The axillary flap in oncoplastic resection of breast cancers located in the upper-outer quadrants: a new surgical technique

Life after oncoplastic surgery (IRONY) trial: Preliminary results

BACKGROUND

Today partial reconstruction in breast cancer (BC) surgery involves displacement or replacement procedures to improve cosmesis without compromising safety. However, patient satisfaction should be compared among several options, in order to get additional criteria for a personalized approach. The aim is evaluate oncological, aesthetic and functional results after monolateral (reshaping or replacement) or bilateral (mammoplasty with contralateral pexy or reduction) conserving strategies.

MATERIALS AND METHODS

The protocol provides for the enrollment of a prospective sample of 250 patients in a time frame of 3 years. The first 108 cases (range 18-85 years) with BC diagnosis, and suitable for type 1-2 oncoplastic surgery who gave informed consent, were selected Data analysis was focused on radicality, complications, cosmetic and functional results related to quality of life, comparing monolateral (ML) and bilateral (BL) groups.

RESULTS

Tumor size (p = 0.01), multifocality (p = 0.05), multicentricity (p = 0.01) and estimated resection volume (p = 0.000) were higher in the BL group. There was a comparable re-excision rate for positive margins (p = 0.72), and after 2.3 years, no difference in local recurrences were recorded. No early (p > 0.05), but late complications were more common in the BL (p = 0.07). The overall satisfaction with cosmesis and well-being were characterized by similar proportions of good results (p>0.05), with some details more related to each procedure.

CONCLUSION

The proposed techniques represent effective solutions for reshaping that follows BC excision, achieving comparable early complications, low re-interventions with good aesthetic results and social functioning. However, is crucial a careful patient selection and surgical plan while predicting any sequel or delayed complication during follow-up.

Aesthetic and surgical outcomes of the modified matrix rotation technique for upper inner quadrant breast tumors: a case series

In patients with breast cancer, oncoplastic breast-conserving surgery can achieve a good aesthetic outcome without compromising oncological outcomes. However, tumors located in the upper inner quadrant (UIQ) are challenging for surgeons because treatment gives rise to visible scars, glandular deformities, and deviation of the nipple-areolar complex. The present study was performed to analyze a modification of the matrix rotation technique for UIQ tumors and address the main drawback of this technique, which is a visible scar on the commonly exposed part of the breast. A prospective database of seven patients who presented with UIQ tumors and underwent the new modification technique was utilized for the analysis. All patients preferred the modified technique over the standard technique because of the absence of a scar in the UIQ (visible breast line). The postoperative patient-reported outcomes regarding breast shape, breast symmetry, and scar location were also satisfactory. No surgical complications were reported. This modified surgical technique results in a scarless UIQ and is an aesthetically acceptable procedure that can be considered for UIQ tumors.

Schematic sectioning approaches for corneal and retinal surfaces used in ophthalmology and vision-related clinical practice and research

Schematically, the corneal surface area and other similar surfaces such as the retinal surface and the visual field area have been represented by a circle. While there are different types of schematic sectioning patterns in use, not all patterns are recognized or referred to with their respective appropriate terminology. In scientific communications, as well as in clinical practice, when dealing with corneal or retinal surfaces, it is imperative to have the ability to refer to specific areas with an as high degree of accuracy as possible. The necessity arises in many situations, either when performing tests such as corneal surface staining, corneal sensitivity test, scanning the corneal surface, reporting of the findings related to any specific corneal surface area, or using a sectioning pattern for parts of the retinal surface when locating retinal lesions, or when referring to loci with changes in the visual field. Applying the appropriate geometric terms when any pattern is used for sectioning of surfaces such as cornea or retina, for precise localization and description of the findings or changes with a high degree of accuracy using the correct terminology is a sine qua non. Hence, the idea for this work is to gain an overview of the sectioning methods that are available and in use as methodological guidance in different sectioning patterns related to the corneal, retinal, and visual field.

Subaxillary Replacement Flap Compared with the Round Block Displacement Technique in Oncoplastic Breast Conserving Surgery: Functional Outcomes of a Feasible One Stage Reconstruction

BACKGROUND

For selected women diagnosed with breast cancer (BC), partial reconstructive techniques involve displacement or replacement procedures to improve cosmesis without compromising oncological safety. This study aims to evaluate the surgical outcomes of the round block (RB) compared with the subaxillary flap (SF) technique for patients with upper outer tumor.

PATIENTS AND METHODS

Thirty-three patients treated with oncoplastic conserving surgery (15 RB and 18 SF) were enrolled in this retrospective study. After carrying out a comparison of baseline characteristics, all cases were recruited for postoperative evaluation of oncological and cosmetic parameters. Moreover, we investigated several scoring combinations to check whether they could discriminate surgeon and patient satisfaction according to different functional results.

RESULTS

Median age (p < 0.05), average tumor size (p > 0.05), estimated resection volume (p > 0.05), and nodal involvement (p > 0.05) were slightly higher in the SF group. A greater frequency of DCIS (p < 0.05) in the RB series correlated with reintervention for positive margins (p > 0.001). At a mean follow-up of 19 months, no locoregional recurrences were recorded and early and late complications were comparable (p > 0.05). The overall satisfaction with cosmesis was characterized by similar proportions of good results (p > 0.05), with some details more related to each procedure.

CONCLUSION

The proposed techniques represent effective solutions for reshaping that follows upper outer wide excision, achieving comparable complication rates, low reinterventions, and good aesthetic results in relation to technical and social functioning evaluations. However, it is crucial to establish a careful patient selection in order to manage correct surgical planning while predicting any potential sequelae or complication.

The Tumor Plastic Surgery Technology versus Traditional Repair Technology on the Repair of Large-Area Skin Defects after Maxillofacial Tumor Resection: A Randomized Controlled Trial

Objective

To explore the effect of tumor plastic surgery on the repair of large-area skin defects after maxillofacial tumor resection.

Methods

90 patients undergoing maxillofacial tumor resection in our hospital from March 2019 to March 2020 were selected and randomized 1 : 1 to receive either tumor plastic surgery (experimental group) or traditional repair (control group). The clinical efficacy and facial cosmetic improvement of the two groups were compared. The Patient and Observer Scar Assessment Scale (POSAS) was used to evaluate the surgical outcomes of the two groups, the Profile of Mood States (POMS) was used to evaluate the patients' psychological status, and the Generic Quality of Life Inventory-74 (GQOLI-74) was used to assess the quality of life of patients.

Results

Total clinical effective rate of the experimental group was significantly higher than that of the control group (p < 0.001). A higher excellent rate of facial cosmetic improvement was observed in the experimental group versus the control group (p < 0.001). Significantly lower POSAS scores of the experimental group than the control group were observed (p < 0.001). The POMS scores of the experimental group after treatment were lower than those of the control group (p < 0.001). Tumor plastic surgery resulted in a remarkably higher GQOLI-74 score in the patients versus traditional repair (p < 0.001).

Conclusion

Tumor plastic surgery is a promising alternative for patients undergoing maxillofacial tumor resection. It can effectively promote the recovery of facial morphology and physiological function of patients, with high clinical efficacy, so it merits promotion and application.

Outcome reporting in therapeutic mammaplasty: a systematic review

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.

Bifurcate inferior pedicle mammoplasty in large ptotic breast for tumor located at the upper outer quadrant with skin involvement-a novel technique allowing good cosmetic outcome: case report

Breast oncoplastic techniques followed by radiotherapy represent nowadays the standard of care for breast cancer treatment. For tumours located at the upper outer quadrant in patients with large and ptotic breasts, the use of level II breast reduction mammoplasty, allows large quadrantectomies without compromising the breast natural shape and reducing the breast volume to be irradiated. When the skin overlying the tumour in the upper outer quadrant is involved, the removal of the skin during mammoplasty could lead to an extreme reduction of the breast, resulting in a bad outcome. Different strategies have been adopted to avoid a poor cosmetic result including a Z plastic or latissimus dorsi (LD) mini flap. At our institution we developed a new technique utilizing an inferior bifurcated pedicle mammoplasty with the preservation of a skin island for a patient with a residual tumour following chemotherapy involving the skin in the upper outer quadrant of the right breast. The patient did show no complications, with no delay for adjuvant radiotherapy treatment. Our method is a novel technique to treat malignancies in this location for patients with large and ptotic breasts when skin removal is indicated and it may represent an effective strategy to prevent excessive gland reduction, thus avoiding poor cosmetic result.