoplastic breast-conserving surgery. Methods We prospectively recruited 120 adult breast cancer patients who were scheduled to undergo oncoplastic breast-conserving surgery with acellular dermal matrix filling from 2017 to 2018. Intraoperatively, diced human acellular dermal matrix measuring 3–5 mm was used on each side to fill in the excisional defect immediately. After 6 months, satisfaction of the patients and surgeons with overall and cosmetic outcomes was evaluated with a survey using a 10-point scale. Postoperative complications were assessed at 2 weeks and 6 months postoperatively. Results Of the 117 patients who were evaluated for their satisfaction, 94.0% were strongly satisfied with the cosmetic outcomes and 90.4% were strongly satisfied overall. Patient overall satisfaction scores were higher than surgeon satisfaction scores (p < 0.001). Of the 117 patients who underwent evaluation of complications 6 months postoperatively, six (5.1%) had hematoma and seven (6.0%) had seroma. The overall reoperation rate due to complications was 8.5%. Only two patients needed acellular dermal matrix removal due to hematoma and inflammation. Conclusion Oncoplastic breast-conserving surgery with acellular dermal matrix filling of defects can be performed safely with high cosmetic satisfaction. Trial registration ICTRP, KCT0003886; retrospectively registered May 3, 2019, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=KCT0003886
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Affiliation(s)
- Hongki Gwak
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Seoul, Suwon, 16247, Republic of Korea
| | - Ye-Won Jeon
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Seoul, Suwon, 16247, Republic of Korea
| | - Seung-Taek Lim
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Seoul, Suwon, 16247, Republic of Korea
| | - Seon-Young Park
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Seoul, Suwon, 16247, Republic of Korea
| | - Young-Jin Suh
- Division of Breast and Thyroid Surgical Oncology, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Seoul, Suwon, 16247, Republic of Korea.
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Abstract
PURPOSE OF REVIEW The goals of surgery for breast cancer have remained the same over the years, to eliminate breast cancer from the breast with the least degree of deformity. With the current expectation of long-term survival after breast cancer treatment, more attention has turned to the cosmetic result of the surgical treatment. Whether lumpectomy or mastectomy, the need for aesthetic improvement was recognized by surgeons both in and outside the USA. RECENT FINDINGS Oncoplastic surgery combines the skills of the cancer surgeon with those of the plastic surgeon. Sometimes, this means a team approach with a breast surgeon and a plastic surgeon both performing their mutual skills for the patient. Other times, the properly trained breast surgeon may perform some of the plastic techniques at the time of cancer surgery. Breast surgeons are rapidly gaining the ability to improve the post-cancer treatment appearance. To simplify the classification of oncoplastic techniques, we have used lower level, upper level, and highest level. The assignment of techniques to levels is based on both the technique and the surgeon's training and experience. Much data has accumulated demonstrating the safety and efficacy of the "aesthetic cancer cure." We describe the development of oncoplastic surgery, the techniques available, matching the right candidate with the right technique, and some comments about the future. It is clear from both clinical benefit and patient satisfaction that oncoplastic breast cancer procedures are here to stay. Plastic surgeons will likely focus on the upper- and highest-level procedures while breast/general surgeons will learn lower-level procedures and some of upper-level procedures as needed by their locale. Opportunities to educate breast/general surgeons in these techniques will continue to increase over the next several years. Formal education in oncoplastic surgery during breast fellowships will be necessary to catch up with the rest of the surgical world outside the USA.
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Affiliation(s)
- Cary S Kaufman
- Department of Surgery, University of Washington, Bellingham Regional Breast Center, 2075 Barkley Blvd., Suite 250, Bellingham, Washington, 98226, USA.
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Zhou L, Wang Y, Cai R, Huang J, Li X, Xie Z, Wang J, Sun Y, Chang EI, Tang J. Pedicled descending branch latissimus dorsi mini‐flap in repairing partial mastectomy defect: Shoulder functional and esthetic outcomes. J Surg Oncol 2019; 120:518-526. [DOI: 10.1002/jso.25524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/10/2019] [Accepted: 05/14/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Lihuan Zhou
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer Center Guangzhou People's Republic of China
- Department of Breast OncologySun Yat‐sen University Cancer Center Guangzhou People's Republic of China
| | - Yan Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer Center Guangzhou People's Republic of China
- Department of Breast OncologySun Yat‐sen University Cancer Center Guangzhou People's Republic of China
| | - Ruizhao Cai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer Center Guangzhou People's Republic of China
- Department of Breast OncologySun Yat‐sen University Cancer Center Guangzhou People's Republic of China
| | - Junhao Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer Center Guangzhou People's Republic of China
- Department of Breast OncologySun Yat‐sen University Cancer Center Guangzhou People's Republic of China
| | - Xing Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer Center Guangzhou People's Republic of China
- Department of Breast OncologySun Yat‐sen University Cancer Center Guangzhou People's Republic of China
| | - Zeming Xie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer Center Guangzhou People's Republic of China
- Department of Breast OncologySun Yat‐sen University Cancer Center Guangzhou People's Republic of China
| | - Jin Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer Center Guangzhou People's Republic of China
- Department of Breast OncologySun Yat‐sen University Cancer Center Guangzhou People's Republic of China
| | - Ya Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer Center Guangzhou People's Republic of China
- Department of Breast OncologySun Yat‐sen University Cancer Center Guangzhou People's Republic of China
| | - Edward I. Chang
- Department of Plastic SurgeryMD Anderson Cancer Center Houston Texas
| | - Jun Tang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer MedicineSun Yat‐sen University Cancer Center Guangzhou People's Republic of China
- Department of Breast OncologySun Yat‐sen University Cancer Center Guangzhou People's Republic of China
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Arnaout A, Ross D, Khayat E, Richardson J, Kapala M, Hanrahan R, Zhang J, Doherty C, Brackstone M. Position statement on defining and standardizing an oncoplastic approach to breast-conserving surgery in Canada. ACTA ACUST UNITED AC 2019; 26:e405-e409. [PMID: 31285685 DOI: 10.3747/co.26.4195] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although mastectomy is an effective procedure, it can have a negative effect on body image, sense of attractiveness, and sexuality. As opposed to the combination of breast oncologic surgery and plastic surgery, whose primary focus is on replacing lost volume, breast-conserving oncoplastic surgery (ops) redistributes remaining breast tissue in a manner that requires vision, anatomic knowledge, and an appreciation of esthetics, symmetry, and breast function. Modern surgical treatment of breast cancer can be realized only with breast and plastic surgeons working together using oncoplastic techniques to deliver superior cosmetic and cancer outcomes alike. Using this collaborative approach, oncologic and plastic surgeons in Canada have a significant opportunity to improve the care of their breast cancer patients. We propose a tri-level classification for volume displacement procedures to act as a rubric for the training of general surgeons and oncologic breast surgeons in oncoplastic breast-conserving therapy techniques. It is our position that ops enhances outcomes for many women with breast cancer and should become part of the standard repertoire of procedures used by Canadian oncologic surgeons treating breast cancer.
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Affiliation(s)
- A Arnaout
- Division of General Surgery, University of Ottawa, Ottawa, ON
| | - D Ross
- Division of Plastic Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - E Khayat
- Division of Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - J Richardson
- Division of General Surgery, Trillium Health Partners, Mississauga, ON
| | - M Kapala
- Division of General Surgery, Trillium Health Partners, Mississauga, ON
| | - R Hanrahan
- Division of General Surgery, Royal Victoria Regional Health Centre, Barrie, ON
| | - J Zhang
- Division of Plastic Surgery, University of Ottawa, Ottawa, ON
| | - C Doherty
- Division of Plastic Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - M Brackstone
- Division of Surgical Oncology, Schulich School of Medicine and Dentistry, Western University, London, ON
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Smeele HP, Van der Does de Willebois EM, Eltahir Y, De Bock GH, Van Aalst VC, Jansen L. Acceptance of contralateral reduction mammoplasty after oncoplastic breast conserving surgery: A semi-structured qualitative interview study. Breast 2019; 45:97-103. [DOI: 10.1016/j.breast.2019.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 03/12/2019] [Accepted: 03/22/2019] [Indexed: 12/17/2022] Open
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Ebadi MR, Aghdam MK, Lima ZS, Younesi L. Investigation into breast cancer and partial breast reconstruction: A review. Eur J Transl Myol 2019; 29:8157. [PMID: 31354921 PMCID: PMC6615071 DOI: 10.4081/ejtm.2019.8157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 04/11/2019] [Indexed: 02/06/2023] Open
Abstract
Growing increasingly in South America, Africa and Asia, breast cancer is known as the dominant type of cancer in women. Different treatments are available for breast cancer, among which surgery is the most widely used, but researchers are trying to develop new strategies. One of the most prominent surgical methods is referred to as oncoplastic surgery, that helps to remove segments of malignant breast tissue. This type of surgery aims to obtain vast surgical margins, while the remaining tissue is rearranged so that the better cosmetic outcome is obtained. This review will investigate the breast cancer and then discuss partial breast reconstruction. Before outlining the procedures, the different types of partial breast reconstruction will be discussed. Finally, advantages and disadvantages will be outlined. MEDLINE database was used to conduct the search. The main terms used were ‘Conservation Breast Surgery Reconstruction’ AND ‘Oncoplastic Surgery’, ‘Partial Mastectomy Reconstruction’ AND ‘Conservative Breast Surgery Reconstruction’, ‘oncoplastic’ [All Fields], ‘breast’ AND ‘surgery’ OR ‘surgery’ operative’, ‘oncoplastic’ (‘breast’)’. The bibliographies of relevant papers were manually searched up to October 2018, but more recent voices are also included.
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Affiliation(s)
- Mohammad Reza Ebadi
- Department of Plastic and Reconstructive Surgery, Hazrat-e Fateme Hospital, Burn Reseach Center, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Maryam Kazemi Aghdam
- Pediatric Pathology Research Center, Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zeinab Safarpour Lima
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Ladan Younesi
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences (IUMS), Tehran, Iran
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Shechter S, Friedman O, Inbal A, Arad E, Menes T, Barsuk D, Gur E, Barnea Y. Oncoplastic partial breast reconstruction improves patient satisfaction and aesthetic outcome for central breast tumours. ANZ J Surg 2019; 89:536-540. [DOI: 10.1111/ans.15078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/15/2018] [Accepted: 12/21/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Shirley Shechter
- Department of Plastic and Reconstructive SurgeryTel‐Aviv Sourasky Medical Center Tel Aviv Israel
| | - Or Friedman
- Department of Plastic and Reconstructive SurgeryTel‐Aviv Sourasky Medical Center Tel Aviv Israel
| | - Amir Inbal
- Department of Plastic and Reconstructive SurgeryTel‐Aviv Sourasky Medical Center Tel Aviv Israel
| | - Ehud Arad
- Department of Plastic and Reconstructive SurgeryTel‐Aviv Sourasky Medical Center Tel Aviv Israel
| | - Tehillah Menes
- The Breast Health CenterTel‐Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel‐Aviv University Tel‐Aviv Israel
| | - Daphna Barsuk
- General SurgeryAssuta Medical Center Tel Aviv Israel
| | - Eyal Gur
- Department of Plastic and Reconstructive SurgeryTel‐Aviv Sourasky Medical Center Tel Aviv Israel
| | - Yoav Barnea
- Department of Plastic and Reconstructive SurgeryTel‐Aviv Sourasky Medical Center Tel Aviv Israel
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Lateral Oncoplastic Breast Surgery (LOBS) - A new surgical technique and short term results. Am J Surg 2018; 216:1166-1170. [DOI: 10.1016/j.amjsurg.2017.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 08/30/2017] [Accepted: 09/16/2017] [Indexed: 11/22/2022]
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39
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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: 2.1] [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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40
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Hillberg NS, Meesters-Caberg MA, Beugels J, Winkens B, Vissers YL, van Mulken TJ. Delay of adjuvant radiotherapy due to postoperative complications after oncoplastic breast conserving surgery. Breast 2018; 39:110-116. [DOI: 10.1016/j.breast.2018.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/21/2018] [Accepted: 04/05/2018] [Indexed: 10/17/2022] Open
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Palsdottir EP, Lund SHL, Asgeirsson KSA. Oncoplastic Breast-Conserving Surgery in Iceland: A Population-Based Study. Scand J Surg 2018; 107:224-229. [PMID: 29756510 DOI: 10.1177/1457496918766686] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS In Iceland, oncoplastic breast-conservation surgery has been performed since 2008. The aim of this population-based study was to assess and compare the efficacy and patient satisfaction of standard breast-conservation surgery with oncoplastic breast-conservation surgery. MATERIALS AND METHODS This is a population-based, retrospective, observational cohort study on all women undergoing breast-conservation surgery in Iceland from the 1 January 2008 to 31 December 2014. A multivariate logistic regression and linear regression were performed to assess differences in outcomes and a patient satisfaction questionnaire was used to assess certain patient-related outcome measures. RESULTS AND CONCLUSION A total of 750 women underwent breast-conserving surgery, 665 had standard breast-conservation surgery and 85 oncoplastic breast-conservation surgery. Oncoplastic breast-conservation surgery was associated with a significantly larger mean size (2.4 cm vs 1.7 cm, p < 0.001) and weight (181.8 g vs 63.4 g, p < 0.001) of breast specimen excised when compared to standard breast-conservation surgery. After correcting for confounding factors, there was no significant difference in surgical margin involvement (odds ratio = 0.97, confidence interval = 0.44-1.97), frequency of complications (odds ratio = 1.06, confidence interval = 0.46-2.18), frequency of reoperations (odds ratio = 0.98; confidence interval = 0.50-1.81), or time to first adjuvant therapy (-0.23 days for oncoplastic breast-conservation surgery, p = 0.95). Patient satisfaction was high in both groups, although not statistically different (96% in oncoplastic breast-conservation surgery group vs 89% in the standard breast-conservation surgery group, p = 0.84). Our results show that oncoplastic breast-conservation surgery is at least as safe as standard breast-conservation surgery in selected cases and may be preferable in ductal carcinoma in situ.
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Affiliation(s)
- E P Palsdottir
- 1 Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - S H L Lund
- 2 School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - K S A Asgeirsson
- 3 Department of surgery, Landspítali University Hospital, Reykjavík, Iceland
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Noguchi M, Ohno Y, Morioka E, Noguchi M, Nakano Y, Kosaka T, Shimada KI. A novel oncoplastic technique for breast cancer localized in the lower pole of the breast. J Surg Oncol 2017; 117:137-141. [PMID: 28940202 DOI: 10.1002/jso.24824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 08/10/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Masakuni Noguchi
- Breast Center, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan.,Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Yukako Ohno
- Breast Center, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan.,Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Emi Morioka
- Breast Center, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan.,Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Miki Noguchi
- Breast Center, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan.,Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Yasuharu Nakano
- Breast Center, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan.,Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Takeo Kosaka
- Department of Surgical Oncology, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
| | - Ken-Ichi Shimada
- Department of Plastic Surgery, Kanazawa Medical University Hospital, Uchinada-Daigaku, Ishikawa, Japan
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van Paridon MW, Kamali P, Paul MA, Wu W, Ibrahim AM, Kansal KJ, Houlihan MJ, Morris DJ, Lee BT, Lin SJ, Sharma R. Oncoplastic breast surgery: Achieving oncological and aesthetic outcomes. J Surg Oncol 2017; 116:195-202. [DOI: 10.1002/jso.24634] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 03/13/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Maaike W. van Paridon
- Division of Plastic Surgery; Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Parisa Kamali
- Division of Plastic Surgery; Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Marek A. Paul
- Division of Plastic Surgery; Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Winona Wu
- Division of Plastic Surgery; Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Ahmed M.S. Ibrahim
- Division of Plastic and Reconstructive Surgery; Louisiana State University Health Sciences Center; New Orleans Louisiana
| | - Kari J. Kansal
- Breast Care Center; Beth Israel Deaconess Medical Center, Harvard Medical School; Boston Massachusetts
| | - Mary Jane Houlihan
- Breast Care Center; Beth Israel Deaconess Medical Center, Harvard Medical School; Boston Massachusetts
| | - Donald J. Morris
- Division of Plastic Surgery; Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Bernard T. Lee
- Division of Plastic Surgery; Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Samuel J. Lin
- Division of Plastic Surgery; Beth Israel Deaconess Medical Center; Harvard Medical School; Boston Massachusetts
| | - Ranjna Sharma
- Breast Care Center; Beth Israel Deaconess Medical Center, Harvard Medical School; Boston Massachusetts
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Özmen V. Paradigm Shift From Halstedian Radical Mastectomy to Personalized Medicine. THE JOURNAL OF BREAST HEALTH 2017; 13:50-53. [PMID: 31244529 DOI: 10.5152/tjbh.2017.312017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Breast cancer management changed from radical mastectomy to precision medicine in a period longer than a century. The aims of these changes were to refrain from overdiagnoses and overtreatments as well as their harmful side effects and extra costs. Breast cancer is a heterogeneous disease and characterized by many morphological, clinical and molecular features. We now increasingly realise that a one-size-fits-all strategy does not apply to all breast cancer patients. Personalized medicine may be used for breast cancer screening, diagnosis and treatment. Individualized screening can decrease the number of unnecessary mammograms, additional radiologic studies, breast biopsies and false positivity rates. However, additional 15 to 20 years are necessary to reach the results of prospective randomized trials comparing low-risk and normal-risk women. We also should wait for outcomes of risk-based screening trials. The rates of overtreatment in patients with early-stage breast cancer have reached 40% in many studies. Personalized treatment has succeeded in reducing it substantially by using tumour genetic profiling and tumour receptors in early breast cancer patients. However, it has its limits and it is impossible to generalize it to all patients. New biomarkers and molecular classifications have also led to the development of novel therapies and treatment strategies. And, they can contribute to a more personalized management of breast cancer patients.
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Affiliation(s)
- Vahit Özmen
- Department of General Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
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45
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Lee J, Jung JH, Kim WW, Yang JD, Lee JW, Li J, Park HY. Comparison of two different types of oxidized regenerated cellulose for partial breast defects. J Surg Res 2017. [PMID: 28624048 DOI: 10.1016/j.jss.2017.03.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A defect after partial mastectomy, sometimes, is hard to be filled with patient's own breast tissue. Two different types of oxidized regenerated cellulose (ORC) for filling of partial defects in small-sized breasts were compared with respect to clinicopathologic factors and outcomes. METHODS A total of 45 patients with breast cancer underwent conventional partial mastectomy with insertion of an ORC filling material. The two filling materials used were a hemostasis-purposed ORC and adhesion barrier-purposed ORC. Clinical factors were compared between these two ORC materials. Both the surgeon and patient assessed the cosmetic outcomes using the Harvard/NSABP/RTOG Breast Cosmesis Grading Scale. RESULTS Partial mastectomy with filling material insertion technique was not inferior to partial mastectomy-only technique in many clinical aspects. And most of the clinicopathologic factors showed no significant difference between the two groups. However, the mean operation time was significantly shorter in the hemostasis-purposed ORC group (P = 0.027). In addition, the infection rate was significantly higher in the adhesion barrier-purposed ORC group (P = 0.040). CONCLUSIONS Reconstructive surgery using a hemostasis-purposed ORC was associated with a shorter operation time and lower incidence of postoperative infection than that using an adhesion barrier-purposed ORC. However, both types of ORC were feasible as filling compounds for partial defects of the breast.
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Affiliation(s)
- Jeeyeon Lee
- Department of Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jin Hyang Jung
- Department of Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Wan Wook Kim
- Department of Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jung Dug Yang
- Department of Plastic Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jeong Woo Lee
- Department of Plastic Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Junjie Li
- Department of Surgery, Sichuan Province Cancer Hospital, Chengdu, China
| | - Ho Yong Park
- Department of Surgery, Kyungpook National University, School of Medicine, Daegu, Republic of Korea.
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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: 0.9] [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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47
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Zhang H, Tan H, Gao J, Wei Y, Yu Z, Zhou Y. The use of sequential X-ray, CT and MRI in the preoperative evaluation of breast-conserving surgery. Exp Ther Med 2016; 12:1275-1278. [PMID: 27588049 PMCID: PMC4998097 DOI: 10.3892/etm.2016.3449] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/13/2016] [Indexed: 12/13/2022] Open
Abstract
The aim of the study was to investigate the value of sequential application of molybdenum target X-ray, multi-slice spiral computed tomography (MSCT) and magnetic resonance imaging (MRI) in the preoperative evaluation of breast-conserving surgeries. In total, 76 patients with indications for breast-conserving surgery due to complicated breast cancer participated in the study and were assigned to either control or observation group (n=38 per group). The patients in the control group were evaluated with two sets of random combinations of molybdenum target X-ray, MSCT or MRI with ultrasound inspection, whereas the patients in the observation group were evaluated by sequential inspection methods of molybdenum target X-ray, MSCT and MRI. A comparison of surgery outcomes, incidence of complications, rate of positive surgical margins, and recurrence and survival rates in the groups during a follow-up period of 24 months was made. Comparisons of the preoperative evaluation results for tumor number, average maximum diameter, number of lymphatic metastatic groups and number of metastatic lymph nodes in the observation group showed the numbers to be significantly higher than those in the control group (P<0.05). Conversely, the comparisons of age, tumor distribution and T-staging yielded no significant differences, validating the analysis. The percentage of successful breast-conserving surgeries in the observation group was significantly higher than that in the control group, while the incidence of complications in the observation group was lower (P<0.05). The rate of positive surgical margins and the recurrence rate of cancer in the observation group were lower than those in the control group, and the survival rate in the observation group was higher, with differences having statistical significance (P<0.05). In conclusion, the sequential application of molybdenum target X-ray, MSCT and MRI during the preoperative evaluation for breast-conserving surgery positively affects the success rate of the procedure improving the diagnostic accuracy and therapeutic effects.
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Affiliation(s)
- Huiyu Zhang
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Hongna Tan
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Jianbo Gao
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Yan Wei
- Department of Urology, Henan Province Zhigong Hospital, Zhengzhou, Henan 450002, P.R. China
| | - Zhan Yu
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Yan Zhou
- Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
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