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Yuan YW, Liu PC, Li FF, Yang YH, Yang W, Fan L, Mou DW, Yang HW, Chen MS. Breast-conserving surgery is an appropriate procedure for centrally located breast cancer: a population-based retrospective cohort study. BMC Surg 2023; 23:298. [PMID: 37789365 PMCID: PMC10548734 DOI: 10.1186/s12893-023-02181-6] [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: 05/21/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND The evidence of breast-conserving therapy (BCT) applied in centrally located breast cancer (CLBC) is absent. This study aims to investigate the long-term survival of breast-conserving therapy (BCT) in centrally located breast cancer (CLBC) compared with mastectomy in CLBC and BCT in non-CLBC. METHODS Two hundred ten thousand four hundred nine women with unilateral T1-2 breast cancer undergoing BCT or mastectomy were identified from the Surveillance, Epidemiology, and End Results database. Kaplan-Meier survival curves were assessed via log-rank test. Propensity score matching (PSM) was used to balance baseline features, and the multivariable Cox model was used to estimate the adjusted hazard ratio [HR] and its 95% confidence interval [CI] for breast cancer-specific survival (BCSS) and overall survival (OS). RESULTS With a median follow-up of 91 months, the BCSS and OS rates in patients who received BCT were greater than those patients treated with mastectomy in the entire CLBC set. Multivariable Cox analyses showed that CLBC patients who received BCT had better BCSS (HR = 0.67, 95%CI: 0.55-0.80, p < 0.001) and OS (HR = 0.78, 95%CI: 0.68-0.90, p = 0.001) than patients who received a mastectomy, but there were no significant differences of BCSS (HR = 0.65, 95%CI: 0.47-0.90, p = 0.009) and OS (HR = 0.82, 95%CI: 0.65-1.04, p = 0.110) after PSM. In patients treated with BCT, CLBC patients had a similar BCSS (HR = 0.99, 95%CI: 0.87-1.12, p = 0.850) but a worse OS (HR = 1.09, 95%CI: 1.01-1.18, p = 0.040) compared to that of the non-CLBC patient, but there was no significant difference both BCSS (HR = 1.05, 95%CI: 0.88-1.24, p = 0.614) and OS (HR = 1.08, 95%CI: 0.97-1.20, p = 0.168) after PSM. CONCLUSION Our findings revealed that BCT should be an acceptable and preferable alternative to mastectomy for well-selected patients with CLBC.
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Affiliation(s)
- Ye-Wei Yuan
- Department of Breast and Thyroid Surgery, Sichuan Provincial Hospital for Women and Children (Affiliated Women and Children’s Hospital of Chengdu Medical College), Chengdu, 610041 People’s Republic of China
| | - Peng-Cheng Liu
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041 People’s Republic of China
| | - Fang-Fang Li
- Department of Operating Room, Suining Central Hospital, 127 Desheng Road West, Suining, 629000 People’s Republic of China
| | - Ya-Han Yang
- Medical Imaging, North Sichuan Medical College, Nanchong, 637000 People’s Republic of China
| | - Wei Yang
- Sichuan Center for Disease Control and Prevention, Chengdu, 610041 People’s Republic of China
| | - Li Fan
- Department of Breast and Thyroid Surgery, Suining Central Hospital, 127 Desheng West Road, Suining, 629000 People’s Republic of China
| | - De-Wu Mou
- Department of Breast and Thyroid Surgery, Suining Central Hospital, 127 Desheng West Road, Suining, 629000 People’s Republic of China
| | - Hong-Wei Yang
- Department of Breast and Thyroid Surgery, Suining Central Hospital, 127 Desheng West Road, Suining, 629000 People’s Republic of China
| | - Mao-Shan Chen
- Department of Breast and Thyroid Surgery, Suining Central Hospital, 127 Desheng West Road, Suining, 629000 People’s Republic of China
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Morrison KA, Choi M, Karp NS. Analysis of Incidentally Found Proliferative Lesions in Oncoplastic and Macromastia Breast Reductions. Plast Reconstr Surg 2023; 152:559e-565e. [PMID: 36862961 DOI: 10.1097/prs.0000000000010341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Reduction mammaplasty pathologic specimens can reveal incidentally found proliferative lesions. However, there is a lack of data investigating the comparative incidences and risk factors for such lesions. METHODS A retrospective review was conducted of all consecutively performed reduction mammaplasty cases at a single large academic medical institution in a metropolitan city by two plastic surgeons over a 2-year period. All reduction mammaplasties, symmetrizing reductions, and oncoplastic reductions performed were included. There were no exclusion criteria. RESULTS A total of 632 breasts were analyzed-502 reduction mammaplasties, 85 symmetrizing reductions, and 45 oncoplastic reductions-in 342 patients. Mean age was 43.9 ± 15.9 years, mean body mass index was 29.2 ± 5.7 kg/m 2 , and mean reduction weight was 610.0 ± 313.1 g. Patients who underwent reduction mammaplasty for benign macromastia had a significantly lower incidence (3.6%) of incidentally found breast cancers and proliferative lesions compared with patients with oncoplastic reductions (13.3%) and symmetrizing reductions (17.6%) ( P < 0.001). On univariate analysis, personal history of breast cancer ( P < 0.001), first-degree family history of breast cancer ( P = 0.008), age ( P < 0.001), and tobacco use ( P = 0.033) were all statistically significant risk factors. Using a backward elimination stepwise reduced multivariable logistic regression model for risk factors associated with breast cancer or proliferative lesions, age ( P < 0.001) was the only retained significant risk factor. CONCLUSIONS Proliferative lesions and carcinomas of the breast found in reduction mammaplasty pathologic specimens may be more common than previously reported. The incidence of newly found proliferative lesions was significantly lower in cases of benign macromastia compared with oncoplastic and symmetrizing reductions. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Affiliation(s)
- Kerry A Morrison
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Mihye Choi
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Nolan S Karp
- From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
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3
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Shen M, Xu Y, Wu Z, Wang J, Pan H, Xu B. Partial breast reconstruction of 30 cases with peri-mammary artery perforator flaps. BMC Surg 2023; 23:41. [PMID: 36810027 PMCID: PMC9945667 DOI: 10.1186/s12893-023-01937-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/10/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Volume replacement is one of the vital techniques of oncoplastic surgery (OPS) when applying breast-conserving surgery. The clinical application of peri-mammary artery perforator flaps for this indication is uneven in China. Here, we describe the results of our clinical experience with peri-mammary artery flaps for partial breast reconstruction. METHODS In this study, 30 patients underwent partial breast resection for quadrant breast cancer followed by partial breast reconstruction with peri-mammary artery perforator flaps, which included the thoracodorsal artery perforator flap (TDAP), anterior intercostal artery perforator flap (AICAP), lateral intercostal artery perforator flap (LICAP), and lateral thoracic artery perforator flap (LTAP). All the patients' operation plans were discussed comprehensively and were performed by sticking to every step. The satisfaction outcome was assessed with the extracted version of the BREAST-Q version 2.0, Breast Conserving Therapy Module Preoperative and Postoperative Scales both preoperatively and postoperatively. RESULTS According to the study outcomes, the mean flap size was 5.3*4.2*2.8 cm (3.0-7.0*3.0-5.0*1.0-3.5 cm). The mean surgical time was 142 min (100-250 min). No partial flap failure was detected, and no severe complications were observed. Most patients were satisfied with the outcomes regarding the dressing, sexual life, and breast shape postoperation. Furthermore, the sensation of the surgical area, scar satisfaction, and recovery state gradually improved. Overall, LICAP and AICAP had higher scores when different flaps were compared. CONCLUSIONS Based on this study, we found that peri-mammary artery flaps had significant value in breast-conserving surgery, especially in patients with small or medium-sized breasts. Perforators could be detected by vascular ultrasound before the operation. More than one perforator could be found most of the time. No severe complications occurred when performing a suitable plan, including discussing and recording the operation procedure; the focus of care, the choice for precise and proper perforators, and the mechanism for hiding the scars were all considered and recorded in a specific chart. Patients were satisfied with the reconstruction technique of peri-mammary artery perforator flaps after breast-conserving, and the satisfaction of AICAP and LICAP was higher. In general, this technique is suitable for partial breast reconstruction and has no negative impact on patient satisfaction.
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Affiliation(s)
- Meiying Shen
- grid.258164.c0000 0004 1790 3548Jinan University, Guangzhou, 510000 China
| | - Yuhang Xu
- grid.258164.c0000 0004 1790 3548Jinan University, Guangzhou, 510000 China
| | - Zongyuan Wu
- grid.513391.c0000 0004 8339 0314Mammary Gland, Maoming People’s Hospital, Maoming, 525000 China
| | - Jiaming Wang
- grid.513391.c0000 0004 8339 0314Mammary Gland, Maoming People’s Hospital, Maoming, 525000 China
| | - Huawen Pan
- grid.258164.c0000 0004 1790 3548Jinan University, Guangzhou, 510000 China
| | - Bo Xu
- Jinan University, Guangzhou, 510000, China.
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4
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Revisiting Reduction Mammaplasty: Complications of Oncoplastic and Symptomatic Macromastia Reductions. Plast Reconstr Surg 2023; 151:267-276. [PMID: 36696305 DOI: 10.1097/prs.0000000000009828] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Oncoplastic breast reduction has been shown to be an effective and safe approach to breast conservation surgery in women with macromastia. However, there remains a paucity of data investigating the comparative outcomes. This study seeks to delineate the complication profiles for oncoplastic and symmetrizing breast reductions versus mammaplasty for benign macromastia. METHODS A retrospective review was conducted of all consecutively performed reduction mammaplasty cases at a single institution by two plastic surgeons over a 2-year period. RESULTS A total of 632 breasts were analyzed: 502 reduction mammaplasties, 85 symmetrizing reductions, and 45 oncoplastic reductions in 342 patients. Mean age was 43.9 ± 15.93 years, mean body mass index was 29.15 ± 5.66 kg/m2, and mean reduction weight was 610.03 ± 313.13 g. Regarding surgical technique, a medial pedicle was used in 86% of cases. There were similar postoperative complication outcomes for nipple necrosis, wound healing, scar revision, fat necrosis, seroma, hematoma, and overall complication rates for all procedures. However, the rate of postoperative revision among reduction mammaplasty (2%), oncoplastic reduction (6.7%), and symmetrizing reduction (5.9%) was significantly different (P = 0.027). In univariate analysis, diabetes (P = 0.011), smoking (P = 0.007), higher body mass index (P = 0.003), larger reduction weight (P = 0.011), longer nipple-to-inframammary fold measurement (P = 0.014), and longer sternal notch-to-nipple measurement (P = 0.039) were all significant risk factors for a surgical complication in reductions performed for any indication. Using a multivariate logistic regression model, diabetes (P = 0.047), smoking (P = 0.025), and higher body mass index (P = 0.002) were all retained as statistically significant risk factors. CONCLUSION The complication profiles for both oncoplastic breast reductions and breast reductions for symptomatic macromastia are similar and acceptably low. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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5
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A new oncoplastic technique with immediate nipple reconstruction for central breast tumors using Würinger's septum based flap. J Plast Reconstr Aesthet Surg 2022; 75:3690-3699. [DOI: 10.1016/j.bjps.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/19/2022] [Accepted: 08/01/2022] [Indexed: 10/16/2022]
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Sundara Rajan S, Verma R, Murthy BL. Chest wall perforator flap to partially reconstruct central mound of breast tissue – evolution of the technique. J Surg Case Rep 2022; 2022:rjac276. [PMID: 35721270 PMCID: PMC9202636 DOI: 10.1093/jscr/rjac276] [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: 04/30/2022] [Accepted: 05/22/2022] [Indexed: 11/24/2022] Open
Abstract
We describe the use of chest wall perforator flap (CWPF) to reconstruct the central mound of breast tissue in women presenting with central/retro areolar breast cancer. We describe the results of seven patients (median age, 59 years) with a median follow-up of 9 months. We were able to conserve the breast in all except one woman who was found to have extensive DCIS. Two patients were taken back to theatre, one for a washout of infected seroma and second for a wound debridement. There was no flap loss or donor site complications in our series. We were able to conserve the breast, maintain aesthetic contour of the central mound along with projection and achieve excellent cosmetic outcome for our patients. Partial breast reconstruction using CWPF provides an oncologically safe and cosmetically superior alternative in selected women with breast cancer needing central wide local excision.
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Affiliation(s)
- Sreekumar Sundara Rajan
- Department of Breast Surgery, University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK
| | - Rashmi Verma
- Department of Breast Surgery, Lancashire Teaching Hospitals NHS Foundation Trust , Chorley , UK
| | - Bade L Murthy
- Department of Breast Surgery, Lancashire Teaching Hospitals NHS Foundation Trust , Chorley , UK
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7
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Malata CM, See IJL, Kazzazi F, Forouhi P, Di Pace B. Combining the Grisotti Flap With a Secondary Dermoglandular Pedicle for Partial Breast Reconstruction Following Contiguous Central-Inferior Segment Breast Cancer Excision. Case Reports Plast Surg Hand Surg 2021; 8:203-207. [PMID: 34881350 PMCID: PMC8648006 DOI: 10.1080/23320885.2021.2008801] [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] [Indexed: 10/31/2022]
Abstract
A 61-year-old patient (38DD) with multifocal invasive ductal carcinomas requested breast-conserving surgery. An innovative two pedicle combination using a laterally-based Grisotti flap and an inferomedially-based secondary pedicle was designed to reconstruct a combined central breast (NAC included) and inferior segment resection defect. Satisfactory cosmesis with clear resection margins was achieved.
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Affiliation(s)
- Charles M Malata
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Anglia Ruskin School of Medicine, Anglia Ruskin University, Cambridge, UK.,Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Isabel Jia Le See
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Fawz Kazzazi
- Clinical School of Medicine, University of Cambridge, Cambridge, UK.,The Royal London Hospital, Barts NHS Health Trust, London, UK
| | - Parto Forouhi
- Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Bruno Di Pace
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Anglia Ruskin School of Medicine, Anglia Ruskin University, Cambridge, UK.,Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", PhD School of Translational Medicine of Development and Active Aging, University of Salerno, Salerno, Italy
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8
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Lee A, Kwasnicki RM, Khan H, Grant Y, Chan A, Fanshawe AEE, Leff DR. Outcome reporting in therapeutic mammaplasty: a systematic review. BJS Open 2021; 5:6459423. [PMID: 34894122 PMCID: PMC8665419 DOI: 10.1093/bjsopen/zrab126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/05/2021] [Indexed: 11/12/2022] Open
Abstract
Background Therapeutic mammaplasty (TM) is an oncological procedure which combines tumour resection with breast reduction and mastopexy techniques. Previous systematic reviews have demonstrated the oncological safety of TM but reporting of critically important outcomes, such as quality of life, aesthetic and functional outcomes, are limited, piecemeal or inconsistent. This systematic review aimed to identify all outcomes reported in clinical studies of TM to facilitate development of a core outcome set. Methods Medline, EMBASE, CINAHL and Web of Science were searched from inception to 5 August 2020. Included studies reported clinical outcomes following TM for adult women. Two authors screened articles independently for eligibility. Data were extracted regarding the outcome definition and classification type (for example, oncological, quality of life, etc.), time of outcome reporting and measurement tools. Results Of 5709 de-duplicated records, 148 were included in the narrative synthesis. The majority of studies (n = 102, 68.9 per cent) reported measures of survival and/or recurrence; approximately three-quarters (n = 75, 73.5 per cent) had less than 5 years follow-up. Aesthetic outcome was reported in half of studies (n = 75, 50.7 per cent) using mainly subjective, non-validated measurement tools. The time point at which aesthetic assessment was conducted was highly variable, and only defined in 48 (64.0 per cent) studies and none included a preoperative baseline for comparison. Few studies reported quality of life (n = 30, 20.3 per cent), functional outcomes (n = 5, 3.4 per cent) or resource use (n = 28, 18.9 per cent). Conclusion Given the oncological equivalence of TM and mastectomy, treatment decisions are often driven by aesthetic and functional outcomes, which are infrequently and inconsistently reported with non-validated measurement tools.
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Affiliation(s)
- Alice Lee
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Hasaan Khan
- Faculty of Medicine, Imperial College London, London, UK
| | - Yasmin Grant
- Department of BioSurgery, Imperial College London, London, UK
| | - Abigail Chan
- Faculty of Medicine, Imperial College London, London, UK
| | - Angela E E Fanshawe
- Department of Breast Surgery, Charing Cross Hospital, Imperial College NHS Trust, London, UK
| | - Daniel R Leff
- Department of Surgery and Cancer, Imperial College London, London, UK
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9
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Chen Y, Chen Q, Dong J, Liu D, Huang L, Xie F, Zeng W, Li W, Zhong S. Modified Grisotti flap technique in centrally located breast cancer: case report. Gland Surg 2021; 10:2867-2873. [PMID: 34733734 DOI: 10.21037/gs-21-176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 08/02/2021] [Indexed: 11/06/2022]
Abstract
Traditionally, breast cancer patients with centrally located mass always receive mastectomy or the combination of central excision and primary closure. With the development of modern oncoplastic breast-conserving techniques, these patients can conserve their breast, and achieve satisfactory cosmetic outcome as well as clear margin. A variety of techniques are available to deal with centrally located breast cancers (CLBCs). Among these techniques, Grisotti flap technique is special, because it is easy to handle, and only causes minor injury by using a local rotational dermoglandular flap to fill the defection of central part. However, in our clinical practice, we find a lot of women in south China have special properties. Such as short distance from inframammary liner to the nipple, long distance from midclavicular to the nipple, and large breast diameter. Simply apply the Grisotti flap technique to those patients is not very suitable that drive us to modify this technique to suit our patients. We adopt the idea that use pedicled skin flap with skin island to replace the central defection to modify Grisotti flap technique. And applied this technique to two patients. We find modified Grisotti flap technique for Paget's disease or CLBC had good cosmetic results as well as safety in suitable patients. In the future, we can use superior pedicle with skin island for ptotic breasts, and lateral pedicle is suitable for patients without large and ptotic breasts.
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Affiliation(s)
- Ying Chen
- Department of Breast Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Qianjun Chen
- Department of Breast Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Jingjing Dong
- Department of Anesthesia, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Dan Liu
- Department of Breast Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Lezhen Huang
- Department of Breast Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Fengfeng Xie
- Department of Breast Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Weijie Zeng
- Department of Breast Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Wenxia Li
- Department of Breast Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Shaowen Zhong
- Department of Breast Surgery, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
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10
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Dabiri C, Hotton J, Wehbe K, Gornes H, Garbar C, Guillemin F, Ceccato V. Assessment of the Grisotti oncoplastic procedure for the management of central breast tumors. Breast J 2021; 27:595-602. [PMID: 34251074 DOI: 10.1111/tbj.14256] [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: 01/14/2021] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The Grisotti technique consists to excise central breast tumor with nipple areolar and mobilize a dermo-glandular flap which is de-epithelized in order to reshape the breast and recreate an areola. The objective was to assess oncological results, postoperative side-effects, and patient and surgeon satisfaction rates resulting from this technique. MATERIALS AND METHODS From September 2016 to December 2019, 38 patients have been treated with a central breast tumor using the Grisotti technique. RESULTS The mean age was 61.6 ± 11. The median body mass index was 27 kg/m² [20-42]. Thirty one patients benefited from a sentinel lymph node dissection. Preoperative histology found a majority of invasive ductal carcinomas (IDC) (71%). There were no intraoperative complications, and the average operating time was 90 min [60-200]. Postoperative histology found IDC associated with ductal carcinoma in situ in 28 patients. The surgical margins were invaded in two patients (reoperated by mastectomy after adjuvant treatment) and invasion of a margin of less than 1 mm in another six patients (supplemented by re-excision). The main postoperative complications were an abscess of the operating site and a partial necrosis of the neo-areola. The appearance of the breasts after radiotherapy gives a high satisfaction rate, both for patients and for surgeons. CONCLUSION The Grisotti technique is an easily reproducible procedure without major complications. It makes it possible to perform a carcinological satisfactory central lumpectomy, correction of the central glandular defect, and reconstruction of a new areola.
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Affiliation(s)
- Clément Dabiri
- Department of Surgical Oncology, Institut Godinot, Reims, France
| | - Judicael Hotton
- Department of Surgical Oncology, Institut Godinot, Reims, France
| | - Karl Wehbe
- Department of Surgical Oncology, Institut Godinot, Reims, France
| | - Hugo Gornes
- Department of Surgical Oncology, Institut Godinot, Reims, France
| | - Christian Garbar
- Department of Pathological Anatomy and Cytology, Institut Godinot, Reims, France
| | | | - Vivien Ceccato
- Department of Surgical Oncology, Institut Godinot, Reims, France
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11
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Akyurek M, Caragacianu D. Oncoplastic reconstruction of central lumpectomy defects using the medial pillar island flap. J Plast Reconstr Aesthet Surg 2021; 74:2863-2869. [PMID: 34011471 DOI: 10.1016/j.bjps.2021.03.102] [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: 09/05/2020] [Revised: 01/31/2021] [Accepted: 03/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE This report presents the medial pillar island flap technique of oncoplastic breast reconstruction of central defects that involve the nipple-areola complex. METHODS The procedure was performed in patients who presented with inferior pole redundancy using a vertical mammaplasty pattern. The flap was designed utilizing the territory of the lower pole as an island flap pedicled by the internal mammary artery perforators surrounded by the soft tissue of the medial pillar. RESULTS Eight patients underwent the procedure with a mean age of 57.6 years. Median breast cup size was D (range: from C to DDD). The mean body mass index was 37.3 kg/m2 (range: from 32.1 to 41.5). The size of the defect ranged from 64 to 150 cm3 (mean, 97.2). Concomitant opposite breast vertical reduction was performed in 6 cases. Flap survival was uneventful. Nipple reconstruction was performed 6 months after radiation treatment in 4 patients. No major complications were encountered. Two patients developed minor wound breakdown after nipple reconstruction. CONCLUSIONS The medial pillar island flap is presented as a safe and reliable option for the reconstruction of central partial mastectomy defects in patients with macromastia or breast ptosis. Internal mammary system provides predictable and robust flap viability while complete separation from the inframammary fold allows for unrestricted mobility. The procedure is designed with vertical scar mammaplasty, which results in a smooth contour to the lower pole. The flap allows for nipple reconstruction using well-vascularized skin paddle. The technique is offered as an alternative oncoplasty option for neoareolar reconstruction.
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Affiliation(s)
- Mustafa Akyurek
- Division of Plastic Surgery, The University of Massachusetts Medical School, Worcester, MA 01605, United States.
| | - Diana Caragacianu
- Surgical Oncology, The University of Massachusetts Medical School, Worcester, MA, United States
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12
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Nipple-Areola Complex Reconstruction Using a Skin Graft and Nipple Sharing after Wise-pattern Central Lumpectomy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3539. [PMID: 33868881 PMCID: PMC8049157 DOI: 10.1097/gox.0000000000003539] [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: 12/30/2020] [Accepted: 02/22/2021] [Indexed: 11/25/2022]
Abstract
Patients with central breast cancers historically underwent mastectomy, as the aesthetic implications of removing the nipple–areola complex and central breast tissue left disfiguring defects after breast conservation. The introduction of oncoplastic techniques allowed for central lumpectomies in ptotic patients, as the excess skin and gland could be mobilized centrally to fill the defect and even immediately reconstruct a nipple and areola. These reconstructions used excess skin on the Wise pattern vertical limbs to create a nipple, or on a “neopedicle” where both the areola and nipple were reconstructed and then mobilized superiorly into position as would be performed for a conventional mastopexy or reduction. These techniques importantly allowed for the immediate reconstruction of a nipple and areola in patients who often imminently required radiotherapy and where subsequent surgery would be challenging. Here we describe another option for immediate nipple and areola reconstruction in these patients—nipple sharing and a skin graft—a well-established approach in post-mastectomy patients but never previously described for patients undergoing breast conservation.
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13
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Tayeh S, Muktar S, Wazir U, Carmichael AR, Al-Fardan Z, Kasem A, Hamdi M, Mokbel K. Is Autologous Fat Grafting an Oncologically Safe Procedure following Breast Conserving Surgery for Breast Cancer? A Comprehensive Review. J INVEST SURG 2020; 35:390-399. [PMID: 33302753 DOI: 10.1080/08941939.2020.1852343] [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] [Indexed: 01/08/2023]
Abstract
BACKGROUND Autologous fat grafting (AFG) is a recognized surgical procedure to correct deformities following breast conservation surgery (BCS) for breast cancer. However, there are concerns about the oncological safety of this technique. In this study we have reviewed the current literature to assess whether AFG adversely influences the oncological outcome after BCS for breast cancer. METHODS We have searched the medical literature using the Embase and PubMed search engines from conception until May 2019 to identify all relevant studies of patients who underwent AFG after BCS. Meta-analysis and meta-regression methodologies were used to calculate the overall relative risk (RR) of loco-regional recurrence (LRR) rates for case-control and case series studies (with historical controls) respectively. RESULTS We have identified 26 eligible studies with a total of 1640 patients who had undergone fat transfer after lumpectomy for breast cancer. The meta-analysis of 11 studies revealed an overall RR for LRR of 0.82 [95% confidence interval (CI):0.14-1.66]. The meta-regression of case series revealed an overall incidence of LRR of 1.85% compared with 2.53% for historical controls. CONCLUSIONS Our study lends further support to the notion that fat transfer after lumpectomy for breast cancer does not seem to increase the risk of LRR. However further prospective research is required in order to confirm this.
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Affiliation(s)
- Salim Tayeh
- The London Breast Institute, Princess Grace Hospital, London, UK.,Department of General Surgery, Homerton University Hospital, London, UK
| | - Samantha Muktar
- The London Breast Institute, Princess Grace Hospital, London, UK
| | - Umar Wazir
- The London Breast Institute, Princess Grace Hospital, London, UK.,Department of General Surgery, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Amtul R Carmichael
- University Hospital of Derby and Burton NHS Foundation Trust, Queens Hospital, Burton upon Trent, UK
| | | | - Abdul Kasem
- Department of General Surgery, King's College Hospitals NHS Trust, Brixton, UK
| | - Moustapha Hamdi
- Brussels University Hospital, Vrij Universiteit Brussels (VUB), Brussels, Belgium
| | - Kefah Mokbel
- The London Breast Institute, Princess Grace Hospital, London, UK
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14
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Papanikolaou IG, Dimitrakakis C, Zagouri F, Marinopoulos S, Giannos A, Zografos E, Zografos CG, Kritikou D, Rodolakis A, Zografos GC, Loutradis D. Paving the way for changing perceptions in breast surgery: a systematic literature review focused on oncological and aesthetic outcomes of oncoplastic surgery for breast cancer. Breast Cancer 2019; 26:416-427. [PMID: 30955172 DOI: 10.1007/s12282-019-00968-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 03/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The emphasis on aesthetic outcomes and quality of life after breast cancer surgery has motivated breast surgeons to develop oncoplastic breast conserving surgery (OPS). Training programs are still rare in most countries, and there is little standardization, which challenges the scientific evaluation of these techniques. This systematic review aims to assess oncological and cosmetic outcomes of OPS. METHODS After a strict selection process with precise inclusion and exclusion criteria, oncologic and aesthetic outcomes of oncoplastic surgery were searched, using the MEDLINE database up to September 30th, 2017. Available published literature was classified in levels of evidence. After a thorough screening process, only studies with the best level of evidence were included on selection. Systematic reviews and meta-analyses were not included for methodological reasons. RESULTS Titles and abstracts of 2.854 citations were identified and after screening 15 prospective studies including 1.391 patients were reviewed and scored in detail. Local relapse was found in 2.8% of cases with a wide range of follow-up (from 6 to 74 months). Close margins were retrieved in 11% of cases and positive margins in 9.4% of cases. Mastectomy was implemented in 6.9% of breast cancer patients to whom OPS was performed. Good cosmetic outcomes were detected in 90.2% of patients undergoing OPS, leaving open issues for who should perform cosmetic evaluation and which method should be used. CONCLUSION Tumor margins, mastectomy rates, and cosmetic outcomes of OPS have to be further improved by standardizing various aspects of OPS. Research efforts should focus on level I evidence assessing both oncological and aesthetic outcomes of OPS and survival rates.
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Affiliation(s)
- I G Papanikolaou
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece.
| | - C Dimitrakakis
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
| | - F Zagouri
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - S Marinopoulos
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
| | - A Giannos
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
| | - E Zografos
- 1st Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - C G Zografos
- 1st Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - D Kritikou
- Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Rodolakis
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
| | - G C Zografos
- 1st Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - D Loutradis
- Breast Unit, 1st Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, 11 Pyrgou street, 16675, Glyfada, Athens, Greece
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15
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Karanlik H, Igci A. Surgical Approach in Invasive Breast Cancer. Breast Cancer 2019. [DOI: 10.1007/978-3-319-96947-3_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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16
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Agrawal J, Mehta S, Goel A, Selvakumar VP, Kumar K, Pande PK. Reconstruction in Breast Conservation Therapy-Single Tertiary Care Institution Experience with 472 Patients. Indian J Surg Oncol 2018; 9:362-368. [PMID: 30287999 PMCID: PMC6154353 DOI: 10.1007/s13193-017-0663-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 04/24/2017] [Indexed: 11/25/2022] Open
Abstract
Breast conservation therapy (BCT) is now internationally accepted treatment for early breast cancer. Despite of high incidence of carcinoma breast in India, BCT rates are very low as compared to the west. In this article, we wish to share our experience of breast conservation with oncoplasty in Indian women. A retrospective analysis of case records of patients treated with oncoplastic breast conservation from January 2009 to June 2014 in a single surgical oncology unit in a tertiary cancer institute. Demographic patient data, stage of disease, location of primary tumour, use of neo-adjuvant chemotherapy if received, tumour size and breast size ratio, reconstruction method used, post-operative complications and aesthetic score of patients were analysed. Various methods of oncoplasty and partial breast reconstruction used are discussed. Four hundred and seventy-two patient records were found suitable for analysis. Most common stage of presentation was T2N0 in 189 patients (40%). Forty-one patients received neo-adjuvant chemotherapy (NACT). Tumour arising in upper outer quadrant was most common site, seen in 268 (56.7%). The most common method of reconstruction was volume displacement, done in 57.6% patients. Overall surgical complications included wound infection with or without dehiscence, seroma formation, partial flap necrosis and fat necrosis. Cosmesis was found to be excellent in 23.09% and good in 58.47% at 6-month follow-up. Breast conservation with oncoplasty is oncologically safe for early breast cancer treatment and has good cosmetic outcome with high patient satisfaction rates. Its practice should be encouraged in Indian set-up also.
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Affiliation(s)
- Juhi Agrawal
- Reconstructive Surgery, Department of Surgical Oncology, BLK Super Specialty Hospital, Pusa Road, Delhi, India
| | - Sandeep Mehta
- Reconstructive Surgery, Department of Surgical Oncology, BLK Super Specialty Hospital, Pusa Road, Delhi, India
| | - Ashish Goel
- Department of Surgical Oncology, Pusa Road, Delhi, Delhi 110005 India
| | | | - Kapil Kumar
- Department of Surgical Oncology, Pusa Road, Delhi, Delhi 110005 India
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17
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Habibi M, Broderick KP, Sebai ME, Jacobs LK. Oncoplastic Breast Reconstruction: Should All Patients be Considered? Surg Oncol Clin N Am 2018; 27:167-180. [PMID: 29132559 DOI: 10.1016/j.soc.2017.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Oncoplastic surgery of the tissue defect from partial mastectomy should be considered for all patients. It can result in in significant asymmetries from scar contraction, skin tethering, and alterations in the nipple areolar complex location. Indications, risks, and benefits are discussed. Optimal procedures are described, considering resected specimen volume, primary tumor location, tumor to breast size ratio, and the impact on the nipple areolar complex. Indications for plastic surgery consultation and joint surgery are discussed. Surgical management includes incision planning, preservation of the nipple areolar complex pedicle and position, patient positioning, incision location, and recovery.
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Affiliation(s)
- Mehran Habibi
- Department of Surgery, Johns Hopkins University, 4940 Eastern Avenue, Room A-562, Baltimore, MD 21224, USA
| | - Kristen P Broderick
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University, 4940 Eastern Avenue, Suite A 520, Baltimore, MD 21224, USA
| | - Mohamad E Sebai
- Department of Surgery, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Building A 5th Floor-Room 562, Baltimore, MD 21224, USA
| | - Lisa K Jacobs
- Department of Surgery, Johns Hopkins University, Blalock 607, Baltimore, MD 21287, USA.
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18
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Pasta V, D'Orazi V, Merola R, Frusone F, Amabile MI, De Luca A, Buè R, Monti M. Oncoplastic central quadrantectomies. Gland Surg 2016; 5:422-6. [PMID: 27563564 DOI: 10.21037/gs.2016.04.01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Tumors localized in the central quadrant (centrally located breast tumors) have always represented a challenge for the surgeon because of the critical aesthetical matters related to the nipple-areola complex (NAC). Many years of experience with breast cancer patients treated by using various oncoplastic techniques, has allowed us to develop the modified hemibatwing for the treatment of central breast tumors, where the NAC is involved. Modified hemibatwing-along with the removal of the NAC-is a useful oncoplastic technique and it represents an ideal option for the treatment of central tumors because it assures oncological safety, a reduced surgical timetable and greater aesthetical results.
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Affiliation(s)
- Vittorio Pasta
- Department of General Surgery, Policlinico Umberto I, University of Rome "La Sapienza", Rome, Italy;; Department of Surgical Science, Policlinico Umberto I, University of Rome "La Sapienza", Rome, Italy
| | - Valerio D'Orazi
- Department of General Microsurgery and Hand Surgery, Fabia Mater Hospital, I-00171 Rome, Italy
| | - Raffaele Merola
- Department of Surgical Science, Policlinico Umberto I, University of Rome "La Sapienza", Rome, Italy
| | - Federico Frusone
- Department of Surgical Science, Policlinico Umberto I, University of Rome "La Sapienza", Rome, Italy
| | - Maria Ida Amabile
- Department of Surgical Science, Policlinico Umberto I, University of Rome "La Sapienza", Rome, Italy
| | - Alessandro De Luca
- Department of Surgical Science, Policlinico Umberto I, University of Rome "La Sapienza", Rome, Italy
| | - Rosanna Buè
- Department of Surgical Science, Policlinico Umberto I, University of Rome "La Sapienza", Rome, Italy
| | - Marco Monti
- Department of Gynecology and Obstetrics, Sapienza University of Rome, 00161 Rome, Italy
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19
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De La Cruz L, Blankenship SA, Chatterjee A, Geha R, Nocera N, Czerniecki BJ, Tchou J, Fisher CS. Outcomes After Oncoplastic Breast-Conserving Surgery in Breast Cancer Patients: A Systematic Literature Review. Ann Surg Oncol 2016; 23:3247-58. [DOI: 10.1245/s10434-016-5313-1] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Indexed: 11/18/2022]
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20
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Yiannakopoulou E, Mathelin C. Oncoplastic breast conserving surgery and oncological outcome: Systematic review. Eur J Surg Oncol 2016; 42:625-30. [DOI: 10.1016/j.ejso.2016.02.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 01/02/2016] [Accepted: 02/02/2016] [Indexed: 10/22/2022] Open
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21
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Chauhan A, Sharma MM. Evaluation of surgical outcomes following oncoplastic breast surgery in early breast cancer and comparison with conventional breast conservation surgery. Med J Armed Forces India 2015; 72:12-8. [PMID: 26900217 DOI: 10.1016/j.mjafi.2015.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 11/01/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The aim of this study was to determine whether oncoplastic breast surgery (OBS) ensures better tumour resection than conventional breast conservation surgery (BCS). METHODS A prospective comparative study, conducted over a 3-year period, enrolled patients with early breast cancer who underwent OBS. The total volume of glandular resection, tumour volume resection and width of the margins obtained were noted. The incidence of complications, requirement of revision surgery and locoregional recurrence during follow-up period were also noted. The data were compared with matched controls who had undergone convention BCS in the past. RESULTS Thirty-three patients underwent oncoplastic surgery and the data was compared with 46 patients of conventional breast conservation. The mean volume of specimen was higher in the oncoplastic group (173.5 cm(3) vs 101.4 cm(3), p = 0.03) though the tumour volume excised was similar (43.2 cm(3) vs 36.4 cm(3), p = 0.14). The mean margin widths were larger in the oncoplastic group (14 mm vs 6 mm, p = 0.01). There were more instances of close and positive margins seen in conventional BCS groups. The incidence of complication rate was similar. Median follow-up 18 months for oncoplasty group showed no cases of locoregional recurrence while in median follow-up of 38 months for conventional BCS group, six cases of locoregional relapse were noted. CONCLUSIONS Oncoplastic surgery results in excision of larger volume of breast tissue and correspondingly obtain wider surgical margins as compared to conventional BCS. Longer follow-up is required to determine if wider resection translates into better locoregional control.
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Affiliation(s)
- Ashutosh Chauhan
- Classified Specialist (Surgery) & Oncosurgeon, Base Hospital, Delhi Cantt 110010, India
| | - Mala Mathur Sharma
- Consultant (Surgical Oncology), Amrita Institute of Medical Sciences, Kochi, India
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22
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A Comparative Retrospective Analysis of Complications After Oncoplastic Breast Reduction and Breast Reduction for Benign Macromastia. Ann Plast Surg 2015; 75:370-5. [DOI: 10.1097/sap.0000000000000159] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Management of central breast tumours with immediate reconstruction of the nipple-areola complex; a suggested guide. Breast 2015; 24:38-45. [DOI: 10.1016/j.breast.2014.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 10/27/2014] [Accepted: 11/04/2014] [Indexed: 11/22/2022] Open
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Abstract
UNLABELLED When immediate reconstruction is applied to breast conservation therapy (BCT), the benefits extend well beyond the minimization of poor cosmetic results. The purpose of this analysis was to compare literature outcomes between BCT alone and BCT with the oncoplastic approach. METHODS A meta-analysis was performed in PubMed using key words "oncoplastic," "partial breast reconstruction," and "breast conservation therapy." Case reports, series with less than 10 patients, and those with less than 1-year follow-up were excluded from the analysis. The 3 comparative groups included BCT with oncoplastic reduction techniques (Group A), BCT with oncoplastic flap techniques (Group B), and BCT alone (Group C). RESULTS Comparisons were made on 3165 patients in the BCT with oncoplastic group (Groups A and B, 41 papers) and 5494 patients in the BCT alone group (Group C, 20 papers). Demographics were similar, and tumor size was larger in the oncoplastic group (2.7 vs 1.2 cm). The weight of the lumpectomy specimen was 4 times larger in the oncoplastic group. The positive margin rate was significantly lower in the oncoplastic group (12% vs 21%, P < 0.0001). Reexcision was more common in the BCT alone group (14.6% vs 4%, P < 0.0001), however, completion mastectomy was more common in the oncoplastic group (6.5% vs 3.79%, P < 0.0001). The average follow-up was longer in the BCT alone group (64 vs 37 months). Local recurrence was 4% in the oncoplastic group and 7% in the BCT alone group. Satisfaction with the aesthetic outcome was significantly higher in the oncoplastic group (89.5% vs 82.9%, P < 0.001). CONCLUSIONS The oncoplastic approach to BCT allows a generous resection with subsequent reduction in positive margins. The true value on local recurrence remains to be determined. Patients are more satisfied with outcomes when the oncoplastic approach is used.
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25
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Partial breast reconstruction using various oncoplastic techniques for centrally located breast cancer. Arch Plast Surg 2014; 41:520-8. [PMID: 25276644 PMCID: PMC4179356 DOI: 10.5999/aps.2014.41.5.520] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/29/2014] [Accepted: 06/11/2014] [Indexed: 11/20/2022] Open
Abstract
Background As the breast cancer incidence has increased, breast-conserving surgery has replaced total mastectomy as the predominant procedure. However, centrally located breast cancers pose significant challenges to successful breast-conserving surgeries. Therefore, we performed partial mastectomy and oncoplastic procedures on centrally located breast cancer as a means of partial breast reconstruction. The authors examined and evaluated the functional and aesthetic usefulness of this reconstruction method. Methods From January 2007 to June 2011, 35 patients with centrally located breast cancers who underwent various oncoplastic procedures based on the breast size and resection volume. The oncoplastic procedures performed included volume displacement surgical techniques such as purse-string suture, linear suture, and reduction mammaplasty. Other oncoplastic procedures included volume replacement procedures with an adipofascial, thoracoepigastric, intercostal artery perforator, thoracodorsal artery perforator, or latissimus dorsi flap. Results Mean patient age was 49 years, and mean follow-up period was 11 months. In cases of small to moderate-sized breasts and resection volumes <50 g, volume displacement procedures were performed. In cases of resection volumes >50 g, volume replacement procedures were performed. In cases of larger breasts and smaller resection volumes, glandular reshaping was performed. Finally, in cases of larger breasts and larger resection volumes, reduction mammaplasty was performed. This reconstruction method also elicits a high patient satisfaction rate with no significant complications. Conclusions In centrally located breast cancer, oncoplastic surgery considering breast size and resection volume is safe and provides appropriate aesthetic outcomes. Therefore, our method is advisable for breast cancer patients who elect to conserve their breasts and retain a natural breast shape.
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Munhoz AM, Montag E, Gemperli R. Oncoplastic breast surgery: indications, techniques and perspectives. Gland Surg 2014; 2:143-57. [PMID: 25083476 DOI: 10.3978/j.issn.2227-684x.2013.08.02] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 08/20/2013] [Indexed: 11/14/2022]
Abstract
Breast-conservation surgery (BCS) is established as a safe option for most women with early breast cancer. Recently, advances in oncoplastic techniques have reduced surgical trauma and thus are capable of preserving the breast form and quality of life. In spite of the most BCS defects can be managed with primary closure, the aesthetic outcome may be unpredictable. Oncoplastic reconstruction may begin at the time of BCS (immediate), weeks (delayed-immediate) or months to years afterwards (delayed). With immediate reconstruction, the surgical process is smooth, since both procedures can be associated in one operative setting. Additionally, it permits wider excision of the tumor, with a superior mean volume of the specimen and potentially reducing the incidence of margin involvement. The oncoplastic techniques are related to volume displacement or replacement procedures including local flaps, latissimus dorsi myocutaneous flap and reduction mammaplasty/masthopexy. Regardless of the fact that there is no consensus concerning the best approach, the criteria are determined by the surgeon's experience and the size of the defect in relation to the size of the remaining breast. On the basis of our 15-year experience, it is possible to identify trends in types of breast defects and to develop an algorithm for immediate BCS reconstruction on the basis of the initial breast volume, the extent/location of glandular tissue ressection and the remaining available breast tissue. The main advantages of the technique utilized should include reproducibility, low interference with the oncologic treatment and long-term results. Surgical planning should include the patients's preferences, and chiefly addressing individual reconstructive requirements, enabling each patient to receive an individual "custom-made" reconstruction.
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Affiliation(s)
- Alexandre Mendonça Munhoz
- 1 Plastic Surgery Division, Hospital Sírio-Libanês, São Paulo/ Brazil ; 2 Breast Reconstruction Group, University of São Paulo School of Medicine, Brazil ; 3 Division of Plastic Surgery, University of São Paulo School of Medicine, Brazil
| | - Eduardo Montag
- 1 Plastic Surgery Division, Hospital Sírio-Libanês, São Paulo/ Brazil ; 2 Breast Reconstruction Group, University of São Paulo School of Medicine, Brazil ; 3 Division of Plastic Surgery, University of São Paulo School of Medicine, Brazil
| | - Rolf Gemperli
- 1 Plastic Surgery Division, Hospital Sírio-Libanês, São Paulo/ Brazil ; 2 Breast Reconstruction Group, University of São Paulo School of Medicine, Brazil ; 3 Division of Plastic Surgery, University of São Paulo School of Medicine, Brazil
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27
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Barnea Y, Inbal A, Barsuk D, Menes T, Zaretski A, Leshem D, Weiss J, Schneebaum S, Gur E. Oncoplastic reduction using the vertical scar superior-medial pedicle pattern technique for immediate partial breast reconstruction. Can J Surg 2014; 57:E134-40. [PMID: 25078939 DOI: 10.1503/cjs.031213] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Oncoplastic breast reduction in women with medium to large breasts has reportedly benefitted them both oncologically and cosmetically. We present our experience with an oncoplastic breast reduction technique using a vertical scar superior-medial pedicle pattern for immediate partial breast reconstruction. METHODS All patients with breast tumours who underwent vertical scar superior-medial pedicle reduction pattern oncoplastic surgery at our centre between September 2006 and June 2010 were retrospectively studied. Follow-up continued from 12 months to 6 years. RESULTS Twenty women (age 28-72 yr) were enrolled: 16 with invasive carcinoma and 4 with benign tumours. They all had tumour-free surgical margins, and no further oncological operations were required. The patients expressed a high degree of satisfaction from the surgical outcome in terms of improved quality of life and a good cosmetic result. CONCLUSION The vertical scar superior-medial pedicle reduction pattern is a versatile oncoplastic technique that allows breast tissue rearrangement for various tumour locations. It is oncologically beneficial and is associated with high patient satisfaction.
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Affiliation(s)
- Yoav Barnea
- The Department of Plastic and Reconstructive Surgery, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Amir Inbal
- The Department of Plastic and Reconstructive Surgery, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israell
| | - Daphna Barsuk
- The Breast Health Center, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tehila Menes
- The Breast Health Center, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arik Zaretski
- The Department of Plastic and Reconstructive Surgery, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - David Leshem
- The Department of Plastic and Reconstructive Surgery, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Jerry Weiss
- The Department of Plastic and Reconstructive Surgery, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Schlomo Schneebaum
- The Breast Health Center, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Gur
- The Department of Plastic and Reconstructive Surgery, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
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Munhoz AM, Montag E, Gemperli R. Current aspects of therapeutic reduction mammaplasty for immediate early breast cancer management: An update. World J Clin Oncol 2014; 5:1-18. [PMID: 24527398 PMCID: PMC3920176 DOI: 10.5306/wjco.v5.i1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 11/02/2013] [Accepted: 11/16/2013] [Indexed: 02/06/2023] Open
Abstract
Breast-conservation surgery (BCS) is established as a safe surgical treatment for most patients with early breast cancer. Recently, advances in oncoplastic techniques are capable of preserving the breast form and quality of life. Although most BCS defects can be managed with primary closure, the aesthetic outcome may be unpredictable. Among technical options, therapeutic reduction mammaplasty (TRM) remains a useful procedure since the BCS defect can be repaired and the preoperative appearance can be improved, resulting in more proportional breasts. As a consequence of rich breast tissue vascularization, the greater part of reduction techniques have based their planning on preserving the pedicle of the nipple-areola complex after tumor removal. Reliable circulation and improvement of a conical shape to the breast are commonly described in TRM reconstructions. With an immediate approach, the surgical process is smooth since both procedures can be carried out in one operative setting. Additionally, it permits wider excision of the tumor, with a superior mean volume of the specimen and potentially reduces the incidence of margin involvement. Regardless of the fact that there is no consensus concerning the best TRM technique, the criteria is determined by the surgeon’s experience, the extent/location of glandular tissue resection and the size of the defect in relation to the size of the remaining breast. The main advantages of the technique utilized should include reproducibility, low interference with the oncological treatment and long-term results. The success of the procedure depends on patient selection, coordinated planning and careful intra-operative management.
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29
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Quality of information reporting in studies of standard and oncoplastic breast-conserving surgery. Breast 2013; 23:104-11. [PMID: 24388734 DOI: 10.1016/j.breast.2013.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 11/30/2013] [Accepted: 12/07/2013] [Indexed: 11/20/2022] Open
Abstract
The aim of this systematic review was to establish the completeness of reporting of key patient, tumour, treatment, and outcomes information in the randomized-controlled trials (RCTs) of standard breast-conserving surgery (sBCS) considered to be the 'gold-standard', and to compare this with the reporting of the same key criteria for all published studies of oncoplastic breast-conserving surgery (oBCS). Pubmed (1966 to 1st April 2013), Ovid MEDLINE (1966 to 1st April 2013), EMBASE (1980 to 1st April 2013), and the Cochrane Database of Systematic Reviews (Issue 4, 2013) were searched separately for the following terms: (i) 'oncoplastic AND breast AND surgery'; and (ii) 'therapeutic AND mammaplasty'. Only English language and full text articles were reviewed. Following a pilot evaluation of all studies, key reporting criteria were identified. 16 RCTs of sBCS (n = 11,767 patients) were included, and 53 studies met the inclusion criteria for oncoplastic BCS (n = 3236 patients), none of which were RCTs. No study reported all of the criteria identified, with a mean of 64% of key criteria (range, 55-75%) reported in studies of sBCS, and 54% of criteria (range, 10-85%) reported in studies of oBCS. It is therefore evident that there is much room for improvement in the quality of reporting is BCS studies. Standards are proposed to give future studies of BCS a framework for reporting key information and outcomes.
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Clough KB, Oden S, Ihrai T, Massey E, Nos C, Sarfati I. Level 2 oncoplastic surgery for lower inner quadrant breast cancers: the LIQ-V mammoplasty. Ann Surg Oncol 2013; 20:3847-54. [PMID: 23838910 DOI: 10.1245/s10434-013-3085-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND Oncoplastic surgical techniques offer an option of breast conserving surgery for larger tumors with the use of glandular reshaping to prevent postoperative deformity. A technique for the excision of lower inner quadrant tumors via a V incision is described, the lower-inner quadrant-V (LIQ-V) mammoplasty, and the results of a pilot study are reported. METHODS Retrospective collection of pre- and postoperative data was collected from patients undergoing a LIQ-V mammoplasty for a LIQ tumor. RESULTS Twenty-two patients were operated on between 2004 and 2011 at a mean age of 58 years. The mean follow-up was 55 months. The mean resection weight was 101 g for tumors ranging in size from 4 to 31 mm. The margins were clear in 95% of cases. There was one case of local recurrence and metastatic disease. The cosmetic outcome was judged as excellent in 68% of cases, and no patient required further ipsilateral or contralateral symmetrizing surgery. DISCUSSION The deformity often associated with tumors of the LIQ is adequately addressed by this new technique. It has a complication rate comparable to other mammoplasty series and a high rate of clear resection margins. Many oncoplastic surgery techniques are based on inverted T mammoplasty, but these are not suited for all tumor locations. The LIQ-V mammoplasty is an adaptation of the standard techniques that best suit the LIQ. It is oncologically safe and provides disease-free margins, and although the resection volumes are large, the cosmetic outcome is not compromised.
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The role of oncoplastic therapeutic mammoplasty in breast cancer surgery--a review. Surg Oncol 2011; 21:133-41. [PMID: 21411311 DOI: 10.1016/j.suronc.2011.01.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 09/22/2010] [Accepted: 01/17/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Reduction mammoplasty is an established technique for symptom relief in women with breast hypertrophy. Therapeutic mammoplasty and radiotherapy may allow cancers to be surgically treated whilst maintaining oncological safety and improving cosmetic outcome. This article aims to review the evidence upon which therapeutic mammoplasty is based and to outline an approach for surgical planning and selection. METHODS A systematic PubMed and Medline literature search was carried out. All abstracts were studied and papers that dealt primarily with breast conservation using plastic surgery techniques were reviewed. RESULTS AND CONCLUSION Therapeutic mammoplasty is a useful procedure for breast conserving cancer surgery in women with large breasts, conferring a good cosmetic and functional outcome. This article proposes that breast surgeons experienced in oncological surgery can safely resect tumours from all aspects of the breast with a minimal number of variations in standard mammoplasty technique.
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Gainer SM, Lucci A. Oncoplastics: Techniques for reconstruction of partial breast defects based on tumor location. J Surg Oncol 2011; 103:341-7. [DOI: 10.1002/jso.21672] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bong J, Parker J, Clapper R, Dooley W. Clinical series of oncoplastic mastopexy to optimize cosmesis of large-volume resections for breast conservation. Ann Surg Oncol 2010; 17:3247-51. [PMID: 20549563 DOI: 10.1245/s10434-010-1140-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Indexed: 02/05/2023]
Abstract
BACKGROUND Oncoplastic mastopexy has been popularized as a method to hide the cosmetic effects of central or large-volume resections associated with breast conservation surgery for breast cancer. MATERIALS AND METHODS This review was undertaken to study the uses and limitations of these techniques in providing adequate breast conservation lumpectomy for breast cancer of any stage in a single surgeon's practice. A review of breast cancer cases March 2004 through December 2009 were analyzed for the use of oncoplastic reconstruction in breast conservation surgery. RESULTS A total of 167 patients had lumpectomies during this period associated with oncoplastic mastopexy reconstruction. The average age was 55.6 years with a range of 33-85 years. Stage 0 breast cancer accounted for 33 cases (19.8%), and 134 cases were invasive cancers stages 1-3 (stage 1, 34.1%; stage 2, 30.6%; and stage 3, 15.6%). The most common oncoplastic techniques used were, in order of frequency: batwing mastopexy, parallelogram mastopexy, and Modified Wise pattern mastopexy. Positive or close margins (≤ 2 mm) were present in 37 of 167 cases (22%). Positive margins were most associated with higher stage, positive nodes, positive lymphovascular invasion (LVI), use of neoadjuvant chemotherapy, and larger initial T stage, positive estrogen receptor (ER), and younger age. Of these higher stage, node positive, and use of neoadjuvant chemotherapy were statistically significant in this small series (P values = 0.034, 0.016, and 0.022, respectively). Ki-67 and HER2 status were not associated with positive margins. Positive margins were manageable by local re-excision of a solitary face of the prior resection wall in more than 2/3 of cases to achieve negative pathologic margins. Only 11 of 167 required mastectomy because of failure to achieve adequate margins for oncologic control. CONCLUSIONS Oncoplastic mastopexy allows the surgeon to address large tumors or tumors in cosmetically difficult sites adequately for breast conservation. Careful margin marking and re-excision of close or positive margins is still often feasible to achieve adequate negative margin with acceptable cosmesis in spite of the large initial volumes of resection.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Cosmetics
- Female
- Humans
- Mammaplasty
- Mammography
- Mastectomy, Segmental
- Middle Aged
- Prognosis
- Prospective Studies
- Plastic Surgery Procedures
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Affiliation(s)
- J Bong
- Division of Surgical Oncology, Department of Surgery, Institute for Breast Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Patani N, Carpenter R. Oncological and aesthetic considerations of conservational surgery for multifocal/multicentric breast cancer. Breast J 2010; 16:222-32. [PMID: 20565467 DOI: 10.1111/j.1524-4741.2010.00917.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Conventional indications for mastectomy (MX) reflect circumstances where breast conserving therapy (BCT) could compromise oncological or cosmetic outcome. MX continues to be recommended for the majority of women with multiple lesions within the same breast. In this article, we review the oncological safety and aesthetic considerations of BCT in the context of multifocal (MF) or multicentric (MC) breast cancer. Literature review facilitated by Medline and PubMed databases. Published studies have reported divergent results regarding the oncological adequacy of BCT in the management of MF or MC disease. Earlier studies demonstrated high rates of local recurrence (LR) for BCT. More recent series have found BCT to be comparable to MX in terms of LR, distant failure, disease free and overall survival. Few studies have adequately evaluated cosmetic outcomes following BCT for MF or MC breast cancer. Contemporary oncoplastic techniques have extended the clinical utility of BCT and are of particular relevance to breast conservation in the context of MF or MC lesions. Appropriate case selection, preoperative oncological and aesthetic planning, satisfactory clearance of the surgical margins and adjuvant radiotherapy are of paramount importance. In the absence of level-1 guidance concerning the management of women with MF or MC disease, each case requires discussion with regard to tumor and patient related factors in the context of the multidisciplinary team. In selected patients with MF or MC disease, BCT is oncologically safe and cosmetically acceptable. Uniformity of practice and the establishment of a standard of care will require an evidence-base from prospective studies.
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Affiliation(s)
- Neill Patani
- The Breast Unit, Elizabeth Garrett Anderson Wing, University College Hospital, London, United Kingdom
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Parrett BM, Schook C, Morris D. Breast reduction in the irradiated breast: evidence for the role of breast reduction at the time of lumpectomy. Breast J 2010; 16:498-502. [PMID: 21054644 DOI: 10.1111/j.1524-4741.2010.00965.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Given the high incidence of breast cancer in our society, it is common to encounter patients with macromastia who desire breast reduction after breast-conserving therapy by lumpectomy and radiation. We hypothesize that radiation leads to a significant increase in postoperative complications after breast reduction. All patients with a history of unilateral breast lumpectomy and radiation who subsequently underwent bilateral breast reduction by a single surgeon from 2004 to 2008 were retrospectively reviewed. Outcomes including cellulitis, wound breakdown, seroma, and need for repeat operations were compared between the radiated and nonradiated breast. The Fisher's exact test was used for statistical analysis. Twelve patients (mean age, 57 years) underwent bilateral breast reduction a mean of 86 months after unilateral lumpectomy and radiation. The nonradiated breasts had no complications postoperatively. The radiated breasts had a significant increase in complications with a total of five breasts (42%, p<0.04) having postoperative complications including cellulitis in two breasts, seroma requiring drainage in five breasts, two cases of fat necrosis, and one case of wound dehiscence. This resulted in two admissions for intravenous antibiotics and two repeat operative procedures. Additionally, three patients had significant breast asymmetry or contour deformities after reduction requiring operative revisions. Breast reduction after radiation leads to a significant increase in complications. Given this data, patients with macromastia undergoing breast conservation therapy for cancer should be considered for reduction at the time of lumpectomy and prior to radiation.
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Affiliation(s)
- Brian M Parrett
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Oncoplastic breast surgery for cancer: analysis of 540 consecutive cases [outcomes article]. Plast Reconstr Surg 2010; 125:454-462. [PMID: 20124831 DOI: 10.1097/prs.0b013e3181c82d3e] [Citation(s) in RCA: 176] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Synchronous plastic and oncological surgery is undertaken to improve the security of excision margins and yield high-quality aesthetic outcomes when conventional breast-conserving therapy either anticipates poor results or is not possible. METHODS A total of 540 consecutive patients underwent primary oncoplastic breast surgery for cancer with high tumor-to-breast volume ratios and locations precluding a good aesthetic result with simple tumor excision. A variety of techniques were employed at the Institut Curie between 1986 and 2007, and aesthetic outcomes were assessed on a five-point scale from 1 (excellent) to 5 (poor). RESULTS The median age was 52 years (range, 28 to 90 years), and median follow-up was 49 months (6 to 262 months). Median tumor size was 29.1 mm (range, 4 to 100 mm), with most patients (72.3 percent) having a brassiere cup size of B or C. Close or involved margins occurred in 18.9 percent, with mastectomy being necessary in 9.4 percent. A satisfactory aesthetic outcome (ratings of 1 to 3) at 5 years was obtained in 90.3 percent. Five-year overall and distant disease-free survival rates were 92.9 and 87.9 percent, respectively, with local recurrence in 6.8 percent. CONCLUSIONS With local recurrence and survival rates similar to those for breast-conserving therapy, this series confirms the safety of oncoplastic breast surgery for tumors both high in volume and difficult in location. Highly satisfactory cosmetic outcomes extend the indications for conservative surgery, further reduce the mastectomy rate, and limit adverse aesthetic sequelae.
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Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol 2010; 17:1375-91. [PMID: 20140531 DOI: 10.1245/s10434-009-0792-y] [Citation(s) in RCA: 377] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Indexed: 12/14/2022]
Abstract
BACKGROUND Oncoplastic surgery (OPS) has emerged as a new approach for extending breast conserving surgery (BCS) possibilities, reducing both mastectomy and re-excision rates, while avoiding breast deformities. OPS is based upon the integration of plastic surgery techniques for immediate reshaping after wide excision for breast cancer. A simple guide for choosing the appropriate OPS procedure is not available. OBJECTIVE To develop an Atlas and guideline for oncoplastic surgery (OPS) to help in patient selection and choice of optimal surgical procedure for breast cancer patients undergoing BCS. METHODS We stratify OPS into two levels based on excision volume and the complexity of the reshaping technique. For resections less than 20% of the breast volume (level I OPS), a step-by-step approach allows easy reshaping of the breast. For larger resections (level II OPS), a mammoplasty technique is required. RESULTS We identified three elements that can be used for patient selection and for determination of the appropriate OPS technique: excision volume, tumor location, and glandular density. For level II techniques, we defined a quadrant per quadrant Atlas that offers a different mammoplasty for each quadrant of the breast. CONCLUSIONS OPS is the "third pathway" between standard BCS and mastectomy. The OPS classification and Atlas improves patient selection and allows a uniform approach for surgeons. It proposes a specific solution for different scenarios and helps improve breast conservation outcomes.
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Affiliation(s)
- Krishna B Clough
- Department of Surgery, The Paris Breast Center, L'Institut du Sein, Paris, France.
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Mascaro A, Farina M, Gigli R, Vitelli CE, Fortunato L. Recent advances in the surgical care of breast cancer patients. World J Surg Oncol 2010; 8:5. [PMID: 20089167 PMCID: PMC2828445 DOI: 10.1186/1477-7819-8-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 01/20/2010] [Indexed: 12/13/2022] Open
Abstract
A tremendous improvement in every aspect of breast cancer management has occurred in the last two decades. Surgeons, once solely interested in the extipartion of the primary tumor, are now faced with the need to incorporate a great deal of information, and to manage increasingly complex tasks. As a comprehensive assessment of all aspects of breast cancer care is beyond the scope of the present paper, the current review will point out some of these innovations, evidence some controversies, and stress the need for the surgeon to specialize in the various aspects of treatment and to be integrated into the multisciplinary breast unit team.
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Affiliation(s)
- Alessandra Mascaro
- Department of Surgery, Senology Unit, San Giovanni-Addolorata Hospital, Via Amba Aradam, 9, 00187 Rome, Italy.
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Lim RJ, Lee KS, Lee SH, Yoon CS, Ko SS, Hur MH, Lee HK, Hong SR, Lee JH, Kang SS. Central Lumpectomy with Resection of the Nipple-areolar Complex for Retroareolar or Central Breast Cancers. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.79.4.275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ra Joo Lim
- Department of General Surgery, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
| | - Kyung Sang Lee
- Department of Radiology, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
| | - Suok Hyun Lee
- Department of General Surgery, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
| | - Chan Seok Yoon
- Department of General Surgery, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
| | - Seung Sang Ko
- Department of General Surgery, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
| | - Min Hee Hur
- Department of General Surgery, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
| | - Hae Kyung Lee
- Department of General Surgery, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
| | - Sung Ran Hong
- Department of Pathology, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
| | - Ji Hyun Lee
- Department of General Surgery, CHA Hospital, CHA University College of Medicine, Seoul, Korea
| | - Sung Soo Kang
- Department of General Surgery, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
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Intramammarian flap reconstruction (IFR) technique in breast conserving surgery. Breast 2009; 18:387-92. [DOI: 10.1016/j.breast.2009.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Revised: 07/30/2009] [Accepted: 10/06/2009] [Indexed: 11/23/2022] Open
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Ballester M, Berry M, Couturaud B, Reyal F, Salmon RJ, Fitoussi AD. Lateral mammaplasty reconstruction after surgery for breast cancer. Br J Surg 2009; 96:1141-6. [PMID: 19787762 DOI: 10.1002/bjs.6696] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Up to 60 per cent of cancers develop laterally in the breast and breast-conserving surgery frequently produces superolateral nipple-areolar complex (NAC) distortion aggravated by postoperative irradiation. Correction is technically demanding and the outcomes are variable. Lateral mammaplasty may allow wider excision margins and prevent such deformities. METHODS This was a review of 86 consecutive patients who had lateral mammaplasty: combined wide tumour excision with NAC repositioning on a reliable dermoglandular pedicle. Simultaneous axillary surgery was performed via a separate or combined incision. Aesthetic outcomes were assessed. RESULTS The median age of the women was 54 (range 29-75) years; 55 (64 per cent) had palpable tumours and 73 (85 per cent) underwent simultaneous axillary surgery. Median radiological and histological tumour sizes were 29.8 and 33.6 mm, respectively, and median weight of excised tumour was 150 g. Two patients required haematoma evacuation. Eleven women required revisional surgery for involved or close margins. Aesthetic outcomes were excellent or good in 93 per cent. CONCLUSION Lateral mammaplasty produced clear margins in 87 per cent of women. It is an option when a deformity is anticipated after breast-conserving surgery, and is particularly valuable when neoadjuvant chemotherapy has downgraded a large tumour.
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Affiliation(s)
- M Ballester
- Department of Surgery, Institut Curie, Paris, France
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Oncoplastic Techniques Extend Breast-Conserving Surgery to Patients with Neoadjuvant Chemotherapy Response Unfit for Conventional Techniques. World J Surg 2009; 33:2082-6. [DOI: 10.1007/s00268-009-0152-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Berry MG, Fitoussi AD, Curnier A, Couturaud B, Salmon RJ. Oncoplastic breast surgery: a review and systematic approach. J Plast Reconstr Aesthet Surg 2009; 63:1233-43. [PMID: 19559661 DOI: 10.1016/j.bjps.2009.05.006] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 04/10/2009] [Accepted: 05/02/2009] [Indexed: 12/20/2022]
Abstract
Oncoplastic breast surgery (OBS) is relatively new, but has made rapid progress from its tentative steps of infancy in the 1990s. The recent Milanese Consensus Conference on Breast Conservation concluded that, firstly, oncoplastic techniques are warranted to allow wide excision and clear margins without compromising cosmesis. Secondly, such surgery is ideally performed at the same time as oncological excision. Whilst technically more challenging than standard breast conserving therapy (BCT), OBS is well proven, if not yet widely practised, both oncologically and aesthetically and a review of the available techniques is perhaps timely. The roots of breast conserving therapy can be traced to the 1930s, actually due to advances made in radiotherapy, and the last 20 years have seen it become firmly established. This review aims to summarise the key historical developments and latest innovations in OBS. Not only are our patients, who expect not only safe cancer treatment but a satisfactory aesthetic outcome, increasingly informed and demanding, but longer follow up has stimulated surgeons to improve outcomes. In many cases, particularly with ptosis and macromastia, the cancer can be treated, usually with wider excision margins, simultaneously improving the aesthetic appearance. Present at the birth of OBS, the Institut Curie has continued to introduce innovative techniques over the last two decades and a systematic approach, comprising nine basic techniques, has evolved to allow high quality treatment of any and all breast cancers suitable for OBS.
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Affiliation(s)
- M G Berry
- Departement de Chirurgie, Institut Curie, Paris, France.
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Hernanz De La Fuente F, Gómez Fleitas M, Martínez García F. [Reduction mammaplasty in breast cancer surgery]. Cir Esp 2009; 85:140-6. [PMID: 19264296 DOI: 10.1016/j.ciresp.2008.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 07/08/2008] [Indexed: 11/26/2022]
Abstract
Reduction mammaplasty techniques enable the breast cancer surgeon to provide an integral surgical treatment, thus significantly increasing and improving surgical options. These techniques are used to correct problems after the conservative treatment of type 1 breast cancer and to achieve symmetry between the breasts after mastectomy. They are also the basis of cosmetic reconstruction techniques in conservative oncoplastic surgery.
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Acea Nebril B. [Oncoplastic techniques in the management of central breast cancer]. Cir Esp 2009; 85:14-9. [PMID: 19239932 DOI: 10.1016/s0009-739x(09)70081-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 04/22/2008] [Indexed: 11/29/2022]
Abstract
Central tumors of the breast are in a difficult location for breast conservation that in many occasions had resulted in mastectomy. At the present time, the use of oncoplastic techniques have increased conservative management in this group of women, with an adequate oncological resection and good aesthetic results being achieved. This article describes oncoplastic procedures for the removal of breast central tumors with special interest in conservation and reconstruction of the areola-nipple complex.
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Affiliation(s)
- Benigno Acea Nebril
- Hospital Abente y Lago, Complexo Hospitalario Universitario Juan Canalejo, La Coruña, España.
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Flexible laryngeal mask airway for head and neck oncoplastic surgery? Eur J Anaesthesiol 2008. [DOI: 10.1017/s026502150800481x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Faure C, Escalon J, Brémond A, Mignotte H, Pérol D, Delay E. Chirurgie oncoplastique pour le traitement des tumeurs mammaires centrales. ANN CHIR PLAST ESTH 2008; 53:112-23. [DOI: 10.1016/j.anplas.2007.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 11/07/2007] [Indexed: 10/22/2022]
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