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This study compared post-operative reconstructive complications and oncologic treatment between patients who underwent unilateral versus bilateral nipple sparing mastectomy (NSM) with implant based reconstruction (IBR).Patients diagnosed with unilateral breast cancer who underwent NSM with IBR between 2010 and 2019 were reviewed. Patient demographics, surgical details, adjuvant therapy and postoperative complications were analyzed.A total of 434 NSM with IBR were performed in 269 patients, 24% unilateral, and 76% bilateral. The bilateral group received a direct implant significantly more frequently and were younger compared to unilateral (p 0.001). The unilateral group received post-mastectomy radiation therapy at significantly higher rate (p 0.001) with no difference in receipt of adjuvant chemotherapy. Overall, 11% of mastectomies developed a 30-day complication requiring reoperation and that extended to 13% at 120 days. There was no difference regarding the incidence of complications requiring reoperation (p = 0.84) or complications type between the two groups (p = 0.29).These findings support the oncologic and reconstructive equivalence to support patient choice in CPM.

The oncologic outcomes of patients diagnosed with inflammatory breast cancer (IBC) based on clinical exam only versus those with dermal lymphatic invasion on skin punch biopsy may be different and are worth further investigation.Patients diagnosed from 2006 to 2021 with IBC at our institution were grouped according to clinical diagnosis or skin biopsy performed. Oncologic and survival outcomes among groups were compared.A total of 72 IBC patients were identified and grouped into 3 categories based on method of diagnosis: skin biopsy positive (n = 24), skin biopsy negative (n = 10) and no biopsy performed (n = 38). Skin biopsy positive patients had a higher incidence of lymphovascular invasion identified on final pathology and were more likely to experience a chest wall recurrence. At 5.1 yrs of follow-up, 40% of patients experienced recurrence, with 61% overall survival.Clinical diagnosis remains diagnostic for IBC, but skin punch biopsy allows for improved oncologic insight.

The aim of this study was to determine whether complications following mastectomy with immediate breast reconstruction (IBR) were associated with breast cancer recurrence.A retrospective review was performed of women diagnosed with stage I-III breast cancer who underwent mastectomy with IBR between 2005 and 2010. Patient demographics, tumor data, surgical wound complications, treatment details and timing were recorded and analyzed.We identified 458 women with a median follow up time of 7.6 years. A total of 22% of patients experienced IBR complications. There was a delay in initiation of adjuvant therapy in patients who had a complication (52 vs 41 days, p 0.001). There was no significant difference in recurrences between groups with and without complications (p = 0.65).In breast cancer patients who undergo mastectomy with IBR, wound complications delayed initiation of adjuvant systemic therapy, but were not associated with an increased risk of cancer recurrence.

Sentinel lymph node biopsy is the gold standard for axillary staging in early-stage, clinically node-negative breast cancer, so it is paramount that this operation be both precise and accurate, because excessive sentinel lymph node removal increases morbidity, whereas understaging risks inadequate treatment. The goal of this study was to assess surgeon variation in the number of sentinel lymph nodes removed and the oncologic yield of sentinel lymph node biopsy for breast cancer.All patients in the Surveillance, Epidemiology, and End Results-Medicare database who underwent operative treatment for breast cancer from 2007-2011 were eligible for inclusion. Deidentified provider codes were used to track operations performed by individual surgeons. Only records in which an individual surgeon could be linked to a specific breast cancer operation were analyzed. The total number of sentinel lymph nodes removed and the number that were pathologically positive (oncologic yield) were recorded. Surgeon variation by T stage was analyzed using linear mixed-effects regression and logistic mixed-effects regression models.Query of the database identified 15,571 patients who met inclusion criteria, representing 2,478 providers. The mean number of sentinel lymph node procedures performed per provider per year was 1.3 (range 1-103). The lowest quartile of providers performed 1 or fewer sentinel lymph node procedures per year. The highest quartile of providers performed8 sentinel lymph node procedures per year. The average number of sentinel lymph node removed per operation increased with increasing T stage for all providers (P.001), including when N0 (P.001) and node-positive (P = .003) patients were evaluated separately. There was surgeon-associated variation in the number of sentinel lymph node removed for each T stage (P.001). In addition, there was surgeon-associated variation in the oncologic yield (sentinel lymph node positivity rate) by T stage (P.001).This study found surgeon-associated variation in axillary sentinel lymph node staging of breast cancer patients, which suggests the need to improve standardization of surgical practices to optimize the oncologic yield of these procedures and ensure accurate staging.

This study investigated patients with invasive lobular breast carcinoma (ILC) to determine the benefit of neoadjuvant systemic therapy (NAST).Patients with ILC treated from 2006 to 2015 were identified. Tumor characteristics and treatment data were analyzed.Of the 560 patients with ILC, 77 patients received NAST. Patients who received NAST presented with larger clinical T stages compared to patients who received surgery first (p 0.001). Pathological complete response (pCR) to NAST was seen in 17% of patients. Only 14% of patients with clinically positive lymph nodes downstaged to N0. These patients were more likely to have HER2 positive tumors (p 0.029) and larger tumor size at diagnosis (p 0.015). Mastectomy was performed in 84% of patients and lumpectomy in 16%.Only a minority of patients with ILC achieve pCR. The majority of patients still undergo mastectomy; therefore the benefit of NAST in ILC appears limited.

One in eight American women develops breast cancer. Of the many patients requiring mastectomy yearly as a consequence, most elect some form of breast reconstruction. Since 2006, only silicone breast implants have been approved by the FDA for the public use. Unfortunately, over one-third of women with these implants experience complications as a result of tissue-material biocompatibility issues, which may include capsular contracture, calcification, hematoma, necrosis and implant rupture. Our group has been working on developing alternatives to silicone. Linear triblock poly(styrene-b-isobutylene-b-styrene) (SIBS) polymers are self-assembling nanostructured thermoplastic rubbers, already in clinical practice as drug eluting stent coatings. New generations with a branched (arborescent or dendritic) polyisobutylene core show promising potential as a biomaterial alternative to silicone rubber. The purpose of this pre-clinical research was to evaluate the material-tissue interactions of a new arborescent block copolymer (TPE1) in a rabbit implantation model compared to a linear SIBS (SIBSTAR 103T) and silicone rubber. This study is the first to compare the molecular weight and molecular weight distribution, tensile properties and histological evaluation of arborescent SIBS-type materials with silicone rubber before implantation and after explantation.