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Alder L, Zaidi M, Zeidan B, Mazari F. Advanced breast conservation and partial breast reconstruction - a review of current available options for oncoplastic breast surgery. Ann R Coll Surg Engl 2021; 104:319-323. [PMID: 34415191 DOI: 10.1308/rcsann.2021.0169] [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: 11/22/2022] Open
Abstract
Breast cancer is the most common cancer affecting one in three women with new cancer diagnosis in England. Breast-conserving surgery is the primary surgical option in a vast majority of these patients. Use of oncoplastic techniques in breast conservation surgery has significantly improved the aesthetic outcomes without compromising the oncological safety of cancer resections. Oncoplastic breast-conserving surgery (OPBCS) has transformed the specialty with a paradigm shift in ideology and the recognition that aesthetic and oncological resections are synonymous when planning surgical intervention for patients with breast cancer. The two main options for OPBCS are therapeutic mammoplasty and partial beast reconstruction using pedicle-based flaps. This review aims to highlight key concepts in OPBCS demonstrating an overview of these surgical techniques, their safety, outcomes and the emergence of extreme oncoplastic breast surgery.
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Affiliation(s)
- L Alder
- University Hospital Southampton NHS Foundation Trust, UK
| | - M Zaidi
- Portsmouth Hospitals NHS Trust, UK
| | - B Zeidan
- University Hospital Southampton NHS Foundation Trust, UK
| | - Fak Mazari
- University Hospital Southampton NHS Foundation Trust, UK
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Emiroglu M, Karaali C, Oztop MB, Gulluoglu BM. National Consensus on Oncoplastic Breast Conserving Surgery in Turkey: Position Paper for the Standardization of Surgical Practice. Turk J Surg 2020; 36:271-277. [PMID: 33778382 DOI: 10.47717/turkjsurg.2020.4639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/27/2020] [Indexed: 11/23/2022]
Abstract
Objectives The algorithms that define most of the application of oncoplastic breast conserving surgery (OBCS) in breast cancer patients are not clearly defined. Therefore, a consensus survey was conducted between the leading and experienced breast surgeons and oncoplastic breast surgeons in Turkey on the controversial areas of oncoplastic breast surgery. Material and Methods This consensus survey was carried out on-line through the Consensus software program (www.consensuss.com) under the roof of Turkish Federation of National Societies for Breast Diseases (TFNSBD). After finalizing each proposition, web-based remote access consensus process was performed on the Likert scale using Delphi method with the Consensus (www.consensuss.com) software program. Through the related software, an invitation was sent to 111 people who had at least 5 years of general surgery expertise in Turkey, and who devoted more than 50% of their daily clinical practice to the treatment and surgery of breast diseases. Results Sixty-two out of 111 people accepted to participate in the panel and made an on-line evaluation. According to the consensus results; Lumpectomy area should be done by placing the clips on at least four walls of the cavity, if the margin of the tumor is clear in central tumors, the distance between the tumor and the nipple is not significantly important, oncoplastic techniques may be used in patients with locally advanced breast cancer after neoadjuvant chemotherapy, in patients who have macromastia with ductal carcinoma in situ or breast cancer, OBCS techniques can be performed, and OBCS should be evaluated in terms of breast aesthetics. After OBCS, re-excision can be performed at a re-do setting in cases with involved surgical margins. Conclusion Our consensus results may provide a basis for the development of some standards in OBCS.
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Affiliation(s)
- Mustafa Emiroglu
- Izmir Tepecik Education And Research Hospital, General Surgery, İzmir, Turkey
| | - Cem Karaali
- Izmir Tepecik Education And Research Hospital, General Surgery, İzmir, Turkey
| | - Mehmet B Oztop
- Izmir Provincial Health Directorate, Health Directorate, İzmir, Turkey
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Koppiker CB, Noor AU, Dixit S, Busheri L, Sharan G, Dhar U, Allampati HK, Nare S. Extreme Oncoplastic Surgery for Multifocal/Multicentric and Locally Advanced Breast Cancer. Int J Breast Cancer 2019; 2019:4262589. [PMID: 30915240 DOI: 10.1155/2019/4262589] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 12/27/2018] [Indexed: 12/11/2022] Open
Abstract
Introduction Breast conserving surgery (BCS) followed by radiation therapy (RT) has become the preferred alternative to mastectomy for patients with early stage breast cancer (BC). Randomized trials have confirmed equivalent locoregional control and overall survival for BCS and mastectomy. Extreme Oncoplasty (EO) extends the indications of BCS for patients who would otherwise require mastectomy, ensuring better aesthetic outcomes and oncological safety. Methods BC patients with multifocal/multicentric (MF/MC) tumors, extensive DCIS, or large tumor >50mm underwent EO at our breast unit. Therapeutic reduction mammaplasty (TRM) with wise pattern preoperative markings and dual pedicle technique involving parenchymal rearrangement was used for oncoplastic reconstructions in majority of the cases followed by RT. Patient reported outcome measures (PROMs) were assessed using the validated Breast-Q questionnaire. Results Of the 39 patients in the study, 36 had unilateral and 3 had bilateral BC. Mean age was 47.2 years. Median tumor size was 75mm. 17 (43.6%) patients received NACT; none achieved a complete clinical response. 28 (71.8%) patients were administered to adjuvant chemotherapy. 33(84.6%) patients received RT to the breast with a median dose of 50Gy in 28 fractions and a boost dose of 10Gy in 5 fractions to the tumor bed. No major complications or local recurrences were observed. Excellent Breast-Q scores were observed in patients undergoing EO after 12 months of follow-up. Conclusion EO followed by RT results in acceptable local-regional control, low rate of complications, and high patient satisfaction. In selected patients, EO could provide a safe alternative for breast conservation surgery instead of mastectomy.
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de Freitas TB, Lopes de Barros Lima KM, de Andrade Carvalho H, de Azevedo Marques P, Belfort Mattos FT, Franco Fonseca AS, Munhoz AM, Filassi JR, Stuart SR, Marta GN. What a difference a clip makes! Analysis of boost volume definition in radiation therapy for conservative breast surgery. Eur J Surg Oncol 2018; 44:1312-1317. [PMID: 30041975 DOI: 10.1016/j.ejso.2018.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 01/24/2018] [Revised: 05/04/2018] [Accepted: 06/11/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE/OBJECTIVE(S) To evaluate the role of surgical clips placement in the definition of boost treatment volume. MATERIALS/METHODS Clinical Target Volumes (CTV) were defined as: CTV Breast, CTV Quadrant (based on physical exam and pre-surgical images), CTV Boost, defined by clip plus margin (1 cm for 2 or more clips and 2 cm for 1 clip only) plus radiological changes, CTV NT (normal tissue), defined by CTV Quadrant minus CTV Boost and CTV MISS (CTV that would be outside the treatment volume), defined by CTV Boost minus CTV Quadrant. RESULTS A total of 247 patients were included. Upper lateral quadrant was the most common clinical location (47.3%). The median number of clips used was three. The mean volumes were: CTV Breast:982.52 cc, CTV Boost:36.59 cc, CTV Quadrant:285.07 cc, CTV NT:210.1 cc and CTV MISS:13.57 cc. Only 50.6% (125) of the patients presented the CTV Boost completely inside the CTV Quadrant and in 47.3% (117), partially inside. Among patients with any CTV MISS, 80.3% (98) had 10% or more of CTV Boost outside the treatment volume. Regarding CTV MISS, there were no statistically significant differences between the groups with 1 clip versus 2 or more clips, nor between patients with or without reconstructive surgery. In average, the CTV Boost was 87% smaller than the CTV Quadrant. The whole quadrant irradiation would lead to unnecessary irradiation of 26% of normal breast tissue. CONCLUSION Surgical bed clipping is up most important in the definition of the boost volume irradiation to ensure precision minimizing geographical miss and optimizing surrounding normal tissue sparing.
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Affiliation(s)
- Thiago Brasileiro de Freitas
- Department of Radiology and Oncology, Division of Radiation Oncology, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
| | | | - Heloísa de Andrade Carvalho
- Department of Radiology and Oncology, Division of Radiation Oncology, Instituto de Radiologia (INRAD), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil.
| | - Patricia de Azevedo Marques
- Department of Plastic Surgery, Division of Breast Reconstruction, Cancer Institute of São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Fabio Teixeira Belfort Mattos
- Department of Plastic Surgery, Division of Breast Reconstruction, Cancer Institute of São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Alexandre Siqueira Franco Fonseca
- Department of Plastic Surgery, Division of Breast Reconstruction, Cancer Institute of São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Alexandre Mendonça Munhoz
- Department of Plastic Surgery, Division of Breast Reconstruction, Cancer Institute of São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Division of Plastic Surgery, Hospital Sírio-Libanês, São Paulo, Brazil.
| | - José Roberto Filassi
- Department of Obstetrics and Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Silvia R Stuart
- Department of Radiology and Oncology, Division of Radiation Oncology, Instituto de Radiologia (INRAD), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Gustavo Nader Marta
- Department of Radiology and Oncology, Division of Radiation Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil; Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil.
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Lin JY, Bluebond-Langner R, Choi E, Cheston S, Nichols EM, Cohen RJ, Bentzen SM, Drogula C, Kesmodel S, Bellavance E, Rosenblatt P, Tkaczuk K, Slezak S, Feigenberg SJ. Effect of reduction mammoplasty on acute radiation side effects and use of lumpectomy cavity boosts. Pract Radiat Oncol 2017; 7:e299-e308. [DOI: 10.1016/j.prro.2017.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/02/2017] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
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Aggarwal S, Marla S, Nyanhongo D, Kotecha S, Basu NN. Current Practice of Therapeutic Mammaplasty: A Survey of Oncoplastic Breast Surgeons in England. Int J Surg Oncol 2016; 2016:1947876. [PMID: 27110398 DOI: 10.1155/2016/1947876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/03/2016] [Indexed: 11/21/2022] Open
Abstract
Introduction. Therapeutic mammaplasty (TM) is a useful technique in the armamentarium of the oncoplastic breast surgeon (OBS). There is limited guidance on patient selection, technique, coding, and management of involved margins. The practices of OBS in England remain unknown. Methods. Questionnaires were sent to all OBS involved with the Training Interface Group. We assessed the number of TM cases performed per surgeon, criteria for patient selection, pedicle preference, contralateral symmetrisation, use of routine preoperative MRI, management of involved margins, and clinical coding. Results. We had an overall response rate of 43%. The most common skin resection technique utilised was wise pattern followed by vertical scar. Superior-medial pedicle was preferred by the majority of surgeons (62%) followed by inferior pedicle (34%). Twenty percent of surgeons would always proceed to a mastectomy following an involved margin, whereas the majority would offer reexcision based on several parameters. The main absolute contraindication to TM was tumour to breast ratio >50%. One in five surgeons would not perform TM in smokers and patients with multifocal disease. Discussion. There is a wide variation in the practice of TM amongst OBS. Further research and guidance would be useful to standardise practice, particularly management of involved margins and coding for optimal reimbursement.
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Hernanz F, González-Noriega M, Pérez RV, Gómez-Fleitas M. Versatility of therapeutic reduction mammoplasty in oncoplastic breast conserving surgery. World J Surg Proced 2015; 5:217-222. [DOI: 10.5412/wjsp.v5.i3.217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 06/09/2015] [Accepted: 07/23/2015] [Indexed: 02/06/2023] Open
Abstract
Oncoplastic breast conserving surgery is the gold standard approach for the surgical treatment of early breast cancer. There is a well defined technique named “therapeutic mammoplasty” which is characterized for using a reduction mammaplasty technique to treat breast cancer conservatively. In our current practice, “therapeutic mammoplasty” or therapeutic reduction mammaplasty is our favorite oncoplastic breast conserving approach which it used in almost half of our patients. This technique is very versatile allows us the resection of tumors located in all breast quadrants of patients with moderate-to large-sized breasts. We describe a series of 57 patients who were treated using a therapeutic reduction mammaplasty. All surgical procedures were carried out by one comprehensive breast surgeon who planned and designed the surgery performing both oncologic and reconstructive procedures. Surgical margins were insufficient in eight patients (14%). Nine patients (15.8%) had a complication in early postoperative period and in one of them adjuvant radiotherapy was delayed four months due to a wound dehiscence. The rate of synchronous contralateral symmetrization was 31.6%. Our conclusion is that reduction mammaplasty is a useful and safe skill to treat breast cancer conservatively playing a very important role therefore it must be situated in the priority of learning objectives.
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Piper M, Peled AW, Sbitany H, Foster RD, Esserman LJ, Price ER. Comparison of Mammographic Findings Following Oncoplastic Mammoplasty and Lumpectomy Without Reconstruction. Ann Surg Oncol 2015; 23:65-71. [DOI: 10.1245/s10434-015-4611-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Indexed: 11/18/2022]
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Acea Nebril B, Cereijo Garea C, García Novoa A. Secuelas estéticas de la cirugía oncoplástica de la mama. Clasificación y principios para su prevención. Cir Esp 2015; 93:75-83. [DOI: 10.1016/j.ciresp.2014.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/10/2014] [Accepted: 06/11/2014] [Indexed: 11/23/2022]
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Emiroğlu M, Sert İ, İnal A. The Role of Oncoplastic Breast Surgery in Breast Cancer Treatment. J Breast Health 2015; 11:1-9. [PMID: 28331682 DOI: 10.5152/tjbh.2014.2215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 07/01/2014] [Indexed: 11/22/2022]
Abstract
The aim of this study is to discuss indications, advantages, disadvantages, oncologic and aesthetic results of Oncoplastic Surgery (OBS). Pubmed and Medline database were searched for articles published between 1998 and 2014 for keywords: oncoplastic breast surgery, therapeutic mammoplasty, oncoplastic breast reduction, synchrenous reconstructions. Role of OBS in breast cancer surgery, its aspects to be considered, its value and results have been interpreted. This technique has advantages by providing more extensive tumourectomy, yielding better aesthetic results compared with breast conserving surgery, allowing oncoplastic reduction in breast cancer patients with macromastia, with higher patient satisfaction and quality of life and by being inexpensive due to single session practice. As for its disadvantages are: re-excision is more difficult, risk for mastectomy is higher, it is depent on the Surgeron's experience, it has a risk for delay in adjuvant therapies and its requirement for additional imaging studies during management. Main indications are patients with small tumour/breast volume, macromastia, multifocality, procedures which can disrupt breast cosmesis such as surgeries for upper inner breas tquadrient tumours. Contraindications are positive margin problems after wide excision, diffuse malign microcalsifications, inflammatory breast cancer, history of radiotherapy and patients' preferences. Despite low evidence level, Oncoplastic Breast Surgery seems to be both reliable and acceptable in terms of oncologic and aesthetic aspects. Oncoplastic Breast Surgery increase the application rate of breast conserving surgery by obviating practical limitations and improve the results of breast conserving surgery. Correct patient and technique choice in OBS is vital for optimization of post surgical.
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Affiliation(s)
- Mustafa Emiroğlu
- Clinic of General Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
| | - İsmail Sert
- Clinic of General Surgery, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Abdullah İnal
- Clinic of General Surgery, Bursa Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
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