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Mohamed AG, Abdelrahman EM, Mohsen SM, Abdeen MS, Elsayed MA, Ibrahim ZM, Abdelraouf OR, Attia END. Racquet Mammoplasty as an Oncoplastic Technique in the Management of Lateral Quadrant Breast Cancer: A Prospective Controlled Study of Oncologic and Cosmetic Outcomes. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:539. [PMID: 40142351 PMCID: PMC11943719 DOI: 10.3390/medicina61030539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2025] [Revised: 02/14/2025] [Accepted: 03/17/2025] [Indexed: 03/28/2025]
Abstract
Background and Objectives: The incorporation of oncoplastic surgery techniques into the management of breast cancer has become more popular and offers both oncological safety and good cosmetic results. However, it is challenging for surgeons to obtain good oncological control and acceptable cosmetic results. This study aims to evaluate racquet mammoplasty in patients managing lateral quadrant breast tumors. Materials and Methods: In total, 59 female patients with lesions in their lateral breast quadrants were operated upon using the racquet mammoplasty technique. Their intraoperative data and postoperative outcomes were assessed and analyzed. Follow-up was planned for at least 1 year later. Results: In the current study, 59 females were enrolled, with a mean age of 38.6 ± 4.3 years. Tumors were located in the lateral upper quadrant in most of the patients (74.4%). The mean size of the tumors was 2.7 ± 1.8. The surgical margins were free of malignancy in all cases. A total of 5.1% of cases reported a wound infection. A single patient developed loco-regional recurrence. Concerning the cosmetic outcomes, 89.8% of patients reported excellent outcomes and none reported poor or bad results. Conclusions: The racquet mammoplasty technique, when used as an oncoplastic technique, provides oncological safety as well as good cosmetic results for tumors in the lateral breast quadrants.
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Affiliation(s)
- Amr G. Mohamed
- Department of General Surgery, Faculty of Medicine, Benha University, Benha 13518, Egypt; (A.G.M.); (E.N.D.A.)
| | - Emad M. Abdelrahman
- Department of General Surgery, Faculty of Medicine, Benha University, Benha 13518, Egypt; (A.G.M.); (E.N.D.A.)
| | - Sherief M. Mohsen
- Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt;
| | - Mostafa S. Abdeen
- Plastic Surgery Unit, Department of General Surgery, Faculty of Medicine, Benha University, Banha 13518, Egypt; (M.S.A.); (M.A.E.)
| | - Mohamed A. Elsayed
- Plastic Surgery Unit, Department of General Surgery, Faculty of Medicine, Benha University, Banha 13518, Egypt; (M.S.A.); (M.A.E.)
| | - Zizi M. Ibrahim
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia;
| | - Osama R. Abdelraouf
- Physical Therapy Program, Batterjee Medical College, Jeddah 21442, Saudi Arabia;
| | - Ebtesam N. D. Attia
- Department of General Surgery, Faculty of Medicine, Benha University, Benha 13518, Egypt; (A.G.M.); (E.N.D.A.)
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Wen Y, Liu R, Xie Y, Li M. Targeted SERS Imaging and Intraoperative Real-Time Elimination of Microscopic Tumors for Improved Breast-Conserving Surgery. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2024; 36:e2405253. [PMID: 38820719 DOI: 10.1002/adma.202405253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/20/2024] [Indexed: 06/02/2024]
Abstract
Breast-conserving surgery is the favorable option for breast cancer patients owing to its advantages of less aggressiveness and better cosmetic outcomes over mastectomy. However, it often suffers from postsurgical lethal recurrence due to the incomplete removal of microscopic tumors. Here, a surface-enhanced Raman scattering (SERS) surgical strategy is reported for precise delineation of tumor margins and intraoperative real-time elimination of microscopic tumor foci, which is capable of complete surgical removal of breast tumors and significantly improve the outcomes of breast-conserving surgery without local tumor recurrence. The technique is chiefly based on the human epidermal growth factor receptor 2 (HER2)-targeting SERS probes with integrated multifunctionalities of ultrahigh sensitive detection, significant HER2 expression suppression, cell proliferation inhibition, and superior photothermal ablation. In a HER2+ breast tumor mouse model, the remarkable capability of the SERS surgical strategy for complete removal of HER2+ breast tumors through SERS-guided surgical resection and intraoperative real-time photothermal elimination is demonstrated. The results show complete eradiation of HER2+ breast tumors without local recurrence, consequently delivering a 100% tumor-free survival. Expectedly, this SERS surgical strategy holds great promise for clinical treatment of HER2+ breast cancer with improved patients' survival.
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Affiliation(s)
- Yu Wen
- School of Materials Science and Engineering, Central South University, Changsha, Hunan, 410083, China
- Furong Laboratory, Central South University, Changsha, Hunan, 410008, China
| | - Ruoxuan Liu
- School of Materials Science and Engineering, Central South University, Changsha, Hunan, 410083, China
| | - Yangcenzi Xie
- School of Materials Science and Engineering, Central South University, Changsha, Hunan, 410083, China
| | - Ming Li
- School of Materials Science and Engineering, Central South University, Changsha, Hunan, 410083, China
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Fortenbery GW, Todd L, Nazir N, Dalla S, Collins M. Oncoplastic Breast Reconstruction in Morbidly Obese Patients: An Acceptable Practice. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5601. [PMID: 38348460 PMCID: PMC10861004 DOI: 10.1097/gox.0000000000005601] [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: 08/14/2023] [Accepted: 12/28/2023] [Indexed: 02/15/2024]
Abstract
Background Breast cancer is the most common noncutaneous malignancy amongst women. Lumpectomy with adjuvant radiation is a mainstay of surgical treatment. Oncoplastic breast reconstruction reduces the resultant breast deformity. Obesity is a risk factor for the development of complications after breast reconstruction. This study's purpose was to determine if oncoplastic breast reconstruction is a safe procedure in obese patients. Methods A single institution retrospective chart review was performed on women undergoing oncoplastic breast reduction from 2009 to 2021. Patients were then divided into groups based on body mass index (BMI). A statistical analysis was performed comparing rates of complications and time to adjuvant therapy. Results An estimated 340 patients were identified with an average age of 56.2 years (140 with BMI <30 kg/m2, 87 with BMI 30-34.9 kg/m2, 62 with BMI 35-39.9 kg/m2, and 51 with BMI >40 kg/m2). There was a significant difference between the BMI greater than 40 kg per m2 and BMI less than 30 kg per m2 group in the number of returns to the operating room (P = 0.0096), major complications (P = 0.0002), and minor complications (P = 0.0051). Average time to adjuvant treatment was 47 days and there was no statistically significant difference between the groups (P = 0.1691). Conclusions There was a significant difference in major and minor complications between the BMI groups; however, there was no delay in the time to adjuvant therapy. Therefore, we conclude that with appropriate counseling on surgical risks, oncoplastic breast reduction is an acceptable option for breast cancer patients after lumpectomy, regardless of BMI.
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Affiliation(s)
- Grey W. Fortenbery
- From the Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kans
| | - Lauren Todd
- University of Kansas School of Medicine, Kansas City, Kans
| | - Niaman Nazir
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kans
| | - Shreeya Dalla
- University of Kansas School of Medicine, Kansas City, Kans
| | - Meredith Collins
- From the Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, Kans
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Kilmer LH, Weidman AA, DeGeorge BR, Stranix JT, Campbell CA. Oncoplastic breast reduction surgery decreases rates of reoperation with no increased medical risk. J Plast Reconstr Aesthet Surg 2024; 88:273-280. [PMID: 38016264 DOI: 10.1016/j.bjps.2023.10.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/30/2023]
Abstract
The purpose of this study is to compare the oncologic, medical, and surgical outcomes of lumpectomy versus oncoplastic breast reduction surgery (OBRS) on a national scale. A national insurance-based database was queried for patients who had a lumpectomy with or without a same-day breast reduction by Current Procedural Terminology (CPT) codes. Patients were then matched by obesity, body mass index range, age, region, neoadjuvant chemotherapy, and outcomes were compared. There were 421,455 patients in the lumpectomy group and 15,909 patients in the OBRS group. After matching, 15,134 patients were identified in each group. Repeat lumpectomy or subsequent mastectomy was more common in the lumpectomy group (15.2% vs. 12.2%, p < 0.001). OBRS patients had higher rates of 90-day surgical complications including dehiscence, infection, fat necrosis, breast abscesses, and antibiotic prescription (p < 0.001). Meanwhile, any medical complication was less common in the OBRS group (3.7% vs. 4.5%, p = 0.001). Logistic regression revealed that OBRS was associated with decreased odds of repeat lumpectomy (OR = 0.71, 95% CI 0.66-0.77, p < 0.001) with no significant increased odds of subsequent mastectomy (OR = 1.01, 95% CI 0.91-1.11, p = 0.914). OBRS was found to be associated with decreased risk for reoperation in the form of lumpectomy without increased likelihood of subsequent mastectomy. Although OBRS was associated with increased wound complications, medical complications were found to occur less frequently. This study endorses increased consideration of OBRS when lumpectomy or OBRS is appropriate.
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Affiliation(s)
- Lee H Kilmer
- Department of Plastic Surgery , Maxillofacial & Oral Health, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
| | - Allan A Weidman
- School of Medicine, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
| | - Brent R DeGeorge
- Department of Plastic Surgery , Maxillofacial & Oral Health, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
| | - John T Stranix
- Department of Plastic Surgery , Maxillofacial & Oral Health, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
| | - Chris A Campbell
- Department of Plastic Surgery , Maxillofacial & Oral Health, University of Virginia, 1215 Lee Street, Charlottesville, VA 22903, USA.
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Feng Y, Li J, Zhang D, Yang H, Qiu M, Zhou J, Qin X, Liu X, Liang F, Du Z. Three-Pedicle Reduction Mammaplasty Technique in the Treatment of Greater Breast Hypertrophy Patients With or Without Breast Cancer: Surgical and Patient-reported outcomes. Aesthetic Plast Surg 2023; 47:2221-2231. [PMID: 36820864 DOI: 10.1007/s00266-023-03285-3] [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: 10/05/2022] [Accepted: 02/04/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Reduction mammoplasty (RM) is an important procedure in the management of symptomatic greater breast hypertrophy with or without early-stage breast cancer. We aim to introduce a new procedure: the three-pedicle reduction mammaplasty technique. METHODS A prospectively maintained database was reviewed, and two prospectively registered clinical studies were included of all breast hypertrophy patients with or without breast cancer who underwent three-pedicle RM with inverted T incision at West China Hospital or the Fourth People's Hospital of Sichuan Province from 2018 to 2022. Patient demographics, patient-reported cosmetic results, quality of life (QoL), surgical outcomes and complications were assessed. RESULTS During a median period of 22.5 months, 101 reduction mammaplasties were performed (Mage= 35.80; MBMI= 27.05). Mean reduction weight was 880.9 g ranging from 423-1630 g per breast. The nipple-to-sternal notch distance (N-SN) at post-operation was significantly shorter than preoperatively (left, 34.51 cm; right, 34.69 cm). Major complications and minor complications were 1.9% (1/52 patients) and 13.5% (7/52 patients), respectively. Multivariate logistic regression analyses showed that BMI > 30 was independent risk factors for a complication. Except for sexual and physical well-being at 1-month post-operation, patients gave a higher score on the BREAST-Q (breast satisfaction, physical well-being, psychosocial well-being) after the operation than before the operation (P<0.001). CONCLUSIONS The three-pedicle RM technique was demonstrated to be an effective and safe RM procedure for moderate to severe breast hypertrophy patients with or without breast cancer, with the advantages of removing the lesions, reducing hypertrophic breasts and accomplishing mammoplasty. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.
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Affiliation(s)
- Yu Feng
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Juan Li
- Department of Breast Surgery, Sichuan Academy of Medical Sciences, Sichuan Province People's Hospital, Chengdu, 610072, Sichuan, People's Republic of China
| | - Donglin Zhang
- Department of General Surgery, The Fourth People's Hospital of Sichuan Province, Chengdu, 610016, Sichuan, People's Republic of China
| | - Huanzuo Yang
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Mengxue Qiu
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jiao Zhou
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiangquan Qin
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xinran Liu
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Faqing Liang
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zhenggui Du
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, 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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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: 8] [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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Atzori G, Franchelli S, Gipponi M, Cornacchia C, Diaz R, Depaoli F, Murelli F, Sparavigna M, Fregatti P, Friedman D. Inferior Pedicle Reduction Mammoplasty as Corrective Surgery after Breast Conserving Surgery and Radiation Therapy. J Pers Med 2022; 12:jpm12101569. [PMID: 36294707 PMCID: PMC9605670 DOI: 10.3390/jpm12101569] [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: 09/05/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background/Aim—Twenty patients had corrective reconstruction surgery by means of a reduction mammaplasty or mastopexy after a previous BCS (Breast Conserving Surgery) and RT (Radiation Therapy); the risk factors and post-operative complications were reported in order to define a safe and effective technique for reduction mammaplasty in previously irradiated breast cancer patients. Materials and Methods—From June 2011 to December 2019, 20 pts. were operated on at the Breast Surgery Clinic of San Martino Policlinic Hospital, Genoa, Italy. Pre- and post-operative parameters included clinic-pathological features of the primary tumor; a lapse of time from primary radio-surgery; the extent of follow-up; the rate of post-operative wound infections; the persistence of breast asymmetry, and a post-operative patient satisfaction index by means of a BREAST-Q questionnaire. Results—Three patients (15%) developed minor complications in the irradiated breast, but no complication was observed into the non-irradiated breast. No statistically significant correlation was found between the post-operative complications and the risk factors. The statistical analysis of BREAST-Q questionnaire responses gave an average patient’s satisfaction index that was equal to 90.8/100 (range: 44 to 100). Conclusions—Inferior pedicle reduction mammoplasty is an effective reduction mammoplasty technique in regard to the extent of breast tissues that are to be removed both in irradiated and contralateral breast; moreover, the incidence of post-operative complications is clearly limited when a careful technique is adopted, and it can be reasonably applied also in patients with co-morbidity factors.
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Affiliation(s)
- Giulia Atzori
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy
| | | | - Marco Gipponi
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy
- Correspondence: ; Tel.: +30-010-5558805
| | - Chiara Cornacchia
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy
| | - Raquel Diaz
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy
| | - Francesca Depaoli
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy
| | - Federica Murelli
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy
| | - Marco Sparavigna
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy
| | - Piero Fregatti
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy
| | - Daniele Friedman
- Breast Surgery Clinic, San Martino Policlinic Hospital, 16132 Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostic (DISC), School of Medicine, University of Genoa, 16132 Genoa, Italy
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Zakhary NY, Mubarak AA, Elkhadrawy OH, Ismail EM. Multislice CT angiography as a roadmap for pedicle selection prior to breast reduction surgery. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00893-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Accurate knowledge of breast arterial supply on individual basis is crucial prior to breast reduction surgery to minimize the risk of post-operative necrosis of nipple-areola complex which is a well reported complication. The purpose of this cross-sectional study was to test the ability of multislice CT angiography to delineate the dominant arterial supply of nipple-areola complex to facilitate accurate breast pedicle selection to improve patient outcome.
Results
Twelve patients underwent multislice CTA of both breasts to delineate dominant arterial supply to NAC, internal mammary artery was the dominant arterial supply in most of breasts (87.5%) based on CTA findings and hence superomedial pedicle was the commonest pedicel chosen. None of patients experienced NAC necrosis postoperatively while minority of patients (16.6%) exhibited decreased NAC sensation bilaterally.
Conclusions
Multislice CT angiography is a useful pre-operative tool to minimize the risk of post-operative necrosis of nipple-areola complex in patients undergoing breast reduction surgery.
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冯 玉, 李 娟, 张 栋, 周 娇, 覃 湘, 刘 馨, 邱 梦, 杨 焕, 杜 正. [Application of three-pedicle reduction mammaplasty in breast cancer patients with moderate or greater breast hypertrophy and/or moderate-to-severe breast ptosis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1595-1602. [PMID: 34913317 PMCID: PMC8669191 DOI: 10.7507/1002-1892.202107068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/26/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To explore the application and effectiveness of three-pedicle reduction mammoplasty in breast cancer patients with moderate or greater breast hypertrophy and/or moderate-to-severe breast ptosis. METHODS The clinical data of 15 breast cancer female patients with hypertrophy and/or moderate-to-severe breast ptosis treated by three-pedicle reduction mammaplasty with inverted T incision between January 2019 and March 2021 were retrospectively analysed. The patients were aged 31-58 years, with a median age of 39 years. The disease duration ranged from 10 days to 9 months (median, 3.4 months). All patients had unifocal tumor, with a maximum diameter of primary tumor of 0.5-3.9 cm (mean, 2.0 cm), of which 12 were diagnosed with invasive carcinoma and 3 carcinoma in situ. Tumor stage: T isN 0M 0 in 3 cases, T 1N 0M 0 in 4 cases, T 1N 2M 0 in 2 cases, T 2N 0M 0 in 4 cases, and T 2N 1M 0 in 2 cases. The preoperative cup sizes of patients were D cup in 3 cases, DD cup in 1 case, E cup in 2 cases, EE cup in 2 cases, F cup in 2 cases, FF cup in 1 case, and ≥G cup in 4 cases. The distance from nipple to inframammary fold was 8-18 cm (mean, 12.2 cm) before operation. The patients were followed up regularly after operation to evaluate the breast reduction effect and complications; Breast cancer reporting outcome scale (BREAST-Q) was used to assess patients' satisfaction and quality of life; and ultrasound, chest and abdominal CT, whole-body bone scan were performed to assess local tumor recurrence or distant metastasis. RESULTS The postoperative nipple position was slightly higher than inframammary fold in all patients. Postoperative cup sizes were A cup in 3 cases, B cup in 6, C cup in 4, D cup in 1, and DD cup in 1, which showing significant difference when compared with preoperative cup sizes ( Z=3.420, P=0.001). The median follow-up time was 9 months (range, 6-33 months). Postoperatively, 2 cases (13.3%) had wound-site cellulitis, 1 (6.7%) had mild fat liquefaction, 2 (13.3%) had nipple and areola hypoesthesia but recovered after 3 months. No complication such as fat necrosis, papillary areola complex, or flap necrosis occurred. All patients had undergone adjuvant radiotherapy, of which 1 (6.7%) showed mild skin color change after radiotherapy, but no radiotherapy-related complication occurred in all patients. No patient was readmitted, received reoperation, or delayed to adjuvant therapy due to complications. In the BREAST-Q score, breast satisfaction and quality of life scores at 3 and 6 months after operation were significantly better than those before operation and at 1 month after operation ( P<0.05); no significant difference was found between at 1 month after operation and before operation ( P>0.05). Nipple satisfaction scores at 1, 3, and 6 months after operation were 15.6±2.2, 18.5±1.4, 19.3±0.7, respectively. At discharge after operation, the patient's satisfaction with the outcome of the operation was scored 84.7±11.4. The score of adverse events of radiotherapy at 6 months after operation was 6.5±0.8. During the follow-up, patient had no local recurrence, distant metastasis, or breast cancer related death. CONCLUSION For breast cancer patients with moderate or greater breast hypertrophy and/or moderate-to-severe breast ptosis, three-pedicle reduction mammoplasty can not only remove the lesions, but also reduce hypertrophic breasts, accomplish the mammoplasty, reduce the radiotherapy complications, and improve the satisfaction and quality of life of patients.
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Affiliation(s)
- 玉 冯
- 四川大学华西医院乳腺外科（成都 610041）Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - 娟 李
- 四川大学华西医院乳腺外科（成都 610041）Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - 栋林 张
- 四川大学华西医院乳腺外科（成都 610041）Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - 娇 周
- 四川大学华西医院乳腺外科（成都 610041）Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - 湘泉 覃
- 四川大学华西医院乳腺外科（成都 610041）Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - 馨然 刘
- 四川大学华西医院乳腺外科（成都 610041）Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - 梦雪 邱
- 四川大学华西医院乳腺外科（成都 610041）Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - 焕佐 杨
- 四川大学华西医院乳腺外科（成都 610041）Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - 正贵 杜
- 四川大学华西医院乳腺外科（成都 610041）Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
- 四川省医学科学院·四川省人民医院乳腺外科（成都 610072）Department of Breast Surgery, Sichuan Academy of Medical Sciences·Sichuan Province People’s Hospital, Chengdu Sichuan, 610072, P.R.China
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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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12
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Kim YS, Kim BS, Kim HS, In SK, Yi HS, Kim HI, Park JH, Choi JH, Kim HY. Oncoplastic breast reduction using the short scar periareolar inferior pedicle reduction technique. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2020. [DOI: 10.14730/aaps.2020.02061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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13
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14
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Shechter S, Friedman O, Inbal A, Arad E, Menes T, Barsuk D, Gur E, Barnea Y. Oncoplastic partial breast reconstruction improves patient satisfaction and aesthetic outcome for central breast tumours. ANZ J Surg 2019; 89:536-540. [DOI: 10.1111/ans.15078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/15/2018] [Accepted: 12/21/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Shirley Shechter
- Department of Plastic and Reconstructive SurgeryTel‐Aviv Sourasky Medical Center Tel Aviv Israel
| | - Or Friedman
- Department of Plastic and Reconstructive SurgeryTel‐Aviv Sourasky Medical Center Tel Aviv Israel
| | - Amir Inbal
- Department of Plastic and Reconstructive SurgeryTel‐Aviv Sourasky Medical Center Tel Aviv Israel
| | - Ehud Arad
- Department of Plastic and Reconstructive SurgeryTel‐Aviv Sourasky Medical Center Tel Aviv Israel
| | - Tehillah Menes
- The Breast Health CenterTel‐Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel‐Aviv University Tel‐Aviv Israel
| | - Daphna Barsuk
- General SurgeryAssuta Medical Center Tel Aviv Israel
| | - Eyal Gur
- Department of Plastic and Reconstructive SurgeryTel‐Aviv Sourasky Medical Center Tel Aviv Israel
| | - Yoav Barnea
- Department of Plastic and Reconstructive SurgeryTel‐Aviv Sourasky Medical Center Tel Aviv Israel
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15
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Extreme Oncoplastic Surgery for Multifocal/Multicentric and Locally Advanced Breast Cancer. Int J Breast Cancer 2019; 2019:4262589. [PMID: 30915240 PMCID: PMC6402217 DOI: 10.1155/2019/4262589] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [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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16
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Patient-Reported Outcomes Are Better after Oncoplastic Breast Conservation than after Mastectomy and Autologous Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1419. [PMID: 28831358 PMCID: PMC5548581 DOI: 10.1097/gox.0000000000001419] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/30/2017] [Indexed: 12/14/2022]
Abstract
Supplemental Digital Content is available in the text. Oncoplastic breast-conserving surgery (OBCS) avoids mastectomy for larger tumors, but patient-reported outcomes are unknown.
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17
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Sanguinetti A, Polistena A, Luchini R, Monacelli M, Avenia S, Galasse S, Cirocchi R, Avenia N. Correct information to patients undergoing breast-conserving surgery: the medicolegal significance. G Chir 2017; 38:61-65. [PMID: 28691668 DOI: 10.11138/gchir/2017.38.2.061] [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: 11/17/2022]
Abstract
Many of the women newly diagnosed with breast cancer not have access to all the information they need to make the surgical and treatment choices that are most appropriate for them. Research clearly shows that lumpectomy and other breast-conserving surgeries are just as safe as mastectomy for most women with early stage disease, and yet approximately half will undergo the more disfiguring procedures, but many healthy women who have strong family histories of breast cancer consider prophylactic mastectomies, and their decisions are also based on very limited information, because there are few studies showing the effectiveness of that procedure. This paper delineates how to avoid limited information and biased recommendations is important for a conscious and informed choice by the patients.
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Cil TD, Cordeiro E. Complications of Oncoplastic Breast Surgery Involving Soft Tissue Transfer Versus Breast-Conserving Surgery: An Analysis of the NSQIP Database. Ann Surg Oncol 2016; 23:3266-71. [PMID: 27518043 DOI: 10.1245/s10434-016-5477-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Oncoplastic breast surgery (OBS) aims to provide breast cancer patients with optimum oncologic outcomes and excellent cosmesis. We sought to determine if there is a difference in complications associated with OBS involving soft tissue transfer compared with the traditional breast-conserving surgical (BCS) approach. METHODS Analysis of the American College of Surgeons National Surgical Quality Improvement Program database was performed. Patients with breast cancer who underwent BCS from 2005 to 2014 were included in the study cohort, while patients undergoing concurrent high-risk non-breast surgery, male patients, and those with metastatic disease were excluded. Patients with concomitant current procedural terminology codes identifying soft tissue transfer were categorized as having OBS. Multivariable analysis was performed to determine the independent effect of OBS on postoperative morbidity. RESULTS We identified 75,972 patients who underwent BCS for breast cancer between 2005 and 2014, of whom 1363 (1.8 %) underwent OBS with soft tissue transfer. Compared with the standard lumpectomy group, patients undergoing OBS were more likely to be younger, had a lower body mass index, were less likely to be smokers, and more often received neoadjuvant chemotherapy. OBS with soft tissue transfer also had a significantly longer operative time (83 vs. 59 min; p < 0.001). The multivariable analysis confirmed that soft tissue transfer OBS was not an independent predictor of overall complications (odds ratio 0.78; 95 % confidence interval 0.50-1.19). CONCLUSIONS These data confirm that the use of OBS with soft tissue transfer for breast cancer treatment does not confer an increased risk of surgical complications, despite the longer operative time. This is important given the increasing use of oncoplastic surgery techniques within North America.
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Affiliation(s)
- Tulin D Cil
- Department of Surgery, University of Toronto, Toronto, ON, Canada. .,Division of General Surgery, University Health Network, Toronto, ON, Canada. .,Department of Surgery, Women's College Hospital, Toronto, ON, Canada.
| | - Erin Cordeiro
- Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
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19
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Piper ML, Esserman LJ, Sbitany H, Peled AW. Outcomes Following Oncoplastic Reduction Mammoplasty. Ann Plast Surg 2016; 76 Suppl 3:S222-6. [DOI: 10.1097/sap.0000000000000720] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Oncoplastic reduction mammoplasty for breast cancer in women with macromastia: long term aesthetic, functional and satisfaction outcomes. Contemp Oncol (Pozn) 2016; 20:256-60. [PMID: 27647991 PMCID: PMC5013678 DOI: 10.5114/wo.2015.55272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 07/13/2015] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY Despite the increase in studies concerning oncoplastic reduction mammoplasty (ORM), data showing long-term aesthetic and patient satisfaction for ORM in patients with macromastia remain limited. Therefore, this study evaluated the long-term results of tumorectomy and concomitant bilateral ORM for early-stage breast cancer patients with macromastia in terms of cosmesis, patient satisfaction, and functional outcomes. MATERIAL AND METHODS Retrospective data of patients with macromastia undergoing ORM for breast cancer between 1996 and 2011 were examined and evaluated regarding the aesthetic results, patient satisfaction, and functional outcomes. RESULTS The median age of the 82 patients was 50 years. The median follow-up was 120 months (range: 28-212 months). The median breast volume was 1402 cm(3), and the median weight of the excised breast material was 679 g. A good or excellent evaluation of the cosmetic outcome was as follows: self-evaluation: 84.1% at the early-stage, 80.3% at the later stage; panel evaluation: 75.4% at the late-stage. Median patient satisfaction rates were 9.1% for early-stage disease and 8.8% for late-stage disease. Reduced mobility and intertrigo improved by three-fold during the post-operative period. CONCLUSIONS ORM for early-stage breast cancer in women with macromastia results in good cosmesis in both the early-stage and long-term, and is quite acceptable for use in patients. Patients reacted favorably to the prospect of having their breast cancer and macromastia treated in a single session, and positive results continued over the long-term.
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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] [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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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: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Indexed: 11/18/2022]
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Emiroğlu M, Sert İ, İnal A. The Role of Oncoplastic Breast Surgery in Breast Cancer Treatment. THE JOURNAL OF BREAST HEALTH 2015; 11:1-9. [PMID: 28331682 PMCID: PMC5351526 DOI: 10.5152/tjbh.2014.2215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [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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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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Lee S, Lee J, Lee S, Bae Y. Oncoplastic breast surgery with latissimus dorsi myocutaneous flap for large defect in patients with ptotic breasts: is it feasible when combined with local flaps? World J Surg Oncol 2014; 12:65. [PMID: 24669908 PMCID: PMC3974747 DOI: 10.1186/1477-7819-12-65] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 03/16/2014] [Indexed: 12/04/2022] Open
Abstract
Background The latissimus dorsi myocutaneous flap (LDMCF) is frequently applied to breast cancer patients for breast reconstruction. However, the LDMCF is considered inappropriate for patients with ptotic breast. The authors investigated combining LDMCF and two local flaps for large defects of the breast after partial mastectomy in patients with ptosis. Methods Nineteen patients with breast cancer underwent a partial mastectomy with immediate reconstruction. Reconstruction methods consisted of LDMCF, thoraco-epigastric flap, and inferior pedicled rotational local flap, referred to as a combined pedicle flap. The cosmetic results were self-assessed after chemotherapy and radiotherapy by a four-point scoring system. Results Ptosis was graded as follows: two patients with grade 1, 10 patients with grade 2, and seven patients with grade 3. The mean tumor size was 2.7 cm and multifocality was identified in 11 patients (57.9%). The mean excised volume was 468.5 cm3 and the percentage of excised volume was 46.2%. The cosmetic results were excellent in five patients, good in seven patients, fair in six patients, and poor in one patient. Conclusion The combined pedicle flap, consisting of LDMCF, thoraco-epigastric flap, and inferior pedicled rotational local flap, allows good cosmesis in breast cancer patients with large breasts or ptosis despite a wide excision.
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Affiliation(s)
| | | | | | - Youngtae Bae
- Department of Surgery, Medical Research Institute, Pusan National University, Ami-dong 1-ga, Seo-gu, Busan 602-739, Republic of Korea.
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Currie A, Chong K, Davies GL. Using therapeutic mammoplasty to extend the role of breast-conserving surgery in women with larger or ptotic breasts. Ann R Coll Surg Engl 2013; 95:192-5. [PMID: 23827290 DOI: 10.1308/003588413x13511609958091] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The equivalence of breast-conserving surgery followed by postoperative radiotherapy against mastectomy is now firmly established in patients with early breast cancer. The results of surgery in large-breasted women can be poor, with radiation-induced fibrosis, chronic pain and poor cosmesis contributing to long-term psychological and physical morbidity. Therapeutic mammoplasty offers an alternative management strategy to both enhance the role of breast-conserving surgery and provide better outcomes. METHODS A retrospective note review was undertaken of all patients undergoing therapeutic mammoplasty for breast malignancy between 2007 and 2011. All cases were performed using a Wise pattern-reduction technique. Histology and pathological outcomes were assessed. Postoperative outcomes reviewed included wound infection, seroma and need for further intervention. RESULTS During the study period, 20 patients underwent therapeutic mammoplasty with a mean follow-up duration of 36 months. The mean weight of the lumpectomy specimen was 330g. The average cancer size was 34mm, with a mean margin clearance of 7mm. There was one episode of wound infection and three of delayed wound healing at the T-junction. One patient required a mastectomy for involved margins. There were no recurrences at the most recent follow-up visit. CONCLUSIONS Therapeutic mammoplasty offers a tailored approach to women with larger breasts and early breast cancers with good cosmetic results and oncological outcomes.
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Affiliation(s)
- A Currie
- Department of Breast Surgery, Kingston Hospital, Galsworthy Road, Kingston upon Thames, Surrey KT2 7QB, UK.
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Down SK, Jha MBBS MS MSc PK, Burger A, Hussien MI. Oncological Advantages of Oncoplastic Breast-Conserving Surgery in Treatment of Early Breast Cancer. Breast J 2013; 19:56-63. [PMID: 23301761 DOI: 10.1111/tbj.12047] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sue K. Down
- Breast Surgery Unit; Norfolk & Norwich University Hospital; Norwich United Kingdom
| | | | - Amy Burger
- Breast Surgery Unit; Norfolk & Norwich University Hospital; Norwich United Kingdom
| | - Maged I. Hussien
- Breast Surgery Unit; Norfolk & Norwich University Hospital; Norwich United Kingdom
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Oncoplastic breast reduction: maximizing aesthetics and surgical margins. Int J Surg Oncol 2012; 2012:907576. [PMID: 23209890 PMCID: PMC3504375 DOI: 10.1155/2012/907576] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 10/03/2012] [Accepted: 10/22/2012] [Indexed: 12/02/2022] Open
Abstract
Oncoplastic breast reduction combines oncologically sound concepts of cancer removal with aesthetically maximized approaches for breast reduction. Numerous incision patterns and types of pedicles can be used for purposes of oncoplastic reduction, each tailored for size and location of tumor. A team approach between reconstructive and breast surgeons produces positive long-term oncologic results as well as satisfactory cosmetic and functional outcomes, rendering oncoplastic breast reduction a favorable treatment option for certain patients with breast cancer.
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Denewer A, Shahatto F, Elnahas W, Farouk O, Roshdy S, Khater A, Hussein O, Teima S, Hafez M, Zidan S, Shams N, Kotb S. Therapeutic reduction mammoplasty in large-breasted women with cancer using superior and superomedial pedicles. BREAST CANCER-TARGETS AND THERAPY 2012; 4:167-72. [PMID: 24367203 DOI: 10.2147/bctt.s32766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Surgical management of breast cancer in large-breasted women presents a real challenge. This study aims to evaluate the outcome of therapeutic reduction mammoplasty in large-breasted women with breast cancer using superior and superomedial pedicles, situated at any breast quadrant except for the central and upper medial quadrants. METHODS Fifty women with breast cancer and large breasts underwent simultaneous bilateral reduction mammoplasty. The weight of the tissue removed ranged from 550 g to 1050 g and the tumor-free safety margins by frozen section were in the range of 4 cm to 12 cm. RESULTS The age of the patients ranged from 36 to 58 (median 43) years and tumor size ranged from 1 cm to 4 cm. The cosmetic outcomes were excellent in 32 patients (64%), good in 15 (30%) patients, and fair in three patients (6%). The follow-up period was 8-36 (mean 20) months, with no local recurrence or systemic metastasis. CONCLUSION Therapeutic reduction mammoplasty using superior and superomedial pedicles was shown to be oncologically safer than traditional conservative surgery. This oncoplastic procedure yields a satisfactory esthetic outcome with lower morbidity in large-breasted women with breast cancer.
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Affiliation(s)
- Adel Denewer
- Surgical Oncology Department, Oncology Center, Mansoura, Egypt
| | - Fayez Shahatto
- Surgical Oncology Department, Oncology Center, Mansoura, Egypt
| | - Waleed Elnahas
- Surgical Oncology Department, Oncology Center, Mansoura, Egypt
| | - Omar Farouk
- Surgical Oncology Department, Oncology Center, Mansoura, Egypt
| | - Sameh Roshdy
- Surgical Oncology Department, Oncology Center, Mansoura, Egypt
| | - Ashraf Khater
- Surgical Oncology Department, Oncology Center, Mansoura, Egypt
| | - Osama Hussein
- Surgical Oncology Department, Oncology Center, Mansoura, Egypt
| | - Saleh Teima
- Clinical Oncology and Nuclear Medicine Department, Mansoura University, Mansoura, Egypt
| | - Mohammed Hafez
- Surgical Oncology Department, Oncology Center, Mansoura, Egypt
| | - Samir Zidan
- Surgical Oncology Department, Oncology Center, Mansoura, Egypt
| | - Nazem Shams
- Surgical Oncology Department, Oncology Center, Mansoura, Egypt
| | - Sherif Kotb
- Surgical Oncology Department, Oncology Center, Mansoura, Egypt
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Urban C, Lima R, Schunemann E, Spautz C, Rabinovich I, Anselmi K. Oncoplastic principles in breast conserving surgery. Breast 2012; 20 Suppl 3:S92-5. [PMID: 22015301 DOI: 10.1016/s0960-9776(11)70302-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Oncoplastic surgery (OP) represents a major advance in breast cancer surgery. It is based on three principles: ideal oncology surgery with free margins and adequate local control of disease, immediate breast reconstruction and symmetry, with the transposition of plastic surgery techniques into breast cancer surgery. Its original focus was to improve the quality of life of patients undergoing oncological treatments that can be more effective from the aesthetic-functional point of view than the traditional breast conserving techniques. As it happens with all changes of paradigms, it brings new challenges for the traversal formation of all involved in the treatment of breast cancer. Besides that, it opens to new perspectives of surgical research related to the aesthetic results, quality of life and local control, as well as optimization of operative timing and reduction of both adverse effects and costs. The aim of this review was to present the principles of this approach and the main techniques applied, evaluating its indications and limits in conservative breast cancer surgery.
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Affiliation(s)
- Cicero Urban
- Breast Unit, Hospital Nossa Senhora das Gragas, Curitiba, Brazil.
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Who Benefits from Oncoplastic Surgical Techniques? CURRENT BREAST CANCER REPORTS 2012. [DOI: 10.1007/s12609-012-0069-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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McIntosh J, O'Donoghue J. Therapeutic mammaplasty – A systematic review of the evidence. Eur J Surg Oncol 2012; 38:196-202. [DOI: 10.1016/j.ejso.2011.12.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 11/15/2011] [Accepted: 12/12/2011] [Indexed: 10/14/2022] Open
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Gulcelik MA, Dogan L, Camlibel M, Karaman N, Kuru B, Alagol H, Ozaslan C. Early complications of a reduction mammoplasty technique in the treatment of macromastia with or without breast cancer. Clin Breast Cancer 2011; 11:395-9. [PMID: 21993009 DOI: 10.1016/j.clbc.2011.08.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 08/05/2011] [Accepted: 08/17/2011] [Indexed: 12/25/2022]
Abstract
UNLABELLED This study was planned to investigate the early postoperative complications of reduction mammoplasty done for benign or malignant reasons on 286 patients. Minor and major complication rates were 16.3% and 1.9%, respectively.There was no significant difference in terms of complications between the patients with and those without breast cancer. Body mass index was found to be the only factor associated with the complication rates. BACKGROUND This study was planned to investigate the early postoperative complications after reduction mammoplasty applied either for benign or malignant reasons and reliability of the technique with respect to wound healing. PATIENTS AND METHODS Two hundred and eighty-six reduction procedures were evaluated prospectively. Fifty-two patients underwent reduction mammoplasty for macromastia and 101 for macromastia with breast cancer. The wound complications were evaluated in 2 groups, as minor and major complications. Seroma, hematoma, surgical site infection, delayed wound healing, and minor wound dehiscence were included in the minor complication group. Severe complications, such as necrosis of nipple-areola complex and major incisional wound dehiscence, were included in the major complications group. RESULTS Mean (SD) age of the patients was 48.8 ± 10.3 years, mean (SD) body mass index was 29 ± 3.3 kg/m(2), and mean (SD) weight of resected specimen was 958 ± 72 g. Mean (SD) preoperative and postoperative volumes for each breast were 1245 ± 75 cm(3) and 436 ± 27 cm(3), respectively. Minor and major complication rates were 25/153 (16.3%) and 3/153 (1.9%), respectively. There was no significant difference in terms of complications between the patients with and without breast cancer. Body mass index was found to be the only factor associated with the complication rates. DISCUSSION Reduction mammoplasty is a surgical technique that has satisfactory cosmetic results in the treatment of macromastia. This technique also is safe in the treatment of breast cancer patients with macromastia and does not increase complication rates.
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Affiliation(s)
- Mehmet Ali Gulcelik
- Department of Surgery, Ankara Oncology Hospital, 12/34 Cukurambar, Ankara, Turkey.
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A Head-to-Head Comparison of Quality of Life and Aesthetic Outcomes following Immediate, Staged-Immediate, and Delayed Oncoplastic Reduction Mammaplasty [Outcomes Article]. Plast Reconstr Surg 2011; 127:2167-2175. [DOI: 10.1097/prs.0b013e3182131c1c] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hernanz F, Santos R, Arruabarrena A, Schneider J, Gómez Fleitas M. Treatment of symptomatic macromastia in a breast unit. World J Surg Oncol 2010; 8:93. [PMID: 21040550 PMCID: PMC2988782 DOI: 10.1186/1477-7819-8-93] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 11/01/2010] [Indexed: 12/31/2022] Open
Abstract
Background Patients suffering from symptomatic macromastia are usually underserved, as they have to put up with very long waiting lists and are usually selected under restrictive criteria. The Oncoplastic Breast Surgery subspeciality requires a cross-specialty training, which is difficult, in particular, for trainees who have a background in general surgery, and not easily available. The introduction of reduction mammaplasty into a Breast Cancer Unit as treatment for symptomatic macromastia could have a synergic effect, making the scarce therapeutic offer at present available to these patients, who are usually treated in Plastic Departments, somewhat larger, and accelerating the uptake of oncoplastic training as a whole and, specifically, the oncoplastic breast conserving procedures based on the reduction mammaplasty techniques such as displacement conservative techniques and onco-therapeutic mammaplasty. This is a retrospective study analyzing the outcome of reduction mammaplasty for symptomatic macromastia in our Breast Cancer Unit. Methods A cohort study of 56 patients who underwent bilateral reduction mammaplasty at our Breast Unit between 2005 and 2009 were evaluated; morbidity and patient satisfaction were considered as end points. Data were collected by reviewing medical records and interviewing patients. Results Eight patients (14.28%) presented complications in the early postoperative period, two of them being reoperated on. The physical symptoms disappeared or significantly improved in 88% of patients and the degree of satisfaction with the care process and with the overall outcome were really high. Conclusion Our experience of the introduction of reduction mammaplasty in our Breast Cancer Unit has given good results, enabling us to learn the use of different reduction mammaplasty techniques using several pedicles which made it posssible to perform oncoplastic breast conserving surgery. In our opinion, this management policy could bring clear advantages both to patients (large-breasted and those with a breast cancer) and surgeons.
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Affiliation(s)
- Fernando Hernanz
- Department of Surgery, University of Cantabria, Hospital Marqués de Valdecilla, Avda Valdecilla s/n, 39008 Santander, Cantabria, Spain.
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