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Nardello SM, Bloom JA, Gaffney KA, Singhal M, Persing S, Chatterjee A. Practical oncoplastic surgery techniques needed for practice. Ann Transl Med 2023; 11:383. [PMID: 37970600 PMCID: PMC10632567 DOI: 10.21037/atm-23-1536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/27/2023] [Indexed: 11/17/2023]
Abstract
Oncoplastic breast surgery (OPS) is a form of breast conservation surgery that includes immediate breast reconstruction. OPS has previously been shown to be a safe and effective treatment for breast cancer. In a special series on Breast Reconstruction, we aimed to describe oncoplastic breast reconstruction options and the corresponding technical details. Sections were divided by descriptions of OPS specific preoperative workup, volume displacement techniques, volume replacement techniques, and postoperative considerations. In addition, to sharing expert surgical pearls gained through performing OPS procedures over the years. Innovations in breast reconstruction offer women treatment options that are both oncologically safe and aesthetically preferred. The rise in reconstructive procedures is changing how patients make decisions based on their diagnosis. The ultimate surgical decision should be determined by the patient's anatomy, patient's personal preferences, tumor characteristics, and clinical presentation in a shared decision-making fashion with a multidisciplinary team. However, with both volume displacement and volume replacement techniques, women of all breast sizes can achieve an aesthetic outcome without sacrificing oncologic resection.
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Affiliation(s)
- Salvatore M Nardello
- Division of Plastic and Reconstructive Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, MA, USA
| | - Joshua A Bloom
- Division of Plastic and Reconstructive Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, MA, USA
| | - Kerry A Gaffney
- Division of Plastic and Reconstructive Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, MA, USA
| | - Meera Singhal
- Division of Plastic and Reconstructive Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, MA, USA
| | - Sarah Persing
- Division of Plastic and Reconstructive Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, MA, USA
| | - Abhishek Chatterjee
- Division of Plastic and Reconstructive Surgery, Division of Surgical Oncology, Tufts Medical Center, Boston, MA, USA
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Retrouvey H, Mahoney MH, Pinchuk B, Jalil W, Somogyi R. The Versatility of Lateral Chest Wall Perforator Flaps in Immediate and Delayed Breast Reconstruction: Retrospective Study of Clinical Experience with 26 Patients. Plast Surg (Oakv) 2023; 31:261-269. [PMID: 37654533 PMCID: PMC10467436 DOI: 10.1177/22925503211051110] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/30/2021] [Accepted: 09/05/2021] [Indexed: 09/02/2023] Open
Abstract
Rationale: Lateral chest flaps represent versatile reconstructive options, especially valuable in times of global healthcare resource restriction. In this series, we present our experience with the use of lateral chest wall flaps in both immediate and delayed reconstruction from both breast conserving and mastectomy surgery. Methods: A retrospective cohort study of patients who had undergone a lateral chest wall flap for immediate or delayed breast reconstruction of a lumpectomy or mastectomy defect was performed. Data collected consisted of patient demographics, procedure type, tumor/oncological characteristics, as well as postoperative complications. Findings: Between September 2015 and April 2021, 26 patients underwent breast reconstruction using a lateral chest wall flap. Fifteen patients (58%) underwent immediate reconstruction (9 lumpectomy; 6 mastectomy) and 11 (42%) underwent delayed breast reconstruction. All flaps survived, though 1 patient required partial flap debridement following venous compromise hours after surgery. There were no incidences of hematoma, seroma, infection, or wound healing delay at either the donor site or breast. There was one positive margin which occurred in a mastectomy patient. Significance: This study describes the use of lateral chest wall flaps in a wide variety of reconstructive breast surgery scenarios. This technique can be safely performed in an outpatient setting and does not require microvascular techniques. Review of our outcomes and complications demonstrate that this is a safe and effective option. Our experience is that this is an easy to learn, versatile flap that could be a valuable addition to the surgeon's arsenal in breast reconstruction.
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Affiliation(s)
- Helene Retrouvey
- University of Toronto, North York General Hospital, Toronto, Ontario, Canada
| | - Mary-Helen Mahoney
- University of Toronto, North York General Hospital, Toronto, Ontario, Canada
| | - Brian Pinchuk
- University of Toronto, North York General Hospital, Toronto, Ontario, Canada
| | - Waqqas Jalil
- University of Toronto, North York General Hospital, Toronto, Ontario, Canada
| | - Ron Somogyi
- University of Toronto, North York General Hospital, Toronto, Ontario, Canada
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3
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Jonczyk MM, Homsy C, Naber S, Chatterjee A. Examining a decade of racial disparity in partial mastectomy and oncoplastic surgery. J Surg Oncol 2023; 127:541-549. [PMID: 36507913 DOI: 10.1002/jso.27173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/25/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Understanding racial disparity is crucial to addressing health equity and access to care. Our study aims to examine racial differences in breast conserving surgery (BCS) utilization rates and determine how these rates have changed over time. METHODS This retrospective cohort analysis utilized the NSQIP database to identify women diagnosed with breast cancer who underwent BCS procedures between 2008 and 2019. Racial utilization trends were analyzed using a Cochran-Armitage test and Index of Disparity analysis. RESULTS In the 12-year period, 202 492 women underwent a breast cancer surgery, of which 47% underwent BCS. Within the BCS subgroup, oncoplastic surgery utilization increased from 3% to 10%, leading to a declining proportion of partial mastectomies: 97% to 90.0% (both p < 0.01). The racial index of disparity for overall BCS patients decreased from 7% to 6%, remained unchanged (1%) for partial mastectomies, and significantly decreased in oncoplastics (23%-7.6%). CONCLUSION BCS represents a mainstay option for early-staged breast cancer interventions, this study demonstrate promising progress in decreasing the index of disparity among races and persistent racial inequalities.
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Affiliation(s)
- Michael M Jonczyk
- Department of General Surgery, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.,Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Christopher Homsy
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Stephen Naber
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, Massachusetts, USA
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Singh NP, Boyd CJ, Aluri A, Kovac S, Mainali B, Girardi A, Duke R, King TW, de la Torre J. One in Three Chance of Finding A Plastic Surgeon on Major Hospital Websites. Plast Reconstr Surg Glob Open 2023; 11:e4781. [PMID: 36699224 DOI: 10.1097/GOX.0000000000004781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/28/2022] [Indexed: 01/26/2023]
Abstract
There is an increasing trend of nonplastic surgeons performing breast surgery. Within, we evaluate the representation of plastic surgeons listed for breast reconstruction on major hospital system websites within the United States. Methods The website search engines for the top 20 US medical centers according to the US News and World Report's Hospital Rankings from 2020 to 2021 were queried for search terms pertaining to breast reconstruction. Information collected for search results included gender, if they were a physician, medical specialty, medical school and residency attended, and each individual's position within the search results. Results Across 80 distinct search attempts, 27 searches (34%) produced no results. The search term "breast reconstruction" yielded the most plastic surgeon search results, with plastic surgeons composing 39% of all search results. The search term "mastectomy" generated the least number of plastic surgeon results, with a 16% representation of plastic surgeons. Nearly two-thirds of physicians identified were nonplastic surgeons (67%). Other surgeons represented 47% of search results and obstetricians/gynecologists, 2%. Nonsurgeons represented 18% of queries. On average, plastic surgeons appeared higher on search lists than nonplastic surgeons, 13th to 39th, respectively (P < 0.001). Conclusions Plastic surgeons composed only a third of physicians identified, and a third of searches produced no results. Patients interested in breast reconstruction may encounter difficulty finding an appropriate plastic surgeon. Inadequate search engines on hospital websites introduce inefficiencies for the entire health care systems and may negatively impact hospital and physician bottom line.
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Hamdi M, Marina C, De Baerdemaeker R, Kapila AK, Vanhoeij M, Giunta G, Zeltzer A. A new oncoplastic technique with immediate nipple reconstruction for central breast tumors using Würinger's septum based flap. J Plast Reconstr Aesthet Surg 2022. [DOI: 10.1016/j.bjps.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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6
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Salibian AA, Olson B, Shauly O, Patel KM. Oncoplastic breast reconstruction: Principles, current techniques, and future directions. J Surg Oncol 2022; 126:450-459. [PMID: 35452129 DOI: 10.1002/jso.26897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 11/06/2022]
Abstract
Oncoplastic breast reconstruction has improved esthetic results after breast-conserving surgery with low complication rates and stable oncologic outcomes. Basic principles can be applied across different volume displacement and replacement techniques including restoration of breast shape and symmetry through esthetic incisions while eliminating dead space. Technique selection is guided by several factors including breast size, resection-to-breast ratio, and patient desires. A surgeon familiar with all techniques will allow individualization of treatment and optimization of outcomes.
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Affiliation(s)
- Ara A Salibian
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA
| | - Blade Olson
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA
| | - Orr Shauly
- Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ketan M Patel
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, California, USA
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7
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Catanuto G, Rocco N, Maglia A, Barry P, Karakatsanis A, Heil J, Karakatsanis A, Weber WP, Gonzalez E, Chatterjee A, Urban C, Sund M, Paulinelli RR, Markopoulos C, Rubio IT, Masannat YA, Meani F, Koppiker CB, Holcombe C, Benson JR, Dietz JR, Walker M, Mátrai Z, Shaukat A, Gulluoglu B, Brenelli F, Fitzal F, Mele M, Sgroi G, Russo G, Pappalardo F, Nava M. Text mining and word embedding for classification of decision making variables in breast cancer surgery. European Journal of Surgical Oncology 2022; 48:1503-1509. [DOI: 10.1016/j.ejso.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
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8
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9
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Yadav P, Jaiswal D. Oncoplastic and Reconstructive Surgery for Breast Cancer. Breast Cancer 2022. [DOI: 10.1007/978-981-16-4546-4_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Dokcu Ş, Başçeken Sİ. Plastic and reconstructive breast surgery techniques in the surgical treatment of idiopathic granulomatous mastitis: a single-center experience. Ann Surg Treat Res 2022; 103:253-263. [DOI: 10.4174/astr.2022.103.5.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/29/2022] [Accepted: 09/01/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Şeref Dokcu
- Department of Surgical Oncology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Salim İlksen Başçeken
- Department of Surgical Oncology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
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11
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Hu H, Guan Q, Zheng Y, Zhong Y, Min N, Wei Y, Geng R, Hong C, Li J, Zhang Y, Li X. Inverted-T pattern reduction mammoplasty in bilateral breast ptosis: cosmetic and oncological outcomes. Gland Surg 2021; 10:2925-2934. [PMID: 34804880 DOI: 10.21037/gs-21-561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/17/2021] [Indexed: 11/06/2022]
Abstract
Background Breast ptosis is directly caused by Cooper's ligament laxity, with the decline of nipple areola complex (NAC) and mammary parenchyma. Breast cancer with ptosis is always a knotty problem that can hardly be repaired by classic breast conservation surgery (BCS) ending up with a pleasing appearance. We analyzed our 12 years' experience of performing inverted-T pattern techniques to treat bilateral breast ptosis, with or without breast cancer. Methods One hundred forty-eight breasts in 74 patients undergoing inverted-T pattern reduction mammoplasty were included in this study. Information about patients' clinical and surgical characteristics, complications, NAC sensitivity, cosmetic and oncological outcomes were collected and retrospectively analyzed. Results In the cohort of 57 patients with pure breast ptosis, the mean body mass index (BMI) was 25.2 kg/m2, and the mean weight of resected tissue from the left and right breast reductions were 744.9 and 756.7 g. In the cohort of 17 patients diagnosed as breast cancer with ptosis, the mean BMI was 25.1 kg/m2, and the mean weight of resected tissue were 504.1 g for left and 535.6 g for right side. The majority of repairs were performed for tumors located in the upper outer (58.8%), mostly with inferior or superomedial pedicles (90%). All the upper inner tumors were repaired with inferior pedicles. Minor complications such as seroma (8.1%), NAC epidermolysis (8.1%), delayed wound healing (4.1%) were detected postoperatively. Partial NAC necrosis occurred in one patient (1.4%). 82.4% of all the patients rated "very satisfied" or "satisfied" as the final cosmetic outcomes. NAC sensitivity was "very high" and "high" in 82.4% patients. No local occurrence, distant metastasis and mortality occurred in tumor patients. Conclusions The inverted-T pattern reduction mammoplasty is a reliable technique to treat bilateral breast ptosis with a low complication rate. For cases with breast cancer, this technique can achieve both satisfying cosmetic outcomes and oncological safety.
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Affiliation(s)
- Huayu Hu
- School of Medicine, Nankai University, Tianjin, China.,Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Qingyu Guan
- School of Medicine, Nankai University, Tianjin, China.,Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yiqiong Zheng
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yuting Zhong
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Ningning Min
- School of Medicine, Nankai University, Tianjin, China.,Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yufan Wei
- School of Medicine, Nankai University, Tianjin, China.,Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Rui Geng
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China.,Medical School of Chinese PLA, Beijing, China
| | - Chenyan Hong
- School of Medicine, Nankai University, Tianjin, China.,Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jie Li
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yanjun Zhang
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xiru Li
- Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
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12
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Orsaria P, Grasso A, Caggiati L, Altomare M, Altomare V. Update on oncoplastic techniques in breast conserving surgery: algorithms for predictable results and custom-made reconstructions. Minerva Surg 2021; 76:512-525. [PMID: 34338466 DOI: 10.23736/s2724-5691.21.08976-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Breast cancer surgery is going to be a relevant specialty involved in the multidisciplinary disease management, finalized to guarantee high performances on mortality reduction together with a quality of life improvement. The intellectual architecture of this field is characterized by its inclination to respect, sharing, empathy and scientific knowledge that can make it a high model of medical culture. In this context, oncoplastic breast conserving surgery is identified by special aesthetic sensitivities, as well as creativity and innovation. Knowing how to reshape the gland and fill the gaps, planning the targeted exeresis design, while anticipating the final outcome, respecting symmetries and ensuring first of all oncological safety, are the new skills that are required to the breast surgeon. Several tecniques could provide a refined surgical treatment but always challenging according to anatomical findings and patient expectations, as a systematic process of self-critical reflection, with the purpose to optimize criteria for improving therapeutic results.
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Affiliation(s)
- Paolo Orsaria
- Department of Breast Surgery, Campus Bio-Medico University Hospital, Rome, Italy -
| | - Antonella Grasso
- Department of Breast Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Lorenza Caggiati
- Department of Breast Surgery, Campus Bio-Medico University Hospital, Rome, Italy
| | - Michele Altomare
- Department of General Surgery, University of Milan, Milan, Italy
| | - Vittorio Altomare
- Department of Breast Surgery, Campus Bio-Medico University Hospital, Rome, Italy
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Jordan RM, Rebielak M, Johnson K, Fluck M, Oxenberg J. Improved Overall Well-Being After Breast Conserving Therapy Using Three-Dimensional Bioabsorbable Markers and Tissue Rearrangement, a Single Institution's Preliminary Experience. Am Surg 2021:31348211031839. [PMID: 34250838 DOI: 10.1177/00031348211031839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Tissue rearrangement (TR) is a basic oncoplastic technique to reshape the breast after breast conserving therapy (BCT). Tissue rearrangement can be combined with three-dimensional bioabsorbable markers (3DBM) as an easily adaptable technique to provide volume replacement and focused radiation. Since 3DBM can take time for absorption and symptoms related to its use have not been fully assessed, we evaluate patient's overall satisfaction and well-being after TR with 3DBM is performed. We surveyed patients receiving BCT with adjuvant radiotherapy using BREAST-QTM BCT satisfaction and physical well-being surveys comparing patients receiving BCT alone to BCT with TR and/or 3DBM. Of 68 patients, 56 underwent BCT alone, 10 had BCT with TR + 3DBM, and 2 had BCT with TR. No significant difference was seen in physical well-being (P = .39), while overall satisfaction was significantly improved following TR + 3DBM (P = .0088). In summary, TR with use of 3DBM provides basic oncoplastic options to improve patient satisfaction without significantly changing symptoms.
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Affiliation(s)
| | | | | | - Marcus Fluck
- 21599Geisinger Medical Center, Danville, PA, USA
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14
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Margenthaler JA, Dietz JR, Chatterjee A. The Landmark Series: Breast Conservation Trials (including oncoplastic breast surgery). Ann Surg Oncol 2021; 28:2120-2127. [PMID: 33521897 DOI: 10.1245/s10434-020-09534-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/14/2020] [Indexed: 12/20/2022]
Abstract
Significant progress has been made in the treatment and outcome of breast cancer. Some of the most dramatic strides have been in the surgical management of breast cancer. Breast-conserving therapy (BCT), including wide local excision of the tumor followed by irradiation, has become a standard treatment option for women with early-stage invasive breast cancer. Large cooperative group trials have contributed to the paradigm shift from mastectomy to BCT. This review reports the landmark BCT trials that provided the data for current surgical practices. The review also describes the body of literature contributing to the increasing use of oncoplastic techniques for patients undergoing BCT.
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Affiliation(s)
- Julie A Margenthaler
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
| | - Jill R Dietz
- Department of Surgery, Case Western Reserve School of Medicine, Cleveland, OH, USA
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15
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Afsharfard A, Ebrahimibagha H, Zeinalpour A. A Novel Local Transposition Flap for Lateral Breast Reconstruction After Breast Conserving Surgery. Clin Breast Cancer 2021; 21:e448-e453. [PMID: 33612372 DOI: 10.1016/j.clbc.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast conserving surgery (BCS) followed by radiotherapy is used for the management of early-stage breast cancers. There are different techniques to reconstruct the breast after BCS, each has its own advantages and disadvantages. In this study, we aim to present a novel local transposition flap and report the follow-up results of patients who underwent breast reconstruction using this method in the short and long term. MATERIAL AND METHODS We enrolled 100 patients who underwent BCS in the form of upper or lower outer quadrant lumpectomy with or without axillary lymph node dissection. After lumpectomy, the patients underwent breast reconstruction using the local transposition flap technique. We followed the patients for 1 year, and the satisfaction results are assessed and reported postoperation, after radiochemotherapy, and after 1 year. RESULTS The patients' mean age is 47.6 (±11.7) years, and the mean BMI is 32.4 (±2.5). The duration of hospitalization was 1 day in 96 patients and 2 days in 2 patients. There were 2 patients hospitalized for 3 days. Three patients developed seroma and there were no cases of any other complication. The surgeon and patients satisfaction surveys conducted postop, after the radiochemotherapy course, and 1 year after BCS shows that the excellent and good satisfaction rate is 85%, 85%, and 92% respectively. CONCLUSION We believe that the local transposition flap can be an excellent substitution for the existing methods in the reconstruction of the lateral side breast defects.
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Affiliation(s)
- Abolfazl Afsharfard
- Department of general surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Ebrahimibagha
- Department of general surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Adel Zeinalpour
- Department of general surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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16
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Yang JD, Lee J, Lee JS, Kim EK, Park CS, Park HY. Aesthetic Scar-Less Mastectomy and Breast Reconstruction. J Breast Cancer 2021; 24:22-33. [PMID: 33634618 PMCID: PMC7920861 DOI: 10.4048/jbc.2021.24.e11] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/02/2020] [Accepted: 11/10/2020] [Indexed: 01/06/2023] Open
Abstract
Surgical approaches in breast cancer have been changing to ensure both oncologic safety and cosmetic results. Although the concept of "oncoplastic breast surgery" has been accepted for decades, breast and plastic surgeons have been striving to develop more advanced surgical skills that ensure non-inferior oncologic outcomes with better cosmetic outcomes. Endoscopic or robotic devices, which are currently available only for chest or abdominal surgeries, could be used for breast surgery to ensure better cosmetic outcomes. The authors refer to this surgical concept as "aesthetic scar-less breast surgery and reconstruction," a term that encompasses the consequential concepts rather than naming it with simple technical words such as endoscopy-assisted or robot-assisted surgery. The "scar-less" term simply means leaving less of a scar, and better results can be expected by designing incisions on invisible areas. Herein, we summarize our experiences with various techniques of "aesthetic scar-less" surgery and review the existing literature on this topic.
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Affiliation(s)
- Jung Dug Yang
- Department of Plastic and Reconstructive Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jeeyeon Lee
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Joon Seok Lee
- Department of Plastic and Reconstructive Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Eun Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, School of Medicine, Seoul National University, Seoul, Korea
| | - Chan Sub Park
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ho Yong Park
- Department of Surgery, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
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17
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Pyfer BJ, Jonczyk M, Jean J, Graham RA, Chen L, Chatterjee A. Analysis of Surgical Trends for Axillary Lymph Node Management in Patients with Ductal Carcinoma In Situ Using the NSQIP Database: Are We Following National Guidelines? Ann Surg Oncol 2020; 27:3448-3455. [PMID: 32232706 DOI: 10.1245/s10434-020-08374-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND For patients with ductal carcinoma in situ (DCIS), multiple national cancer organizations recommend that sentinel lymph node biopsy (SLNB) be offered when treated with mastectomy, but not when treated with breast-conserving surgery (BCS). This study analyzes national surgical trends of SLNB and axillary lymph node dissection (ALND) in DCIS patients undergoing breast surgery with the aim to quantify deviations from national guidelines. METHODS A retrospective cohort analysis of the American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP) database from 2005 to 2017 identified patients with DCIS. Patients were categorized by their primary method of breast surgery, i.e. mastectomy or BCS, then further categorized by their axillary lymph node (ALN) management, i.e. no intervention, SLNB, or ALND. Data analysis was conducted via linear regression and a non-parametric Mann-Kendall test to assess a temporal trend and Sen's slope. RESULTS Overall, 43,448 patients with DCIS met the inclusion criteria: 20,504 underwent mastectomy and 22,944 underwent BCS. Analysis of DCIS patients from 2005 to 2017 revealed that ALND decreased and SLNB increased in every subgroup, regardless of surgical treatment modality. Evaluation in the mastectomy group increased overall: mastectomy alone increased from 57.1 to 65.8% (p < 0.01) and mastectomy with immediate reconstruction increased from 58.5 to 72.1% (p < 0.01). Increases also occurred in the total BCS population: partial mastectomy increased from 14.0 to 21.1% and oncoplastic surgery increased from 10.5 to 23.0% (both p < 0.01). CONCLUSIONS Despite national guideline recommendations for the management of ALN surgery in DCIS patients, approximately 20-30% of cases continue to not follow these guidelines. This warrants further education for surgeons and patients.
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Affiliation(s)
| | | | - Jolie Jean
- Tufts University Medical School, Boston, MA, USA
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18
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Abstract
PURPOSE OF REVIEW The goals of surgery for breast cancer have remained the same over the years, to eliminate breast cancer from the breast with the least degree of deformity. With the current expectation of long-term survival after breast cancer treatment, more attention has turned to the cosmetic result of the surgical treatment. Whether lumpectomy or mastectomy, the need for aesthetic improvement was recognized by surgeons both in and outside the USA. RECENT FINDINGS Oncoplastic surgery combines the skills of the cancer surgeon with those of the plastic surgeon. Sometimes, this means a team approach with a breast surgeon and a plastic surgeon both performing their mutual skills for the patient. Other times, the properly trained breast surgeon may perform some of the plastic techniques at the time of cancer surgery. Breast surgeons are rapidly gaining the ability to improve the post-cancer treatment appearance. To simplify the classification of oncoplastic techniques, we have used lower level, upper level, and highest level. The assignment of techniques to levels is based on both the technique and the surgeon's training and experience. Much data has accumulated demonstrating the safety and efficacy of the "aesthetic cancer cure." We describe the development of oncoplastic surgery, the techniques available, matching the right candidate with the right technique, and some comments about the future. It is clear from both clinical benefit and patient satisfaction that oncoplastic breast cancer procedures are here to stay. Plastic surgeons will likely focus on the upper- and highest-level procedures while breast/general surgeons will learn lower-level procedures and some of upper-level procedures as needed by their locale. Opportunities to educate breast/general surgeons in these techniques will continue to increase over the next several years. Formal education in oncoplastic surgery during breast fellowships will be necessary to catch up with the rest of the surgical world outside the USA.
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Affiliation(s)
- Cary S Kaufman
- Department of Surgery, University of Washington, Bellingham Regional Breast Center, 2075 Barkley Blvd., Suite 250, Bellingham, Washington, 98226, USA.
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19
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Burrah R, James K, Lund J, Vinayagam R. Breast conservation surgery by round block mammoplasty. Eur J Surg Oncol 2019; 46:240-244. [PMID: 31699338 DOI: 10.1016/j.ejso.2019.10.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/13/2019] [Accepted: 10/25/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Round block mammoplasty (RBM) is a type of Oncoplastic procedure to facilitate breast conservation surgery for breast cancer. METHODS Retrospective study of 270 patients who underwent this surgery. The surgical and oncological outcomes of RBM were studied. RESULTS The median age was 61 years and median follow-up 39 months. Most cancers (59%) were screen-detected. The location of the cancer was commonly in the upper outer quadrant followed by upper inner quadrant (20%). The average tumor size was 18 mm and in 48% of patients the whole tumor size increased to 23.5 mm due to associated DCIS. The median specimen weight was 41 gm. Forty patients (14.8%) had positive margins. Postoperative complications were seen in 18 patients (6.6%). There were 4 local and 1 axillary recurrences, and 8 distant metastasis. Contralateral symmetrising surgery was required in 13 patients (4.8%). CONCLUSION RBM is a robust and easily adaptable technique which provides good exposure for a safe oncological excision. The surgical and oncological outcomes are good and contralateral symmetrising surgery is rarely required.
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Affiliation(s)
- Rajaram Burrah
- Wirral Breast Unit, Wirral University Teaching Hospital, Clatterbridge Hospital, Wirral, Merseyside, CH63 4JY, UK.
| | - Karen James
- Wirral Breast Unit, Wirral University Teaching Hospital, Clatterbridge Hospital, Wirral, Merseyside, CH63 4JY, UK
| | - Jonathan Lund
- Wirral Breast Unit, Wirral University Teaching Hospital, Clatterbridge Hospital, Wirral, Merseyside, CH63 4JY, UK
| | - Raman Vinayagam
- Wirral Breast Unit, Wirral University Teaching Hospital, Clatterbridge Hospital, Wirral, Merseyside, CH63 4JY, UK
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20
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Patel K, Bloom J, Nardello S, Cohen S, Reiland J, Chatterjee A. An Oncoplastic Surgery Primer: Common Indications, Techniques, and Complications in Level 1 and 2 Volume Displacement Oncoplastic Surgery. Ann Surg Oncol 2019; 26:3063-3070. [DOI: 10.1245/s10434-019-07592-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Indexed: 12/24/2022]
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21
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Chatterjee A, Gass J, Patel K, Holmes D, Kopkash K, Peiris L, Peled A, Ryan J, El-Tamer M, Reiland J. A Consensus Definition and Classification System of Oncoplastic Surgery Developed by the American Society of Breast Surgeons. Ann Surg Oncol 2019; 26:3436-3444. [DOI: 10.1245/s10434-019-07345-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Indexed: 01/07/2023]
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22
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Struik GM, Hoekstra N, Klem TM, Ghandi A, Verduijn GM, Swaak-Kragten AT, Schoonbeek A, de Vries KC, Sattler MA, Verhoef K, Birnie E, Pignol JP. Injection of radiopaque hydrogel at time of lumpectomy improves the target definition for adjuvant radiotherapy. Radiother Oncol 2018; 131:8-13. [PMID: 30773191 DOI: 10.1016/j.radonc.2018.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/14/2018] [Accepted: 11/04/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE During oncoplastic breast-conserving surgery (BCS), the surgical cavity is closed to reduce seroma formation. This makes the radiotherapy target definition using clips challenging, leading to poor inter-observer agreement and potentially geographical misses. We hypothesize that injecting a radiopaque hydrogel in the lumpectomy cavity before closure improves radiotherapy target definition and agreement between observers. MATERIALS AND METHODS Women undergoing BCS in a single university hospital were prospectively accrued in the study. Three to 9 ml of iodined PolyEthylene Glycol (PEG) hydrogel and clips were inserted in the lumpectomy cavity. A CT-scan was performed at 4 to 6 weeks. CT images of BCS patients with standard clips only were used as control group, matched on age, specimen weight, and distance between clips. Six radiation oncologists delineated the tumor bed volumes and rated the cavity visualization scores (CVS). The primary endpoint was the agreement between observers measured using a Conformity Index (Cx). RESULTS Forty-two patients were included, 21 hydrogel procedures and 21 controls, resulting in 315 observer pairs. The feasibility of the intervention was 100%. The median Cx was higher in the intervention group (Cx = 0.70, IQR [0.54-0.79]) than in the control group (Cx = 0.54, IQR [0.42-0.66]), p < 0.00, as were the CVS (3.5 [2.5-4.5] versus 2.5 [2-3.5], p < 0.001). The rate of surgical site infections was similar to literature. CONCLUSIONS The use of radiopaque PEG enables to identify the lumpectomy cavity, resulting in a high inter-observer agreement for radiotherapy target definition. This intervention is easy to perform and blend well into current practice.
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Affiliation(s)
- Gerson M Struik
- Franciscus Gasthuis and Vlietland, Department of Surgery, Rotterdam, the Netherlands; Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Nienke Hoekstra
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Taco M Klem
- Franciscus Gasthuis and Vlietland, Department of Surgery, Rotterdam, the Netherlands
| | - Ali Ghandi
- Franciscus Gasthuis and Vlietland, Department of Radiology, Rotterdam, the Netherlands
| | - Gerda M Verduijn
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | | | - Alja Schoonbeek
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Kim C de Vries
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Margriet A Sattler
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands
| | - Kees Verhoef
- Erasmus MC, Department of Surgery, Rotterdam, the Netherlands
| | - Erwin Birnie
- Franciscus Gasthuis and Vlietland, Department of Statistics and Education, Rotterdam, the Netherlands
| | - Jean-Philippe Pignol
- Erasmus MC, Department of Radiation Oncology, Rotterdam, the Netherlands; Dalhousie University, Department of Radiation Oncology, Halifax, Canada.
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23
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Asban A, Homsy C, Chen L, Fisher C, Losken A, Chatterjee A. A cost-utility analysis comparing large volume displacement oncoplastic surgery to mastectomy with single stage implant reconstruction in the treatment of breast cancer. Breast 2018; 41:159-164. [PMID: 30099327 DOI: 10.1016/j.breast.2018.07.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 07/26/2018] [Accepted: 07/31/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND For larger cancers in moderate to large breast sized women, breast surgical cancer treatment may include large volume displacement oncoplastic surgery (LVOS) or mastectomy with single stage implant reconstruction (SSIR). Often in the case of LVOS, reduction mammaplasty designs are used in the oncoplastic reconstructions with a contralateral symmetry operation. The goal of this study was to investigate the cost-utility between LVOS versus SSIR to determine which approach is cost-effective in the treatment of breast cancer. METHODS A review of the literature was performed to determine baseline values and ranges. An average national Medicare payment rates using DRG and CPT codes were used for cost assessment. After constructing a decision tree, an incremental cost-utility ratio (ICUR) was calculated comparing the difference for both surgical options in costs by the difference in clinical-effectiveness. To validate our results, we performed one-way sensitivity analyses in addition to a Monte-Carlo analysis. RESULTS An ICUR of $546.81/QALY favoring LVOS was calculated based off of its clinical-effectiveness gain of 7.67 QALY at an additional cost of $4194. One-way sensitivity analyses underscored the degree by which LVOS was cost-effective. For example, LVOS became cost-ineffective when a successful LVOS cost more than $50,000. Similarly, probabilistic sensitivity analysis using Monte-Carlo simulation showed that even with varying multiple variables at once, results tended to favor our conclusion supporting the cost-effectiveness of LVOS. CONCLUSIONS For the appropriate patients with moderate to large sized breasts with breast cancer, large volume displacement oncoplastic surgery is cost-effective compared to mastectomy with single staged implant reconstruction.
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Affiliation(s)
- Ammar Asban
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Christopher Homsy
- Department of Surgery, Tufts University Medical Center, Boston, MA, United States
| | - Lilian Chen
- Department of Surgery, Tufts University Medical Center, Boston, MA, United States
| | - Carla Fisher
- Department of Surgery, Indiana University, IN, United States
| | - Albert Losken
- Department of Plastic Surgery, Emory University, GA, United States
| | - Abhishek Chatterjee
- Department of Surgery, Tufts University Medical Center, Boston, MA, United States.
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24
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Abstract
Breast cancer surgery includes a wide array of surgical treatment options. Not only does it involve the oncologic excision of the breast cancer disease but it also involves the reconstruction of the breast. Surgical treatment options vary with regards to the size of the tumor relative to the size of the breast further complicated by the preferences of the patient and the ability of the available surgeon(s). The goal of this paper is to highlight major long-term effects, positive and negative, of modern breast cancer surgery.
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Affiliation(s)
- Abhishek Chatterjee
- Division of Surgical Oncology and Plastic Surgery, Tufts Medical Center, Boston, MA, USA
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25
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Chatterjee A, Gass J, Burke MB, Kopkash K, El-Tamer MB, Holmes DR, Clark P, Reiland J. Results from the American Society of Breast Surgeons Oncoplastic Surgery Committee 2017 Survey: Current Practice and Future Directions. Ann Surg Oncol 2018; 25:2790-2794. [PMID: 30003450 DOI: 10.1245/s10434-018-6586-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Oncoplastic surgery is emerging as a validated, safe, patient-centric approach to breast cancer surgery in the United States. The American Society of Breast Surgeons Oncoplastic Surgery Committee (ASBrS-OSC) conducted a survey to assess the scope of practice and level of interest in oncoplastic surgery among its members. Furthermore, the group sought to identify barriers to incorporating oncoplastic skills in a surgeon's practice. METHODS A 10-question survey was administered in March 2017 to the entire ASBrS membership using an online format. Three solicitations were sent. Unique identifiers allowed a single response. RESULTS Of the 2655 surveys sent out, 708 members responded. Nearly all (99%) respondents had at least some interest in oncoplastic surgery. The current rates of performing nipple-sparing mastectomy, adjacent tissue transfer, and breast reduction with lumpectomy were 80, 60, and 51%, respectively. A minority of respondents reported independently performing breast reductions/mammaplasties (19%) or contralateral symmetrization (10%). Barriers to learning oncoplastic surgery included surgeon's time and access to oncoplastic educational material/courses. Most respondents felt that training courses and videos may allow them to better incorporate oncoplastic techniques in their practices. CONCLUSIONS The interest in oncoplastic surgery among U.S. surgeons is significant, yet there are barriers to incorporate these surgical techniques into a breast surgeon's practice. As professional organizations provide access to effective training and enduring educational resources, breast surgeons will be enabled to develop their oncoplastic skill set and safely offer these techniques to their patients.
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Affiliation(s)
| | - Jennifer Gass
- Women and Infants' Hospital, Breast Health Center, Providence, USA
| | | | | | - Mahmoud B El-Tamer
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA
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26
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Liang Y, Naber SP, Chatterjee A. Anatomic and terminological description and processing of breast pathologic specimens from oncoplastic large volume displacement surgeries. Mod Pathol 2018; 31:1004-11. [PMID: 29449682 DOI: 10.1038/s41379-018-0020-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/14/2017] [Accepted: 12/17/2017] [Indexed: 11/08/2022]
Abstract
Oncoplastic surgery provides breast cancer patients with greater aesthetic satisfaction without compromising disease-free survival or overall survival rate. Large volume displacement oncoplastic surgical techniques have become increasingly popular as a strategy for improving aesthetic outcomes and extending the option of breast conservation therapy. They often involve breast reduction or mastopexy reconstructive techniques to facilitate resection of large breast volumes on the side of the breast cancer and accompanied with symmetry contralateral breast reductions or mastopexies. However, dissection of large volume displacement oncoplastic surgical specimens presents unique challenges. Compared with traditional mastectomy specimens, they are relatively complicated, which requires the pathologist to understand the surgical procedure and the anatomy of the specimens. Given this, we introduce the standard anatomical and terminological description for the breast pathologic specimens of five large volume displacement oncoplastic surgical techniques commonly performed in our institution for breast cancer management. The individual surgical specimen is composed of one or several components, which include lateral wall, superior keyhole, medial wall, lateral wing, inferior pole, and medial wing. We also present specimen documentation and sectioning procedures used in our institution. The advantages for the patient provided by large volume reduction oncoplastic surgery must be supported by proper evaluation of the surgical pathology specimen. Therefore, we recommend that each section taken from the oncoplastic specimen be labeled as to its specific location in the specimen components. Standardized nomenclature and technique will assist pathologists in accurately evaluating the surgical margins.
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