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The purpose of our project is to determine the feasibility and effectiveness of a prehabilitation (prehab) program for patients undergoing breast cancer surgery as compared to only receiving post-surgical rehabilitation. Our clinical mentor has recently obtained certification as a lymphedema specialist and is assisting with the opening of an outpatient mastectomy clinic through the Methodist University systems. Through our research process, we critically appraised two Level II articles, two Level III articles, and one Level IV article. Positive outcomes related to the feasibility were identified, however there is limited significant evidence supporting the effectiveness of the intervention. We recommend using the intervention with caution and monitoring based on the preliminary nature of the current evidence. Further studies should be conducted to determine the effectiveness of the intervention.

Purpose Indications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion. Methods The panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative process in question development, voting, and wording of the recommendations followed the modified Delphi methodology. Results Consensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference. Conclusions In case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest and most efficacious reconstruction techniques.

Persistent pain following breast cancer surgery is a significant clinical problem. Both inherited and acquired inflammatory factors (e.g., cytokines) appear to play a role in the development and maintenance of persistent pain. However, less is known about the molecular mechanisms of inflammation associated with the development of persistent pain following breast cancer surgery. Growth mixture modeling was used to identify persistent breast pain phenotypes based on pain assessments obtained prior to and monthly for six months following breast cancer surgery. The purpose of this dissertation is to evaluate for differences in demographic and clinical characteristics as well as to evaluate the associations between single nucleotide polymorphisms contained within candidate cytokine genes and pain group membership. In addition, methylation of the promoter region of the genes that harbored gene variations associated with pain group membership were evaluated in the no pain and mild pain classes. Different subsets of phenotypic characteristics (i.e., age, strange sensations prior to surgery, reconstruction performed at the time of surgery, re-excision/mastectomy done within six months and worst postoperative pain intensity) and genes (i.e., interleukin (IL) 1 receptor 2, IL4, IL10, IL13 and IL6, tumor necrosis factor alpha (TNFA)) were associated with the distinct phenotypes (i.e., mild persistent pain, severe persistent pain) and suggest that different mechanisms of heritable susceptibility may exist. In addition, CpG methylation within the TNFA promoter may provide an additional mechanism through which TNFA may alter the risk for mild persistent breast pain after breast cancer surgery. Coupled with phenotypic variations, these genetic and epigenetic variations may help to identify individuals who are predisposed to the development of persistent breast pain following breast cancer surgery, differentiate biological mechanisms, and facilitate the development of novel therapies.