1,447 results on '"Oncoplastic Surgery"'
Search Results
202. Therapeutic Breast Reduction in Upper Quadrant Breast Tumor
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Augusta Cardoso, Gustavo Coelho, Joana Esteves, and Horacio Costa
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,medicine.disease ,Oncoplastic Surgery ,Radiation therapy ,Patient satisfaction ,Breast cancer ,Breast-conserving surgery ,medicine ,Radiology ,Breast reduction ,Breast reconstruction ,business ,Mastectomy - Abstract
Introduction: Breast conserving surgery plus radiation therapy and mastectomy procedures has equal results in terms of survival. Oncoplastic surgery principles along with breast reduction techniques allow for very good aesthetic results in immediate breast reconstruction with local tissues in several well-defined clinical scenarios. Nevertheless, we still find several limitations to their use regarding the location of the tumor or the need for inconvenient skin resections out of the standard markings of breast reduction. We present a case where traditional breast reduction techniques were inadequate and technical modifications of standard markings and pedicle design were developed to avoid the need to undergo a mastectomy. Methods: We present a patient diagnosed with breast cancer where the clinical characteristics of the tumor (location, skin excision needed) precluded the use of traditional oncoplastic breast reduction techniques. Modifications to the traditional breast reduction techniques were used to cope with the oncological resections needed. Results: A good global symmetry and aesthetic result were achieved. Scar pattern obtained was considered relatively camouflaged and patient satisfaction was high. Conclusion: Breast reduction procedures can be the solution for the treatment of breast cancer. The location of the tumor in the superior quadrants outside standard markings and the need to include skin in the tumor resection can be sidetracked by using enlarged NAC pedicles with modifications to classic skin markings without compromising oncologic safety. The final aesthetic results obtained are considered very good and the patient is very satisfied.
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- 2021
203. Breast Cancer Surgery, History and Current State: a Literature Review
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E. P. Kashirina, R. N. Komarov, and D. V. Vychuzhanin
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medicine.medical_specialty ,RD1-811 ,Breast surgery ,medicine.medical_treatment ,skin-sparing mastectomy ,organ-preserving surgery ,breast cancer ,Breast cancer ,plastic surgery ,medicine ,RC254-282 ,Radical mastectomy ,radical mastectomy ,business.industry ,General surgery ,mastectomy ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,General Medicine ,medicine.disease ,Oncoplastic Surgery ,Radiation therapy ,Plastic surgery ,Surgery ,business ,Quadrantectomy ,Mastectomy - Abstract
Breasts symbolise femininity, sexuality and motherhood. The breast size and shape affect the woman’s self-esteem and social activity. Surgical treatment of malignant breast diseases concerns the medical, psychological, social and sexual aspects of life. Surgery for breast cancer dawns back to 1,600 B.C., with a milestone operation of radical mastectomy proposed in 1891–1894 by W. Halsted and W. Meyer and modified by D. Patey and W. Dyson in 1948. Tissue preservation has shaped a trend towards improving the technique. Since the 1990s, the modified J. Madden’s operation has become the treatment standard in breast cancer, irregardless of stage. The improvement of mass first-visit check-up advanced early diagnosis of initial breast tumourisation, which also influenced the choice of surgical tactics. U. Veronesi proposed a variant of organ-preserving surgery in 1970–80s involving three-level axillary lymph node dissection quadrantectomy, followed by radiotherapy. This combination facilitated aesthetic results at no compromise of radicality of the treatment. The need to observe radicality and sustain aesthetics contributed to the integration of plastic surgery into oncological cure and emergence of reconstructive and plastic breast surgery. The field has entered new cycle. Oncoplastic surgery is recognised safe, improves aesthetics and gives a salutary impact on psychological and social adjustment. Manifold surgical options in breast cancer coexist and develop towards maximal tissue preservation.
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- 2021
204. ONCOPLASTIC BREAST SURGERY FOR EARLY BREAST CANCER
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Ahmed Mahmoud Eid Mahmoud, Mahmoud Mohamed Ibrahim Mohamed, and Abdoh Salem
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medicine.medical_specialty ,Wound dehiscence ,business.industry ,Breast surgery ,medicine.medical_treatment ,General surgery ,Cancer ,medicine.disease ,Oncoplastic Surgery ,Patient satisfaction ,Breast cancer ,medicine ,Fat necrosis ,Stage (cooking) ,business - Abstract
Background: Breast cancer is the most commonly diagnosed cancer worldwide, and is the second most common cause of cancer-related deaths between females, with about 18000 new cases diagnosed among female in 2014 in Egypt. Objective: To evaluate the oncological outcomes and patient satisfaction on the esthetical side with oncoplastic surgery for patients with early stage breast cancer. Patients and Methods: The present study was enrolled from January 2019 to January 2020 at Al- Azhar University Hospitals and Nasser's Institute Hospital for Research and Treatment. This were a descriptive study done on 30 participants with breast cancer who met inclusion criteria underwent various level II, III Oncoplastic breast surgery. The oncological and aesthetic satisfaction was evaluated. Results: Our study results showed statistically significant difference between surgeons score on cosmetic outcome as regards wound dehiscence and fat necrosis. Conclusion: Oncoplastic breast surgery techniques are effective and results in improved patient-reported outcomes in early breast cancer.
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- 2021
205. Comparative study of surgical and oncological outcomes in oncoplastic versus non oncoplastic breast-conserving surgery for breast cancer treatment
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Cassio Cardoso-Filho, Luiz Carlos Zeferino, Giuliano Mendes Duarte, César Cabello dos Santos, Natalie R. Almeida, Renato Zocchio Torresan, Fabricio Brenelli, Nicoli S. de Azevedo, and Julia Yoriko Shinzato
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medicine.medical_specialty ,Complications ,RD1-811 ,medicine.medical_treatment ,Local Recurrence ,030230 surgery ,Dehiscence ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Breast-conserving surgery ,medicine ,Carcinoma ,Margin ,business.industry ,Retrospective cohort study ,medicine.disease ,Surgery ,Oncoplastic Surgery ,Axilla ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Original Article ,business ,Oncoplastic surgery ,Mastectomy - Abstract
Summary: Background: Oncoplastic surgery has been increasingly used in breast cancer treatment and allows the performance of breast-conserving surgery in cases of larger tumors with unfavorable location or tumor-breast disproportion. Purpose: To compare surgical and oncological outcomes of patients undergoing oncoplastic and nononcoplastic breast-conserving surgery. Methods: Retrospective cohort study with convenience sampling of 866 patients who consecutively underwent breast-conserving surgery from 2011 to 2015. Results: The mean follow-up was 50.4 months. Nononcoplastic breast conservation surgery was performed on 768 (88.7%) patients and oncoplastic surgery on 98 (11.3%) patients. Patients in the oncoplastic group were younger (p2 cm (p
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- 2021
206. Modified Grisotti flap technique in centrally located breast cancer: case report
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Qianjun Chen, Fengfeng Xie, Ying Chen, Shaowen Zhong, Dan Liu, Jingjing Dong, Wenxia Li, Lezhen Huang, and Weijie Zeng
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medicine.medical_specialty ,South china ,Minor injury ,business.industry ,medicine.medical_treatment ,Skin flap ,Case Report ,medicine.disease ,Surgery ,Oncoplastic Surgery ,Breast cancer ,Large breast ,medicine ,Inframammary fold ,business ,Mastectomy - Abstract
Traditionally, breast cancer patients with centrally located mass always receive mastectomy or the combination of central excision and primary closure. With the development of modern oncoplastic breast-conserving techniques, these patients can conserve their breast, and achieve satisfactory cosmetic outcome as well as clear margin. A variety of techniques are available to deal with centrally located breast cancers (CLBCs). Among these techniques, Grisotti flap technique is special, because it is easy to handle, and only causes minor injury by using a local rotational dermoglandular flap to fill the defection of central part. However, in our clinical practice, we find a lot of women in south China have special properties. Such as short distance from inframammary liner to the nipple, long distance from midclavicular to the nipple, and large breast diameter. Simply apply the Grisotti flap technique to those patients is not very suitable that drive us to modify this technique to suit our patients. We adopt the idea that use pedicled skin flap with skin island to replace the central defection to modify Grisotti flap technique. And applied this technique to two patients. We find modified Grisotti flap technique for Paget’s disease or CLBC had good cosmetic results as well as safety in suitable patients. In the future, we can use superior pedicle with skin island for ptotic breasts, and lateral pedicle is suitable for patients without large and ptotic breasts.
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- 2021
207. Plastic surgery for breast cancer: еssentials, classification, performance algorithm
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A. Kh. Ismagilov, A. S. Vanesyan, A. R. Khamitov, and I. F. Kamaletdinov
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oncoplastic surgery ,breast cancer ,algorithm for oncoplastic surgery ,Gynecology and obstetrics ,RG1-991 - Abstract
The choice of plastic surgical techniques for cancer is influenced by two factors: resection volume/baseline breast volume ratio and tumor site.Based on these factors, the authors propose a two-level classification and an algorithm for performing the most optimal plastic operation onthe breast for its cancer.
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- 2015
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208. The adoption of oncoplastic surgery: Is there a learning curve?
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Karamchandani MM, Jonczyk MM, De La Cruz Ku G, Gaffney KA, Wareham C, Nardello S, Persing SM, Homsy C, and Chatterjee A
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- Humans, Female, Learning Curve, Retrospective Studies, Treatment Outcome, Mastectomy, Breast Neoplasms surgery
- Abstract
Introduction: Oncoplastic surgery (OPS) is a form of breast conservation surgery involving partial mastectomy followed by volume displacement or replacement surgery. As the field of OPS is growing, we sought to determine if there was a learning curve to this surgery., Methods: A retrospective chart review was conducted of all patients who underwent OPS over a 6-year period with a single surgeon formally trained in both Plastic Surgery and Breast Oncology. Cumulative summation analysis (CUSUM) was performed on mean operative time to generate the learning curve and learning curve phases. Outcomes were compared between phases to determine significance., Results: Mean operative time decreased significantly across the 6-year period, generating three distinct learning curve phases: Learner phase (cases 1-23), Competence phase (24-73), and Mastery phase (74 and greater). The overall positive margin rate was 10.9% and there was no significant difference in rates between phases (p = 0.49). Overall complication rates, reoperation rates, and locoregional recurrence remained the same across all phases (p = 0.16; p = 0.65; p = 0.41). The rate of partial nipple loss decreased between phases (p = 0.02)., Conclusion: As with many complex operations, there does appear to be a learning curve with OPS, as the operative time and the rates of partial nipple loss decreased over time., (© 2023 Wiley Periodicals LLC.)
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- 2023
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209. Oncologic and Cosmetic Outcomes of Oncoplastic Breast Surgery in Locally Advanced Breast Cancer After Neoadjuvant Chemotherapy, Experience from a Developing Country.
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Youssef, Mina M. G., Namour, Alfred, Youssef, Omar Z., and Morsi, Ahmed
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Oncoplastic surgery (OPS) has emerged as a new approach for extending breast conserving surgery (BCS) possibilities, reducing both mastectomy and re-excision rates, while avoiding breast deformities. OPS is based upon the integration of plastic surgery techniques for immediate reshaping after wide excision for breast cancer. This is a prospective feasibility cohort study of oncoplastic breast surgery after neoadjuvant chemotherapy that was carried at the National Cancer Institute, Cairo University and included 70 patients. The primary outcome was the local recurrence rate. Secondary outcomes included survival and margins obtained as well as cosmetic outcomes. Survival analysis was performed. Oncoplastic breast surgery did not compromise oncologic safety in the patients included in the study. It even allowed wider margins of resection which could be associated with better oncologic outcomes. At the same time, it gave a better cosmetic outcome and therefore higher patient satisfaction. Oncoplastic breast surgery includes a wide spectrum of surgical techniques, ranging from the basic level I techniques in breast conserving surgery to the more complex procedures of level II which are broadly classified into volume replacement (therapeutic mammoplasty) and volume displacement procedures. We suggest that oncoplastic breast surgery techniques should be the standard of care in breast surgery. They are the basis for breast conserving surgery techniques in early breast cancer. In our experience, oncoplastic surgery is feasible in locally advanced tumours after downstaging with neoadjuvant chemotherapy without compromising the oncologic safety. [ABSTRACT FROM AUTHOR]
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- 2018
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210. Skin-reducing oncoplasty: A new concept and classification in breast cancer surgery.
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La Padula, S., Billon, R., Schonauer, F., D’Andrea, F., Noel, W., Belkacémi, Y., Bosc, R., Hersant, B., and Meningaud, J.P.
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LUMPECTOMY , *MASTECTOMY , *BREAST surgery , *ENGLISH literature - Abstract
Summary Background and objectives Breast-conserving surgery and skin-sparing mastectomy are nowadays widely accepted as the standard of care in selected patients with early breast cancer. After an accurate review of the literature, it appeared that no ordered list of the numerous techniques described for conservative breast surgery has been established so far. The aim of this study was to develop a simple classification of the different skin incision patterns that may be used in breast surgery. Methods A systematic review of the English literature was conducted using the PubMed database to identify all the articles reporting breast-conserving surgery and skin-sparring mastectomy techniques up to the 31st of December 2016. Results Among the 1426 titles identified, 230 were selected for review. Based on the reviewed papers, the skin-reducing oncoplasty incision pattern (SROIP) classification was elaborated. Conclusions Breast cancer surgery should nowadays optimise aesthetic outcomes by improving the final breast shape, volume and scar location. This may be achieved using different procedures that we grouped together under the term skin-reducing oncoplasty (SRO). Depending on the breast cancer location, the SROIP classification helps in the choice of the best technique to be used. [ABSTRACT FROM AUTHOR]
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- 2018
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211. Oncoplastic breast surgery for the management of ductal carcinoma in situ (DCIS): is it oncologically safe? A retrospective cohort analysis.
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De Lorenzi, Francesca, Di Bella, Julien, Maisonneuve, Patrick, Rotmensz, Nicole, Corso, Giovanni, Orecchia, Roberto, Colleoni, Marco, Mazzarol, Giovanni, Rietjens, Mario, Loschi, Pietro, Marcelli, Stefano, Veronesi, Paolo, and Galimberti, Viviana
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BREAST surgery ,DUCTAL carcinoma ,MASTECTOMY ,CANCER relapse ,PROGRESSION-free survival ,THERAPEUTICS - Abstract
Background Few data exist in literature regarding oncoplastic surgery (ONC) and ductal carcinoma in situ (DCIS). The role of ONC in the treatment of DCIS has not been elucidated yet: no case-control study has yet been published on the issue and no long-term oncologic results are reported. Methods Using the European Institute of Oncology (IEO) institutional breast cancer data base we investigated the oncologic safety of ONC for DCIS comparing a consecutive series of 44 patients who have underwent ONC followed by external irradiation for DCIS (Group A-study group) with 375 patients who received conservation alone followed by external irradiation for DCIS (Group B control group) in the same period. We excluded patients presenting with secondary tumors or local relapses and those requiring re-excision or completion mastectomy for positive margins. Primary endpoints were disease-free survival (DFS) and ipsilateral breast tumor recurrence (IBTR) within the study group and comparison with the control group. Results Events rates and death rates were similar in the two groups. The average annual rate of invasive IBTR in group A and B was 1.6% and 1.0% respectively. No difference in the rate of lymphnode metastasis, distant metastasis, contralateral breast cancer, other primary cancer or death was observed across the two groups. Conclusions Our findings suggest the safety of ONC and irradiation for the management of DCIS extending the indications for conservation in DCIS patients otherwise treated with mastectomy. It provides the best available evidence supporting ONC as a valid treatment option for the management of DCIS. [ABSTRACT FROM AUTHOR]
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- 2018
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212. Long-term Results After Oncoplastic Surgery for Breast Cancer: A 10-year Follow-up.
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Clough, Krishna B., van la Parra, Raquel F. D., Thygesen, Helene H., Levy, Eric, Russ, Elisabeth, Halabi, Najeeb M., Sarfati, Isabelle, and Nos, Claude
- Abstract
Objective: The aim of this study was to evaluate the long-term oncologic outcome after oncoplastic surgery (OPS). Background: OPS combines wide tumor excision with reduction mammoplasty techniques thus extending breast conserving surgery to large tumors that might else be proposed a mastectomy. Little data are available about the oncologic results for breast conserving surgery of these larger tumors. Methods: From January 2004 until March 2016, a total of 350 oncoplastic breast reductions were prospectively entered into a database. Patients were included if their breast reshaping included a reduction mammoplasty with skin excision (Level 2 oncoplastic techniques). Results: Histologic subtypes were: invasive ductal carcinoma in 219 cases (62.6%), ductal carcinoma in situ (DCIS) in 88 cases (25.1%), and invasive lobular carcinoma in 43 (12.3%) cases. Seventy-three of the invasive cancers (27.9%) received neoadjuvant chemotherapy. The mean resection weight was 177 grams. The mean pathological tumor size was 26 mm (range 0-180 mm) and varied from 23 mm (4-180 mm) for invasive cancers to 32 mm (0-100 mm) for DCIS. Specimen margins were involved in 12.6% of the cases; 10.5% of invasive ductal, 14.7% of DCIS, and 20.9% of invasive lobular. The overall breast conservation rate was 92% and varied from 87.4% for DCIS to 93.5% for the invasive cancers. Thirty-one patients (8.9%) developed one or more postoperative complications, inducing a delay in postoperative treatments in 4.6% of patients. The median follow up was 55 months. The cumulative 5-year incidences for local, regional, and distant recurrences were 2.2%, 1.1%, and 12.4%, respectively. Conclusions: Oncoplastic breast reductions allow wide resections with free margins and can be used for large cancers as an alternative to mastectomy. [ABSTRACT FROM AUTHOR]
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- 2018
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213. Surgical and oncological outcomes of free dermal fat graft for breast reconstruction after breast-conserving surgery.
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de Biasio, Fabrizio, Bertozzi, Serena, Londero, Ambrogio P., Almesberger, Daria, Zanin, Chiara, Marchesi, Andrea, Cedolini, Carla, Risaliti, Andrea, and Parodi, Pier C.
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BREAST surgery ,MAMMAPLASTY ,SURGICAL excision ,PLASTIC surgery ,BREAST implants - Abstract
Background. Oncoplastic breast surgery originated in order to improve the esthetic result of breast-conserving surgery (BCS). Autologous free dermal fat graft (FDFG) is an emerging oncoplastic technique to improve the cosmetic outcome of breast-conserving surgery. Objectives. The aim of this study was to analyze our experience with FDFGs in breast reconstruction after breast-conserving surgery. Oncological outcomes, surgical complications and cosmetic results were considered. Material and methods. This retrospective chart review study considered all consecutive oncoplastic breast treatment by means of FDFG reconstruction during the period between September 2011 and September 2012 in our Clinic of Surgery (University of Udine, Italy). The data collected included patient and tumor characteristics and outcomes (cosmetic and oncological). Results. During the study period, 37 women were treated by breast cancer surgery and immediate breast reconstruction by FDFG. At a 3-year follow-up, we found no cases of recurrence among breast cancer patients treated by FDFG; at a 18-month follow-up, we found a prevalence of 75.0% of women extremely satisfied with their oncoplastic surgery and a high prevalence of excellent or good cosmetic outcomes (70.3%) according to objective and subjective cosmetic assessment. Conclusions. Immediate breast reconstruction by FDFG after BCS in a population selected for a low risk of breast cancer recurrence seems to be an oncologically safe option, with a good cosmetic outcome and a high prevalence of women satisfied with the treatment. [ABSTRACT FROM AUTHOR]
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- 2018
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214. Comparison of Surgical Margin After Breast Cancer Surgery Between Oncoplastic Technique and Conventional Breast-Conserving Surgery.
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Nisiri, Ahmadreza, Pour, Ramesh Omrani, Zadeh, HabibMahmood, and Ramim, Tayeb
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BREAST cancer ,BREAST tumors ,COMPARATIVE studies ,LONGITUDINAL method ,MASTECTOMY ,PLASTIC surgery ,DISEASE relapse ,LUMPECTOMY ,DISEASE prevalence ,CROSS-sectional method ,DUCTAL carcinoma ,SURGICAL site ,DESCRIPTIVE statistics - Abstract
Background: Compared to other breast surgery methods, the accurate determination of pathologic margin in oncoplastic technique can affect its development and further employment of this technique. The current study aimed at evaluating positive pathologic margin after oncoplastic surgery and comparing it to that of the conventional breast-conserving surgery. Methods: The current cross sectional and prospective study enrolled patients with breast cancer referring to the surgical clinic of Tehran Cancer Institute from 2010 to 2013. In this study, patients with breast cancer were evaluated based on the type of surgery (oncoplastic or conventional breast-conserving) they had undergone. Accordingly, the positive or negative result of the margin surgery was compared between the groups. Results: In the current study, 317 patients with breast cancer underwent the surgery during the study period (154 patients in the oncoplastic and 163 patients in the conventional breast-conserving surgery groups). The highest frequency in the oncoplastic surgery belonged to Omega method (27.3%). The pathological evaluations after surgery showed ductal breast carcinoma in most of the cases in both groups (oncoplastic surgery = 94.2%; conventional breast-conserving surgery = 90.8%; P = 0.053). Positive margin in oncoplastic surgery and conventional breast-conserving surgery groups were 10.4% and 18.4%, respectively (P = 0.043). Among the 317 studied subjects, 14 relapse cases were observed; in 7 cases, mastectomy and in the rest, re-excision were conducted. Two out of 14 cases belonged to the positive margin group. Conclusions: Using oncoplastic surgery as a method for breast surgery may play an important role in reducing the prevalence of positive margins compared to the conventional breast-conserving surgery. [ABSTRACT FROM AUTHOR]
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- 2018
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215. Oncoplastic surgery for the conservative treatment of breast cancer in Perú's National Cancer Institute.
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Ziegler Rodriguez, Gonzalo Javier, Diaz Chavez, Marcelo, Calderon Valencia, Gabriela Guadalupe, Cotrina Concha, Jose Manuel, Garces Castre, Milko Raphael, and Mantilla, Raul
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BREAST cancer surgery , *MAMMAPLASTY , *MASTECTOMY - Abstract
Background: Oncoplastic surgery for breast cancer (OPS) has been a surgical trend for the past 25 years. In 2012, OPS has been introduced as the standard treatment for a selected group of patients at the National Cancer Institute of Peru (INEN). The aim of this study is to describe our findings. Methods: This is a retrospective and descriptive study that identified demographics, tumour-pathologic features and includes patients solely treated since diagnosis until late follow-up at INEN. These OPS patients were identified from the conservative treatment patients group by review of medical charts and creation of a database for periods December 2005 through December 2015. Results: A total of 146 patients were ruled in by the inclusion criteria. All patients were Peruvian females, 56.2% being 51 or older. 93.8% had core biopsy diagnosis of breast cancer and 52.1% located at the upper outer quadrant. 79.5% patients had upfront OPS and the round block (43.2%) and reduction/mastopexy (23.3%) were the most used techniques. pT2 was the most frequent size (54.7%). We achieved negative margins in 134 patients (93.2%) in a single procedure. Of 29 patients, who had neoadjuvant treatment, 11 achieved pCR. Only 5.5% had pN2 or higher. 95.2% received complimentary external beam radiotherapy. Conclusions: OPS has proven to be a reliable surgical option, both for aesthetic and oncologic outcomes. Important points for achieving these results are breast surgeons having properly trained under the OPS philosophy and knowing the patients' characteristics for correct technique selection. [ABSTRACT FROM AUTHOR]
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- 2018
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216. Oncoplastic Breast Conserving Surgery: Aesthetic Satisfaction and Oncological Outcomes.
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Yazar, Sevgi Kurt, Altınel, Dinçer, Serin, Merdan, Aksoy, Şefika, and Yazar, Memet
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BREAST cancer , *BREAST surgery , *MAMMAPLASTY , *CANCER patients , *PATIENT satisfaction - Abstract
Objective: Oncoplastic breast conserving surgery (BCS) involves radical excision of tumors while maintaining the natural breast contours. In this study, we present the results of the oncoplastic BCS surgeries performed in our clinic. Material and Methods: 13 breast cancer patients who had undergone oncoplastic BCS were included in this retrospective study. Postoperative photographs and retrospective chart reviews were used to evaluate the results. Aesthetic satisfaction level was verbally obtained from the patients. Results: Oncoplastic BCS was performed using superomedial, superolateral, superior and inferior pedicles. All the patients were highly satisfied with the final aesthetic results and tumor free at the postoperative 12 months. Conclusion: Oncoplastic BCS can achieve favorable results regarding the final aesthetic appearance and tumor control. [ABSTRACT FROM AUTHOR]
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- 2018
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217. Oncoplastic Surgery
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Lebovic, Gail S. and Schwab, Manfred, editor
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- 2009
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218. New challenges in multimodal workout of locally advanced breast cancer.
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Sanchez, Alejandro Martin, Franceschini, Gianluca, Orlandi, Armando, Di Leone, Alba, and Masetti, Riccardo
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BREAST cancer treatment , *BREAST surgery , *ADJUVANT treatment of cancer , *COMBINED modality therapy , *BREAST tumor diagnosis , *BREAST tumor treatment , *ANTINEOPLASTIC agents , *BREAST tumors , *MEDICAL protocols , *TUMOR classification - Abstract
The term "locally advanced breast cancer" (LABC) encompasses a heterogeneous group of breast neoplasms that represent an extremely variable percentage of newly diagnosed breast cancers (4-90%, depending of world regions). These cancers may have different clinical and biological characteristics that can be managed by primary surgery or neoadjuvant integrated treatments. In this paper we review the updated guidelines and discuss most recently reported evidence related to LABC multidisciplinary workout, in order to maximize results of combined systemic therapies, modern surgical procedures and radiotherapy. [ABSTRACT FROM AUTHOR]
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- 2017
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219. Does Preoperative Positron Emission Tomography Help Delineate the Boost Volume After Oncoplastic Surgery for Breast Cancer?
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YILDIRIM ALTINOK, Ayşe, DOYURAN, Mine, ÇAĞLAR, Mustafa, ÇAKIR, Tansel, ACAR, Hilal, KÜÇÜKMORKOÇ, Esra, KÜÇÜK, Nadir, ÇAĞLAR, Hale, and ATASEVER, Tamer
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BREAST tumors , *CANCER patients , *COMPUTED tomography , *LONGITUDINAL method , *SURGICAL instruments , *POSITRON emission tomography , *DESCRIPTIVE statistics - Abstract
The tumor bed within the breast shifts during oncoplastic surgery (OPS) for breast cancer (BC). Preoperative imagery is used to determine the boost volume (BV) for patients not implanted with surgical clips. This prospective study was conducted to geometrically compare BVs determined using preoperative imagery and BVs determined utilizing surgical clips. METHODS Patients diagnosed with BC were scanned using PET-CT during 2013-2015. Twenty patients who had undergone OPS but who did not have metastasis underwent CT prior to radiotherapy. Their preoperative images were fused with planning CT images. The tumor volume (CTVboost-pet), as determined from the preoperative PET-CT images, was contoured. Next, CTVboost-clips was determined using surgical clips. Geometric relationships between these two volumes were statistically compared. RESULTS Planar projections of CTVboost-pet and CTVboost-clips were evaluated. Displacements between CTVboost- pet and CTVboost-clips in the axial (XZ) and coronal (XY) planes were 1.17 cm (min-max: 0.03- 3.64 cm) and 1.67 cm (min-max: 0.38-4.14 cm), respectively and were statistically significant (p<0.001), whereas the displacement in the sagittal (YZ) plane was 1.07 cm (min-max: 0.04-4.45 cm) and was not significant (p>0.7). CONCLUSION Preoperative imaging alone was not reliable when determining the BV in patients who had undergone OPS and had no clips. Large PTV margins can be an option to overcome this issue. Surgical clips need to be inserted during OPS. [ABSTRACT FROM AUTHOR]
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- 2017
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220. Landscape of oncoplastic breast surgery across Poland.
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Kołacinska, Agnieszka, Hodorowicz-Zaniewska, Diana, Bocian, Artur, Michalik, Dariusz, Matkowski, Rafal, Kurylcio, Andrzej, Pyka, Paweł, Charytonowicz, Michał, and Berkan, Maciej
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BREAST surgery , *PLASTIC surgery , *ONCOLOGIC surgery , *SURGICAL complications - Abstract
Oncoplastic and reconstructive techniques are essential tools in the armamentarium of contemporary breast surgeons. The aim of the study was to identify oncoplastic reconstructive patterns in breast cancer centers across Poland. A questionnaire of 18 questions was sent by email to the members of the Polish Society of Surgical Oncology and the Polish Society of Plastic, Reconstructive and Esthetic Surgery via their dedicated websites. The numbers of breast cancer patients operated on in each center ranged from 120 to 904 per year. Breast conserving surgery (BCS) predominated in all but one center (range 50-70%). Immediate breast reconstructions (IBR) accounted for 6-42% of procedures, The most frequent type of IBR was either a two-stage expander followed by a permanent implant or one-stage implant- based with or without synthetic mesh. The most frequent type of delayed breast reconstruction (DBR) was a two- stage expander followed by implant- based reconstruction. None of the surveyed cancer centers performed free flap reconstruction. Deep inferior epigastric perforator (DIEP) flaps were performed in the plastic surgery department. Reconstructions based on pedicled flaps were performed in cancer centers. Acellular dermal matrices (ADM) and fat transfer were used in selected centers. In the clinical scenario of adjuvant radiotherapy, delayed breast reconstruction was favored. The full range of oncoplastic BCS was performed. Patient-reported outcome measures (PROM) and complications were assessed. Our findings can act as a platform for further improvement in skills, certification, data collection and audit, including patient reported expectation measures. There is also an urgent need to address pan-European inconsistencies in procedural reimbursement. [ABSTRACT FROM AUTHOR]
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- 2017
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221. The Usefulness of Endoscopic Harvesting of the Latissimus Dorsi Flap for Breast Reconstruction Using a Single-Port and CO2 Gas Insufflation Technique
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Do Gon Kim, Jong Seong Kim, Jeeyeon Lee, Joon Seok Lee, Ho Yong Park, and Jung Dug Yang
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Insufflation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Surgery ,Oncoplastic Surgery ,Plastic surgery ,Patient satisfaction ,Otorhinolaryngology ,medicine ,business ,Prospective cohort study ,Breast reconstruction ,Mastectomy - Abstract
In the recent trend toward less aggressive approaches to breast reconstruction, minimally invasive harvesting of the latissimus dorsi (LD) flaps has long been a desirable goal. Endoscopically-assisted LD flap harvesting was reported as a method for minimizing scar formation and reducing donor-site morbidity. This study investigates the surgical outcomes of endoscopically-assisted immediate breast reconstruction with LD muscle flaps. This prospective study included 21 patients who underwent endoscopically-assisted breast reconstruction with LD muscle flap and 20 patients who underwent breast reconstruction with conventional harvesting LD musculocutaneous flap. In patients with nonexcised skin or possible primary closure, the reconstruction was performed with endoscopically-assisted LD muscle flaps using the single-port and CO2 gas insufflation technique. The patients were classified into groups according to the location of the defect and mastectomy type. Moreover, patient satisfaction was investigated 6 months after surgery. In patients who underwent endoscopically-assisted breast reconstruction with LD muscle flaps, the scar of the donor-site was vertical, and the size was 4 cm to be obscured when lowering the arms. In comparison with patients who underwent breast reconstruction with conventional LD flaps, those who underwent endoscopically-assisted breast reconstruction with LD muscle flaps showed shorter hospital stay and no difference in patient satisfaction. Endoscopically-assisted breast reconstruction with LD flaps showed no difference in patient satisfaction with good esthetic results compared with conventional LD flaps. The endoscopic LD muscle flap harvest technique using a single-port and CO2 insufflation technique can be very useful in breast reconstruction that does not require a skin paddle. 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 www.springer.com/00266 .
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- 2021
222. Oncoplastic Breast-Conserving Surgery According to Tumor Location
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Turgay Şimşek, Sibel Özkan Gürdal, and Nuh Zafer Cantürk
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,General surgery ,Breast surgery ,Cosmesis ,Review ,medicine.disease ,Oncoplastic Surgery ,Quadrant (abdomen) ,Breast cancer ,Quality of life ,Breast-conserving surgery ,medicine ,Tumor location ,skin and connective tissue diseases ,business - Abstract
The use of oncoplastic breast surgery is an essential cornerstone for breast cancer management. The main aim of breast cancer surgery is to obtain an adequate oncological safety margin. Still, the cosmetic outcome also seems important for social and psychological wellbeing and quality of life. After breast-conserving surgery, the remaining breast may be reconstructed with volume displacement or volume replacement techniques. A better cosmetic outcome can be achieved by selecting appropriate surgical techniques according to tumor location. In this review, we show each technique step-by-step based on the tumor's location for each quadrant. The most important thing is to select the technique first for oncological safety and then for better cosmesis.
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- 2021
223. Should oncoplastic breast conserving surgery be used for the treatment of early stage breast cancer? Using the GRADE approach for development of clinical recommendations
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John R. Benson, Ivan Moschetti, Rachel O'Connell, Carmen Criscitiello, Michela Cinquini, Zoe Winters, Loredana Pau, Giacomo Montagna, Giuseppe Catanuto, Nicola Rocco, Henry Mark Kuerer, Nahid Nafissi, Achilles Thoma, Serena Oliveri, Rosa Di Micco, Werner Audretsch, Tibor Kovacs, Gianfranco Scaperrotta, Maurizio B. Nava, Laura Lozza, Rocco, N., Catanuto, G., Cinquini, M., Audretsch, W., Benson, J., Criscitiello, C., Di Micco, R., Kovacs, T., Kuerer, H., Lozza, L., Montagna, G., Moschetti, I., Nafissi, N., O'Connell, R. L., Oliveri, S., Pau, L., Scaperrotta, G., Thoma, A., Winters, Z., and Nava, M. B.
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medicine.medical_specialty ,medicine.medical_treatment ,Breast surgery ,Breast Neoplasms ,Mastectomy, Segmental ,Adult women ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Quality of life ,Breast conserving surgery ,medicine ,Breast-conserving surgery ,Humans ,GRADE method ,GRADE Approach ,Prospective Studies ,030212 general & internal medicine ,Stage (cooking) ,RC254-282 ,business.industry ,General surgery ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,General Medicine ,Evidence-based medicine ,medicine.disease ,Oncoplastic Surgery ,Cross-Sectional Studies ,030220 oncology & carcinogenesis ,Oncoplastic breast surgery ,Quality of Life ,Female ,Original Article ,Surgery ,business - Abstract
Introduction The potential advantages of oncoplastic breast conserving surgery (BCS) have not been validated in robust studies that constitute high levels of evidence, despite oncoplastic techniques being widely adopted around the globe. There is hence the need to define the precise role of oncoplastic BCS in the treatment of early breast cancer, with consensual recommendations for clinical practice. Methods A panel of world-renowned breast specialists was convened to evaluate evidence, express personal viewpoints and establish recommendations for the use of oncoplastic BCS as primary treatment of unifocal early stage breast cancers using the GRADE approach. Results According to the results of the systematic review of literature, the panelists were asked to comment on the recommendation for use of oncoplastic BCS for treatment of operable breast cancer that is suitable for breast conserving surgery, with the GRADE approach. Based on the voting outcome, the following recommendation emerged as a consensus statement: Oncoplastic breast conserving surgery should be recommended versus standard breast conserving surgery for the treatment of operable breast cancer in adult women who are suitable candidates for breast conserving surgery (with very low certainty of evidence). Discussion This review has revealed a low level of evidence for most of the important outcomes in oncoplastic surgery with lack of any randomized data and absence of standard tools for evaluation of clinical outcomes and especially patients’ values. Despite areas of controversy, about one-third (36%) of panel members expressed a strong recommendation in support of oncoplastic BCS. Presumably, this reflects a synthesis of views on the relative complexity of these techniques, associated complications, impact on quality of life and costs.
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- 2021
224. A Comparative Study Assessing Surgical Outcome of Excision of Giant or Multiple Benign Breast Lesions Using Circumareolar Incision versus Round Block Technique
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Dina H. Ahmed Ahmed F. Amer, Ashraf El-Zoghby Hany R. Wakim, and Abdel-Rahman A. Abdel-Aziz
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medicine.medical_specialty ,Diagnostic methods ,business.industry ,Scars ,medicine.disease ,Benign breast tumors ,Surgery ,Oncoplastic Surgery ,Patient satisfaction ,Informed consent ,Medicine ,Breast disease ,medicine.symptom ,Circumareolar incision ,business - Abstract
Background: Breast disease seriously affects the physical and mental health of women. In recent years, the incidence rates of Benign Breast Tumors (BBTs) and malignant tumors have been rising. The traditional surgical resection method for the various types of BBT leaves obvious scars and affects the appearance of the breast, with the continuous development of the social economy and the gradual improvement of living standards, demands for breast appearance are higher. Surgery should not only cure the breast disease, but it should also avoid damage to the functions and appearance of the breasts. Benign breast lesions, especially when multiple or giant, constitute a difficulty in obtaining complete wide excision with minimal breast deformity and minimal small scars in addition to the high risk of recurrence. In cases of benign breast lesions, bad cosmetic results are unacceptable neither by the patients nor by the surgeons. Aim of Study: The aim of the study is to compare between post-operative outcome of surgical excision of giant or multiple benign breast lesions (giant fibro adenomas or phylloids tumors) through a circum-areolar incision versus round block technique as regard cosmetic & oncological outcome & patient satisfaction. Patients and Methods: It was a prospective randomized study that included 20 patients aiming to compare between post-operative outcome of surgical excision of giant or multiple benign breast lesions (giant fibro adenomas or phylloids tumors) through a circum-areolar incision versus round block technique as regard cosmetic & oncological outcome & patient satisfaction. This study was conducted at Ain-Shams University Hospitals. Approval of the Ethical Committee and written informed consent from all participants was obtained. Circum-areolar incisions and Round block techniques were proposed for patients in whom breast conservative treatment is possible on oncologic grounds but where a standard resection without reconstruction would lead to a poor cosmetic outcome. Study period: March 2020 to October 2020. Results: It was found that there is a rapid progress in the development of diagnostic methods and interventional methods of diagnosis. This increased the accuracy of these methods and their ability to differentiate benign from malignant tumors. Also the round block techniques proved to have a better outcome than the circumareolar technique in all the previous mentioned criteria. Conclusion: The application of oncoplastic surgery to benign breast disease is a new revolution in the surgical management of cases and should be the standard of care for selected cases.
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- 2021
225. Innovations for the future of breast surgery
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Daniel R. Leff, Christopher Holcombe, A Carmichael, C C Kirwan, Deborah Fenlon, A Subramanian, L. Romics, Mark A. Green, E R St John, Shelley Potter, Rachel O'Connell, Ramsey I. Cutress, Fairbrother P, Stuart McIntosh, John R. Benson, and Raghavan Vidya
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Reconstructive surgery ,medicine.medical_specialty ,Cost effectiveness ,business.industry ,Breast surgery ,medicine.medical_treatment ,Sentinel lymph node ,Breast Neoplasms ,Mastectomy, Segmental ,medicine.disease ,Oncoplastic Surgery ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,030220 oncology & carcinogenesis ,Adjuvant therapy ,Breast-conserving surgery ,Humans ,Medicine ,Female ,Surgery ,030212 general & internal medicine ,business ,Intensive care medicine ,Forecasting - Abstract
Background Future innovations in science and technology with an impact on multimodal breast cancer management from a surgical perspective are discussed in this narrative review. The work was undertaken in response to the Commission on the Future of Surgery project initiated by the Royal College of Surgeons of England. Methods Expert opinion was sought around themes of surgical de-escalation, reduction in treatment morbidities, and improving the accuracy of breast-conserving surgery in terms of margin status. There was emphasis on how the primacy of surgical excision in an era of oncoplastic and reconstructive surgery is increasingly being challenged, with more effective systemic therapies that target residual disease burden, and permit response-adapted approaches to both breast and axillary surgery. Results Technologies for intraoperative margin assessment can potentially half re-excision rates after breast-conserving surgery, and sentinel lymph node biopsy will become a therapeutic procedure for many patients with node-positive disease treated either with surgery or chemotherapy as the primary modality. Genomic profiling of tumours can aid in the selection of patients for neoadjuvant and adjuvant therapies as well as prevention strategies. Molecular subtypes are predictive of response to induction therapies and reductive approaches to surgery in the breast or axilla. Conclusion Treatments are increasingly being tailored and based on improved understanding of tumour biology and relevant biomarkers to determine absolute benefit and permit delivery of cost-effective healthcare. Patient involvement is crucial for breast cancer studies to ensure relevance and outcome measures that are objective, meaningful, and patient-centred.
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- 2021
226. Oncoplastic surgery. How do I do it? Choice and design of the pattern
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A Pareja López, JM Rodríguez Alonso, M García Redondo, and Á Reina Duarte
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Oncoplastic Surgery ,medicine.medical_specialty ,business.industry ,General surgery ,medicine ,General Medicine ,business - Abstract
Resumen La cirugía oncoplástica está especialmente indicada en mujeres de 50 a 69 años con tumores menores de 2 cm sin componente intraductal extenso donde es posible conseguir una resección R0. Los elementos básicos de la mama son el complejo areola-pezón, el surco submamario y las distancias anatómicas que armonizan la estructura tridimensional. Las pacientes fumadoras, obesas con IMC > 30 y diabéticas con microangiopatía tienen un elevado riesgo de necrosis vascular. A la hora de planificar la intervención quirúrgica, debemos tener en cuenta dos variables independientes; las características psicofísicas de la paciente y las de su tumor. En función de ellas elegiremos una técnica quirúrgica determinada que, a su vez, supondrá unas limitaciones propias de cada patrón. La mamoplastia lateral está especialmente indicada en los tumores que afectan al segmento lateral. La mamoplastia circular es una buena opción para tumores centrales, cercanos a la areola. La mamoplastia horizontal es un buen abordaje para lesiones del polo superior y periareolares. La mamoplastia vertical de rama única es un patrón muy versátil que permite resecciones multicéntricas. La mamoplastia vertical de doble rama permite el abordaje directo o indirecto de lesiones situadas en prácticamente cualquier localización. La técnica de Grisotti es una alternativa para la extirpación de lesiones que no permiten conservar el complejo areola-pezón. La mamoplastia de rotación es una cuadrantectomía interna indicada para el abordaje de tumores del cuadrante interno con afectación de la piel.
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- 2021
227. Level II Oncoplastic Surgery as an Alternative Option to Mastectomy with Immediate Breast Reconstruction in the Neoadjuvant Setting: A Multidisciplinary Single Center Experience
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Di Leone, Alba, Franco, Antonio, Terribile, Daniela Andreina, Magno, Stefano, Fabi, Alessandra, Sanchez, Alejandro Martin, D'Archi, Sabatino, Scardina, Lorenzo, Natale, Maria, Mason, Elena Jane, Murando, Federica, Marazzi, Fabio, Orlandi, Armando, Paris, Ida, Visconti, Giuseppe, Palazzo, Antonella, Masiello, Valeria, Barone Adesi, Liliana, Salgarello, Marzia, Masetti, Riccardo, Franceschini, Gianluca, Terribile, Daniela Andreina (ORCID:0000-0002-3511-0010), Orlandi, Armando (ORCID:0000-0001-5253-4678), Visconti, Giuseppe (ORCID:0000-0002-0041-5420), Salgarello, Marzia (ORCID:0000-0003-4296-4214), Masetti, Riccardo (ORCID:0000-0002-7520-9111), Franceschini, Gianluca (ORCID:0000-0002-2950-3395), Di Leone, Alba, Franco, Antonio, Terribile, Daniela Andreina, Magno, Stefano, Fabi, Alessandra, Sanchez, Alejandro Martin, D'Archi, Sabatino, Scardina, Lorenzo, Natale, Maria, Mason, Elena Jane, Murando, Federica, Marazzi, Fabio, Orlandi, Armando, Paris, Ida, Visconti, Giuseppe, Palazzo, Antonella, Masiello, Valeria, Barone Adesi, Liliana, Salgarello, Marzia, Masetti, Riccardo, Franceschini, Gianluca, Terribile, Daniela Andreina (ORCID:0000-0002-3511-0010), Orlandi, Armando (ORCID:0000-0001-5253-4678), Visconti, Giuseppe (ORCID:0000-0002-0041-5420), Salgarello, Marzia (ORCID:0000-0003-4296-4214), Masetti, Riccardo (ORCID:0000-0002-7520-9111), and Franceschini, Gianluca (ORCID:0000-0002-2950-3395)
- Abstract
Oncoplastic surgery level II techniques (OPSII) are used in patients with operable breast cancer. There is no evidence regarding their safety and efficacy after neoadjuvant chemotherapy (NAC). The aim of this study was to compare the oncological and aesthetic outcomes of this technique compared with those observed in mastectomy with immediate breast reconstruction (MIBR), in post-NAC patients undergoing surgery between January 2016 and March 2021. Local disease-free survival (L-DFS), regional disease-free survival (R-DFS), distant disease-free survival (D-DFS), and overall survival (OS) were compared; the aesthetic results and quality of life (QoL) were evaluated using BREAST-Q. A total of 297 patients were included, 87 of whom underwent OPSII and 210 of whom underwent MIBR. After a median follow-up of 39.5 months, local recurrence had occurred in 3 patients in the OPSII group (3.4%), and in 13 patients in the MIBR group (6.1%) (p = 0.408). The three-year L-DFS rates were 95.1% for OPSII and 96.2% for MIBR (p = 0.286). The three-year R-DFS rates were 100% and 96.4%, respectively (p = 0.559). The three-year D-DFS rate were 90.7% and 89.7% (p = 0.849). The three-year OS rates were 95.7% and 95% (p = 0.394). BREAST-Q highlighted significant advantages in physical well-being for OPSII. No difference was shown for satisfaction with breasts (p = 0.656) or psychosocial well-being (p = 0.444). OPSII is safe and effective after NAC. It allows oncological and aesthetic outcomes with a high QoL, and is a safe alternative for locally advanced tumors which are partial responders to NAC.
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- 2022
228. Level II Oncoplastic Surgery as an Alternative Option to Mastectomy with Immediate Breast Reconstruction in the Neoadjuvant Setting: A Multidisciplinary Single Center Experience
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Di Leone, A., Franco, Antonio, Terribile, Daniela Andreina, Magno, Stefano, Fabi, A., Sanchez, A. M., D'Archi, S., Scardina, L., Natale, Maria, Mason, Elena Jane, Murando, F., Marazzi, Fabio, Orlandi, Armando, Paris, Ida, Visconti, Giuseppe, Palazzo, Antonella, Masiello, V., Adesi, L. B., Salgarello, Marzia, Masetti, Riccardo, Franceschini, Gianluca, Franco A., Terribile D. A. (ORCID:0000-0002-3511-0010), Magno S., Natale M., Mason E. J., Marazzi F., Orlandi A. (ORCID:0000-0001-5253-4678), Paris I., Visconti G. (ORCID:0000-0002-0041-5420), Palazzo A., Salgarello M. (ORCID:0000-0003-4296-4214), Masetti R. (ORCID:0000-0002-7520-9111), Franceschini G. (ORCID:0000-0002-2950-3395), Di Leone, A., Franco, Antonio, Terribile, Daniela Andreina, Magno, Stefano, Fabi, A., Sanchez, A. M., D'Archi, S., Scardina, L., Natale, Maria, Mason, Elena Jane, Murando, F., Marazzi, Fabio, Orlandi, Armando, Paris, Ida, Visconti, Giuseppe, Palazzo, Antonella, Masiello, V., Adesi, L. B., Salgarello, Marzia, Masetti, Riccardo, Franceschini, Gianluca, Franco A., Terribile D. A. (ORCID:0000-0002-3511-0010), Magno S., Natale M., Mason E. J., Marazzi F., Orlandi A. (ORCID:0000-0001-5253-4678), Paris I., Visconti G. (ORCID:0000-0002-0041-5420), Palazzo A., Salgarello M. (ORCID:0000-0003-4296-4214), Masetti R. (ORCID:0000-0002-7520-9111), and Franceschini G. (ORCID:0000-0002-2950-3395)
- Abstract
Oncoplastic surgery level II techniques (OPSII) are used in patients with operable breast cancer. There is no evidence regarding their safety and efficacy after neoadjuvant chemotherapy (NAC). The aim of this study was to compare the oncological and aesthetic outcomes of this technique compared with those observed in mastectomy with immediate breast reconstruction (MIBR), in post-NAC patients undergoing surgery between January 2016 and March 2021. Local disease-free survival (L-DFS), regional disease-free survival (R-DFS), distant disease-free survival (D-DFS), and overall survival (OS) were compared; the aesthetic results and quality of life (QoL) were evaluated using BREAST-Q. A total of 297 patients were included, 87 of whom underwent OPSII and 210 of whom underwent MIBR. After a median follow-up of 39.5 months, local recurrence had occurred in 3 patients in the OPSII group (3.4%), and in 13 patients in the MIBR group (6.1%) (p = 0.408). The three-year L-DFS rates were 95.1% for OPSII and 96.2% for MIBR (p = 0.286). The three-year R-DFS rates were 100% and 96.4%, respectively (p = 0.559). The three-year D-DFS rate were 90.7% and 89.7% (p = 0.849). The three-year OS rates were 95.7% and 95% (p = 0.394). BREAST-Q highlighted significant advantages in physical well-being for OPSII. No difference was shown for satisfaction with breasts (p = 0.656) or psychosocial well-being (p = 0.444). OPSII is safe and effective after NAC. It allows oncological and aesthetic outcomes with a high QoL, and is a safe alternative for locally advanced tumors which are partial responders to NAC.
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- 2022
229. Oncoplastic Breast-Conserving Surgery for Synchronous Multicentric and Multifocal Tumors: Is It Oncologically Safe? A Retrospective Matched-Cohort Analysis
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De Lorenzi, F, Borelli, F, Pagan, E, Bagnardi, V, Peradze, N, Jereczek-Fossa, B, Leonardi, C, Mazzarol, G, Favia, G, Corso, G, Montagna, E, Rietjens, M, Veronesi, P, De Lorenzi, Francesca, Borelli, Francesco, Pagan, Eleonora, Bagnardi, Vincenzo, Peradze, Nickolas, Jereczek-Fossa, Barbara Alicia, Leonardi, Cristina, Mazzarol, Giovanni, Favia, Giorgio, Corso, Giovanni, Montagna, Emilia, Rietjens, Mario, Veronesi, Paolo, De Lorenzi, F, Borelli, F, Pagan, E, Bagnardi, V, Peradze, N, Jereczek-Fossa, B, Leonardi, C, Mazzarol, G, Favia, G, Corso, G, Montagna, E, Rietjens, M, Veronesi, P, De Lorenzi, Francesca, Borelli, Francesco, Pagan, Eleonora, Bagnardi, Vincenzo, Peradze, Nickolas, Jereczek-Fossa, Barbara Alicia, Leonardi, Cristina, Mazzarol, Giovanni, Favia, Giorgio, Corso, Giovanni, Montagna, Emilia, Rietjens, Mario, and Veronesi, Paolo
- Abstract
Background: Oncoplastic surgery is a well-established approach that combines breast-conserving treatment for breast cancer and plastic surgery techniques. Although this approach already has been described for multicentric and multifocal tumors, no long-term oncologic follow-up evaluation and no comparison with patients undergoing mastectomy have been published. This study aimed to evaluate whether oncoplastic surgery is a safe and reliable treatment for managing invasive primary multicentric and multifocal breast cancer. Methods: The study compared a consecutive series of 100 patients with multicentric or multifocal tumors who had undergone oncoplastic surgery (study group) with 100 patients who had multicentric or multifocal tumors and had undergone mastectomy (control group) during a prolonged period. The end points evaluated were disease-free survival (DFS), overall survival (OS), cumulative incidence of local recurrence (CI-L), regional recurrence (CI-R), and distant recurrence (CI-D), all measured from the date of surgery. Results: The OS and DFS were similar between the two groups. The incidence of local events was higher in the oncoplastic group, whereas the incidence of regional events was slightly higher in the mastectomy group. These differences were not statistically significant. The cumulative incidence of distant events was similar between the two groups. Conclusions: To the authors’ knowledge, the current study provides the best available evidence suggesting that the oncoplastic approach is a safe and reliable treatment for managing invasive multifocal and multicentric breast cancers.
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- 2022
230. The Use of Vertical Scar Techniques in Reconstructive Surgery
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Hamdi, Moustapha, Blondeel, Phillip, Van Landuyt, Koenraad, Monstrey, Stan, Hamdi, Moustapha, editor, Hammond, Dennis C., editor, and Nahai, Foad, editor
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- 2005
- Full Text
- View/download PDF
231. Skin sparing mastectomy: Technique and suggested methods of reconstruction
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Ahmed M. Farahat, Tarek Hashim, Hussein O. Soliman, Tamer M. Manie, and Osama M. Soliman
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Breast cancer ,Oncoplastic surgery ,Breast reconstruction ,Skin sparing mastectomy ,Volume replacement ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Aim: To demonstrate the feasibility and accessibility of performing adequate mastectomy to extirpate the breast tissue, along with en-block formal axillary dissection performed from within the same incision. We also compared different methods of immediate breast reconstruction used to fill the skin envelope to achieve the best aesthetic results. Methods: 38 patients with breast cancer underwent skin-sparing mastectomy with formal axillary clearance, through a circum-areolar incision. Immediate breast reconstruction was performed using different techniques to fill in the skin envelope. Two reconstruction groups were assigned; group 1: Autologus tissue transfer only (n = 24), and group 2: implant augmentation (n = 14). Autologus tissue transfer: The techniques used included filling in the skin envelope using Extended Latissimus Dorsi flap (18 patients) and Pedicled TRAM flap (6 patients). Augmentation with implants: Subpectoral implants(4 patients), a rounded implant placed under the pectoralis major muscle to augment an LD reconstructed breast. LD pocket (10 patients), an anatomical implant placed over the pectoralis major muscle within a pocket created by the LD flap. No contra-lateral procedure was performed in any of the cases to achieve symmetry. Results: All cases underwent adequate excision of the breast tissue along with en-block complete axillary clearance (when indicated), without the need for an additional axillary incision. Eighteen patients underwent reconstruction using extended LD flaps only, six had TRAM flaps, four had augmentation using implants placed below the pectoralis muscle along with LD flaps, and ten had implants placed within the LD pocket. Breast shape, volume and contour were successfully restored in all patients. Adequate degree of ptosis was achieved, to ensure maximal symmetry. Conclusions: Skin Sparing mastectomy through a circum-areolar incision has proven to be a safe and feasible option for the management of breast cancer in Egyptian women, offering them adequate oncologic control and optimum cosmetic outcome through preservation of the skin envelope of the breast when ever indicated. Our patients can benefit from safe surgery and have good cosmetic outcomeby applying different reconstructive techniques.
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- 2014
- Full Text
- View/download PDF
232. Archives of Breast Cancer
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breast cancer ,mammography ,ultrasonography ,breast disease ,breast biopsy ,oncoplastic surgery ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Published
- 2016
233. Icing the Muffin (Sponge): An Easily Reproducible and Cost-Effective Dressing Technique Used for Nipple Areola Reconstruction
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Michelle D Palazzo and Uzair A Qazi
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Areola reconstruction ,medicine.medical_specialty ,business.industry ,Adverse outcomes ,Breast surgery ,medicine.medical_treatment ,030230 surgery ,Surgery ,Oncoplastic Surgery ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Plastic surgery ,0302 clinical medicine ,Medicine ,business ,Breast reconstruction - Abstract
Nipple areola reconstruction is an integral part of breast reconstruction and serves as the "cherry on top" of the reconstructed breast. These delicate tissues need protection and stabilization. There are many techniques to dress skin grafts and the NAC. The ideal NAC dressing should not be bulky and should stent the nipple. Having less bulk enables the patient to wear a bra immediately after the procedure to reduce edema. We have developed a dressing for nipple areola reconstruction which has all these qualities and more. This is a very cost-effective, fast, and easy to perform technique. There have been no adverse outcomes, and it can be accomplished within a few minutes.Level of Evidence V 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 https://www.springer.com/00266 .
- Published
- 2021
234. A multidisciplinary approach for autologous breast reconstruction
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Dirk De Ruysscher, Tine Engberg Damsgaard, Philip Poortmans, Naama Hermann, Oreste Gentilini, Birgitte Vrou Offersen, Wies Maarse, Trine Tramm, Zoltan Matrai, Miri Sklair-Levi, Thorsten Kühn, Orit Kaidar-Person, and Liesbeth J. Boersma
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Breast surgery ,Mammaplasty ,Breast Neoplasms ,030218 nuclear medicine & medical imaging ,POSTMASTECTOMY RADIATION-THERAPY ,03 medical and health sciences ,RECIPIENT VESSELS ,0302 clinical medicine ,Breast cancer ,Postoperative Complications ,IMMEDIATE RECONSTRUCTION ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Contraindication ,Mastectomy ,Computer. Automation ,SPARING MASTECTOMY ,business.industry ,General surgery ,RADIOTHERAPY HYPOFRACTIONATION ,Cosmesis ,INTERNAL MAMMARY VESSELS ,Hematology ,Microsurgery ,medicine.disease ,CANCER ,Radiation therapy ,Oncoplastic Surgery ,Oncology ,030220 oncology & carcinogenesis ,FREE TRAM ,UK STANDARDIZATION ,Radiotherapy, Adjuvant ,Human medicine ,Reconstruction ,business ,Breast reconstruction ,FOLLOW-UP ,Autologous - Abstract
Breast reconstruction and oncoplastic surgery have become an important part of breast cancer care. The use of autologous breast reconstruction (ABR) has evolved significantly with advances in microsurgery, aiming to reduce donor site complications and improve cosmesis. For years, immediate-ABR was considered a contraindication if postmastectomy irradiation (PMRT) was planned. As a result of de-escalation of axillary surgery the indication of PMRT are increasing along-side with observations that PMRT in the setting of ABR is not contraindicated. Surgical techniques may result in different amount and areas of breast residual glandular tissue and patient selection is important to reduce potential residual disease. Meticulus radiation planning is important to potentially reduce complications without compromising oncologic outcomes. Surgical techniques change constantly in aim to improve aesthetic results but should most importantly maintain priority to the oncological indications. By multidisciplinary team work with a comprehensive understanding of each discipline, we can preserve the accomplishments of breast surgery in the setting of PMRT, without compromising disease control. (C) 2021 Elsevier B.V. All rights reserved.
- Published
- 2021
235. Oncological Safety of Oncoplastic Level II Mammoplasties After Neoadjuvant Chemotherapy for Large Breast Cancers: A Matched-Cohort Analysis
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Bruno Poulet, Isabelle Sarfati, Raquel F. D. van la Parra, Claude Nos, Krishna B. Clough, Helene H. Thygesen, and Eric Levy
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Oncology ,medicine.medical_specialty ,Chemotherapy ,business.industry ,medicine.medical_treatment ,Cancer ,medicine.disease ,Oncoplastic Surgery ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Surgical oncology ,030220 oncology & carcinogenesis ,Internal medicine ,Cohort ,medicine ,Breast-conserving surgery ,030211 gastroenterology & hepatology ,Surgery ,business ,Mastectomy - Abstract
Oncoplastic surgery (OPS) has extended the indications for breast-conserving surgery (BCS). Its role in patients with large breast cancers treated with neoadjuvant chemotherapy (NAC) is unclear. This study evaluated the oncological safety of OPS for tumors with partial response after NAC. A consecutive series of 65 patients who underwent OPS (study group) after NAC for large breast cancer from January 2004 to July 2018 was compared with 130 matched patients treated by NAC, followed by standard BCS in 65 cases and mastectomy in 65 cases (two case-controlled groups). The mean initial radiological tumor size was 46 mm. Residual pathological tumor size was 22 mm in the OPS cohort, 19 mm in the standard BCS cohort, and 31 mm in the mastectomy cohort (p > 0.05). The mean follow-up was 59 months in the study cohort. Five-year local recurrence rates were 0%, 0%, and 10.5% (0–22%) for the OPS, BCS, and mastectomy cohorts, respectively, while 5-year regional recurrence rates were 4.1% (0–11.1%), 0, and 19.4% (0–35.2%, p > 0.05), respectively. Five-year overall survival was 85.3% for the OPS cohort, 94.1% for the standard BCS cohort (p = 0.194), and 79.9% for the mastectomy cohort (p = 0.165). OPS is safe after NAC for large breast cancers, and provides excellent local control, identical to that of tumors with a better response, treated by standard BCS. After NAC, OPS can be a valuable treatment option for tumors that did not shrink optimally and would not be suitable for standard BCS.
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- 2021
236. Abstract PS1-11: Natural transition targeted surgery
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Peter Kern, Alina Kessel, Oliver Hoffmann, Rainer Kimmig, Mahdi Rezai, Ann-Kathrin Bittner, and Ines Bücker
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Cancer Research ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Lumpectomy ,Cancer ,Nomogram ,medicine.disease ,Surgery ,Oncoplastic Surgery ,medicine.anatomical_structure ,Breast cancer ,Oncology ,medicine ,Breast-conserving surgery ,Stage (cooking) ,business ,Areola - Abstract
Background: Breast conserving surgery is the standard in T1-T3 primary breast cancer. The cosmetic result is very much depending on the surgeon´s experience, the tumor-size/breast ratio and the technique applied. To improve cosmetic outcome and reduce repeated surgery, we have proposed a nomogram earlier (1) which has been cited by the American Society of Breast Surgeons Consensus Conference (2). In this nomogram, we proposed 5 simple oncoplastic techniques to handle the vast majority of breast cancer cases with a good cosmetic result. However, these techniques used direct access to the mammary gland, leaving scars in the visible skin of the breast. To avoid this, we chose a more natural access to the mammary gland at the natural transitions. Methods: We conducted a prospective open-arm study including all primary invasive and non-invasive breast cancer cases of tumor stages AJCC 0-III A (Version 8.0). Access to the tumor was chosen according to the proximity of the tumor to one of the following natural transitions (Areola, Lateral Insertion of the breast, inframmary fold): Non-palpable tumors and those undergoing neoadjuvant chemotherapy had to be marked by a wireand clippes before. Intraoperative ultrasound was applied before skin incision and after removal of the tumour (ultrasound of the specimen to confirm clear margins). Resection was performed as a segmentectomy and SLN biopsy and axillary clearance was done according to current guidelines.Results: 84 patients with breast conserving NTT-surgery have been enrolled so far. 76 patients had primary surgery with stage distribution as follows: Tis (1), T1a (3), T1b (8), T1c (30), T2 (30), T3 (4) and T4b(1). 8 patients had neoadjuvant chemotherapy with stage distribution as follows: ypT0 (3), ypT1a(2), ypT1c(1) and ypT2 (2). Histopathology was predominantly invasive-ductal breast cancer (70), followed by invasive-lobular (6), ductulo-lobular (5), invasive-ductal and DCIS (1),invasive-ductal and mucinous (1) and mucinous only (1). After first surgery 77 patients had a tumor resection according to the nomogramm of NTT-surgery with free margins and 7 with involved margins, thus 91,6 % tumors were resected with free margins at first surgery. The remaining 8,4 % were margin-free after second surgery. Conclusion: Scars were not visible on the surface of the breast outside of natural transitions and rate of free margins was high at 91,6 % without impairment due to the remote access to the mammary gland. We report a high patient satisfaction. Patient-reported outcome in detail has been evaluated by validated questionnaires and will be presented onsite. References:1. Rezai M., Knispel S., Kellersmann S., Lax H., Kimmig R., Kern P: Systematization of Oncoplastic Surgery: Selection of Surgical Techniques and Patient-Reported Outcome in a Cohort of 1,035 Patients, Ann Surg Oncol (2015) 22:3730-37372. Landercasper J. et al.: Toolbox to Reduce Lumpectomy Reoperations and Improve Cosmetic Outcome in Breast Cancer Patients: The America Society of Breast Surgeons Consensus Conference, Ann Surg Oncol 22, 3174-3183 (2015) Citation Format: Peter Kern, Oliver Hoffmann, Ann-Kathrin Bittner, Rainer Kimmig, Mahdi Rezai, Ines Bücker, Alina Kessel. Natural transition targeted surgery [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-11.
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- 2021
237. A comprehensive literature review of patient‐reported outcome measures (PROMs) among common breast reconstruction options: What types of breast reconstruction score well?
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Sydney Char, Zachary Erlichman, Michael M. Jonczyk, Abhishek Chatterjee, and Joshua A Bloom
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medicine.medical_specialty ,Breast Implants ,Mammaplasty ,Breast surgery ,medicine.medical_treatment ,Breast Neoplasms ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Breast cancer ,Internal Medicine ,medicine ,Humans ,Patient Reported Outcome Measures ,Breast Implantation ,Mastectomy ,Retrospective Studies ,business.industry ,General surgery ,medicine.disease ,Oncoplastic Surgery ,Oncology ,030220 oncology & carcinogenesis ,Female ,Surgery ,Patient-reported outcome ,Implant ,Breast reconstruction ,business - Abstract
Purpose Breast cancer continues to be the most prevalent cancer affecting women. Many reconstructive options exist after oncologic resection. Breast reconstruction can have a lasting impact on many areas of the patient's life, and therefore, a high consideration for patient satisfaction is crucial. Patient-reported outcome measures (PROMs) provide an important tool in the evaluation of different surgical methodologies. The aim of this comprehensive systematic review is to look at various surgical modalities in breast reconstruction as they relate to patient satisfaction. Methods A PubMed PRISMA search was performed. Criteria for inclusion included nipple-sparing or skin-sparing mastectomy with autologous or implant-based reconstruction, level 2 volume displacement or volume replacement oncoplastic surgery, and measurement of patient-reported outcomes using the BREAST-Q or other validated PROMs. From the data set, weighted proportions were generated and analyzed using the Kruskal-Wallis rank sum test and a post hoc Dunn's test. Results After obtaining 254 full text copies, 43 articles met inclusion criteria and were included. Analysis of BREAST-Q data showed oncoplastic breast surgery was significantly preferred over mastectomy regardless of the type of reconstruction. Nipple-sparing was significantly preferred over skin-sparing mastectomy, autologous reconstruction was significantly preferred over implant-based reconstruction, and prepectoral implant placement was preferred over subpectoral implant placement. Validated PROMs other than BREAST-Q showed similar trends in all but type of mastectomy. Conclusions In this comprehensive systematic review, oncoplastic surgery showed the most favorable PROMs when compared to other reconstructive modalities. Autologous was preferred over implant-based reconstruction, and prepectoral was preferred over subpectoral implant placement.
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- 2021
238. A systematic review and meta-analysis on the effect of neoadjuvant chemotherapy on complications following immediate breast reconstruction
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Peter Schmid, Laura Johnson, Jajini Varghese, Hirah Rizki, Shireen Gohari, Benjamin Langridge, Michael Faheem, and Sherko Kümmel
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medicine.medical_specialty ,Post-operative complications ,Mammaplasty ,medicine.medical_treatment ,Breast Neoplasms ,Review ,lcsh:RC254-282 ,Neoadjuvant chemotherapy ,Breast surger ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Humans ,Medicine ,030212 general & internal medicine ,Chemotherapy ,Immediate breast reconstruction ,business.industry ,General Medicine ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Combined Modality Therapy ,Neoadjuvant Therapy ,Oncoplastic Surgery ,Plastic and reconstructive surgery ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Meta-analysis ,Female ,Surgery ,Implant ,Radiology ,business ,Complication ,Breast reconstruction ,Oncoplastic surgery - Abstract
Background: The impact of neoadjuvant chemotherapy (NACT) on surgical outcomes following immediate breast reconstruction (IBR) remains unclear. While it is generally considered safe practice to perform an IBR post NACT, reported complication rates in published data are highly variable with the majority of studies including fewer than 50 patients in the NACT and IBR arm. To evaluate this further, we conducted a systematic review and meta-analysis on the effect of NACT on autologous and implant based immediate breast reconstructions. We aimed to assess for differences in the post-operative course following IBR between patients who received NACT with those who did not. Methods: PubMed, EMBASE, and Cochrane Library were searched from 1995 to Sept 2, 2020 to identify articles that assessed the impact of NACT on IBR. All included studies assessed outcomes following IBR. Only studies comparing reconstructed patients receiving NACT to a control group of women who did not receive NACT were included. Unadjusted relative risk of outcomes between patients who received or did not receive NACT were synthesized using a fixed-effect meta-analysis. The evidence was assessed using the Newcastle Ottawa Scale scores and GRADE. Primary effect measures were risk ratios (RRs) with 95% confidence intervals. Results: A total 17 studies comprising 3249 patients were included in the meta-analyses. Overall, NACT did not increase the risk of complications after immediate breast reconstructions (risk ratio [RR]: 0.91, 95% CI 0.74 to 1.11, p = 0.34). There was a moderate, but not significant, increase in flap loss following NACT compared with controls (RR: 1.23, 95% CI 0.70 to 2.18, p = 0.47; I2 = 0%). Most notably, there was a statistically significant increase in implant/expander loss after NACT (RR: 1.54, 95% CI 1.04 to 2.29, p = 0.03; I2 = 34%). NACT was not shown to significantly increase the incidence of hematomas, seromas or wound complications, or result in a significant delay to commencing adjuvant therapy (RR: 1.59, 95% CI 0.66 to 3.87, p = 0.30). Conclusion: Immediate breast reconstruction after NACT is a safe procedure with an acceptable post-operative complication profile. It may result in a slight increase in implant loss rates, but it does not delay commencing adjuvant therapy.
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- 2021
239. The impact of age on patient-reported outcomes after oncoplastic versus conventional breast cancer surgery
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J. Lévy, L. Zehnpfennig, Walter P. Weber, Elisabeth A. Kappos, Barbara Ling, Christian Kurzeder, Madleina Müller, Martin Haug, Savas D. Soysal, Mathilde Ritter, Ida Oberhauser, L. López Castrezana, Fabienne Schwab, and Giacomo Montagna
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Quality of life ,Cancer Research ,medicine.medical_specialty ,Breast surgery ,medicine.medical_treatment ,Mammaplasty ,Breast Neoplasms ,030230 surgery ,Mastectomy, Segmental ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Age ,Elderly ,Medicine ,Humans ,Patient Reported Outcome Measures ,Stage (cooking) ,Total Mastectomy ,Contraindication ,Mastectomy ,Aged ,Retrospective Studies ,business.industry ,Patient-related outcomes ,Middle Aged ,medicine.disease ,Clinical Trial ,Surgery ,Oncoplastic Surgery ,Breast cancer surgery ,Oncology ,030220 oncology & carcinogenesis ,Female ,business ,Psychosocial ,Oncoplastic surgery - Abstract
Purpose Some studies have indicated age-specific differences in quality of life (QoL) among breast cancer (BC) patients. The aim of this study was to compare patient-reported outcomes after conventional and oncoplastic breast surgery in two distinct age groups. Methods Patients who underwent oncoplastic and conventional breast surgery for stage I-III BC, between 6/2011–3/2019, were identified from a prospectively maintained database. QoL was prospectively evaluated using the Breast-Q questionnaire. Comparisons were made between women Results One hundred thirty-three patients were included. Seventy-three of them were ≥ 60 years old. 15 (20.5%) of them received a round-block technique (RB) / oncoplastic breast-conserving surgeries (OBCS), 10 (13.7%) underwent nipple-sparing mastectomies (NSM) with deep inferior epigastric perforator flap (DIEP) reconstruction, 23 (31.5%) underwent conventional breast-conserving surgeries (CBCS), and 25 (34.2%) received total mastectomy (TM). Sixty patients were younger than 60 years, 15 (25%) thereof received RB/OBCS, 22 (36.7%) NSM/DIEP, 17 (28.3%) CBCS, and 6 (10%) TM. Physical well-being chest and psychosocial well-being scores were significantly higher in older women compared to younger patients (88.05 vs 75.10; p p = 0.002, respectively). In multivariate linear regression, longer time intervals had a significantly positive effect on the scales Physical Well-being Chest (p = 0.014) and Satisfaction with Breasts (p = 0.004). No significant results were found concerning different types of surgery. Conclusion Our findings indicate that age does have a relevant impact on postoperative QoL. Patient counseling should include age-related considerations, however, age itself cannot be regarded as a contraindication for oncoplastic surgery.
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- 2021
240. Acute perioperative hyperlactatemia in oncoplastic reconstructive surgeries: What is the significance?
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Sudha Sinha, Kamal Bharti, Yatin Mehta, Sangeeta Khanna, and Preety Mittal Roy
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Reconstructive surgery ,medicine.medical_specialty ,Blood transfusion ,medicine.medical_treatment ,Free flap ,law.invention ,Pharmacy and materia medica ,reconstructive ,Anesthesiology ,law ,medicine ,RD78.3-87.3 ,Pharmacology (medical) ,General Pharmacology, Toxicology and Pharmaceutics ,lactate ,business.industry ,oncoplastic surgery ,Retrospective cohort study ,Perioperative ,Intensive care unit ,RS1-441 ,Oncoplastic Surgery ,Anesthesiology and Pain Medicine ,Anesthesia ,Free flap surgery ,Hyperlactatemia ,Original Article ,business - Abstract
Background and Aims: We aim to study the significance of intraoperative hyperlactatemia in reconstructive oncoplastic surgery. Material and Methods: A retrospective observational study was conducted on a cohort of patients who underwent reconstructive oncoplastic surgery with free flap for oral cancer over a 6-month period. The study population was divided into two groups based on peak lactate levels. Group N with peak lactate level less than 2 mmol/L and Group H peak lactate level more than 2 mmol/L. The various parameter studied were patient's comorbidities; intraoperative events (vasopressor requirement, blood transfusion, and duration of surgery); postoperative parameters including the need for re- exploration and duration of stay in hospital and intensive care unit. Results: The study demonstrates that intraoperative rise of lactate was not influenced by comorbidities. None of the intraoperative parameters studied influenced the lactate levels. Baseline lactate level was found to correlate with peak lactate level intraoperatively. But it was observed that there was normalization of lactate level within 24 hours postoperatively in both the groups. There was no difference in outcome parameters in the two groups. Conclusion: Intraoperative hyperlactatemia is not a significant prognostic factor for outcome in oncoplastic reconstructive surgery.
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- 2021
241. Safety and Outcomes of Oncoplastic Breast Surgery
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Janie Grumley, Crystal Fancher, and Alicia M. Terando
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,General surgery ,Breast surgery ,Lumpectomy ,Cosmesis ,medicine.disease ,Oncoplastic Surgery ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Oncology ,Quality of life ,Surgical oncology ,030220 oncology & carcinogenesis ,medicine ,030212 general & internal medicine ,business ,Total Mastectomy - Abstract
Traditional breast-conserving surgery combined with whole breast radiation results in equivalent overall survival as total mastectomy, with the benefit of being less invasive with fewer surgical complications and faster recovery. However, the surgical defect in the breast parenchyma, when combined with whole breast radiation, can result in cosmetic deformities that many patients find distressing. Partial mastectomy performed using plastic/reconstructive surgical techniques with the goal of optimizing both oncologic and esthetic outcomes is referred to as oncoplastic (breast) surgery. Herein, the surgical complications, oncologic, esthetic, and quality of life outcomes of oncoplastic surgery are reviewed. Overall, the oncologic and surgical outcomes of oncoplastic surgery are similar to traditional partial mastectomy. The esthetic outcomes of oncoplastic surgery are, by design, objectively superior to that which can be achieved with standard partial mastectomy and translate into improved psychosocial quality of life for many women. Oncoplastic surgery provides patients with the benefit of improved cosmesis over traditional lumpectomy without compromising cancer treatment outcomes.
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- 2021
242. Oncoplastic Surgery
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Lebovic, Gail S. and Schwab, Manfred, editor
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- 2011
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243. Evaluation of Virtual Breast Oncoplastic Surgery Simulator (VBOSS) as a training tool
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Yogen Thever, Geok Hoon Lim, Ruey Pyng Ng, Teng Chuan Eng, Ching Chiuan Yen, and Jieying Lee
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medicine.medical_specialty ,business.industry ,MEDLINE ,Breast Neoplasms ,Mastectomy, Segmental ,Oncoplastic Surgery ,Oncology ,Internal Medicine ,medicine ,Humans ,Female ,Surgery ,Medical physics ,Breast ,business ,Mastectomy - Published
- 2020
244. Assessing the effect of a hands-on oncoplastic surgery training course: A survey of Canadian surgeons
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Renee Hanrahan, Fahima Osman, Fernando A. Angarita, Megan E. Leroux, Marianna Kapala, Muriel Brackstone, Angel Arnaout, Vanessa N. Palter, and Jeannie Richardson
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Male ,medicine.medical_specialty ,Mammaplasty ,Training course ,medicine.medical_treatment ,Breast Neoplasms ,Mammoplasty ,030230 surgery ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Surveys and Questionnaires ,medicine ,Breast-conserving surgery ,Humans ,Practice Patterns, Physicians' ,Mastectomy ,Ontario ,Surgeons ,Response rate (survey) ,business.industry ,Nipple areola complex ,General surgery ,Cosmesis ,Prognosis ,medicine.disease ,Oncoplastic Surgery ,Surgical Oncology ,Oncology ,030220 oncology & carcinogenesis ,Education, Medical, Continuing ,Female ,Surgery ,business - Abstract
Background The adoption of oncoplastic surgery in North America is poor despite evidence supporting the benefits. Surgeons take courses to acquire oncoplastic techniques, however, the effect of these courses is unknown. This study aimed to assess the impact of a hands-on oncoplastic course on surgeons’ comfort with oncoplastic techniques and rate of adoption of these techniques in their practice. Material and methods An online 10-question survey was developed and distributed to surgeons who had participated in a hands-on oncoplastic course offered in Ontario, Canada. Categorical data were reported using frequencies and percentages. Results A total of 105 surveys were sent out of which 69 attending surgeons responded (response rate: 65.7%). All respondents stated cosmesis was of the utmost importance in breast conserving surgery. The most common oncoplastic techniques they currently use included glandular re-approximation (98.4%), undermining of skin (93.6%), undermining of the nipple areolar complex (63.4%), and de-epithelialization and repositioning of the nipple areola complex (49.2%). Only 26% of respondnets stated they used more advanced techniques such as mammoplasty. Sixty percent of surgeons reported they used oncoplastic techniques in at least half of their cases. Ninety-two percent of respondents stated that the hands-on course increased the amount of oncoplastic techniques in their practice. At least 70% of respondents stated they would do another hands-on course. The main factor that facilitated the uptake of oncoplastic techniques was a better understanding of surgical techniques and planning. Conclusion A hands-on oncoplastic course helps surgeons adopt oncoplastic surgery techniques into their clinical practice. This teaching model allows surgeons to become comfortable with a variety of techniques. This study supports the relevance of a hands-on oncoplastic course to enhance the availability of safe oncoplastic surgery for breast cancer patients.
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- 2020
245. Review of 107 Oncoplastic Surgeries Using an Acellular Dermal Matrix with the Round Block Technique
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Hong-Il Kim, Byeong-Seok Kim, Yoon-Soo Kim, Hyung-Suk Yi, Jin-Hyung Park, Jin-Hyuk Choi, Sung-Ui Jung, and Hyo-Young Kim
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General Medicine ,breast cancer ,breast-conserving surgery ,oncoplastic surgery ,mammaplasty ,breast reconstruction ,acellular dermal matrix - Abstract
The round block technique (RBT) is an oncoplastic surgery method that uses volume displacement techniques after partial mastectomy. However, cosmetic problems occur after tissue rearrangement in patients with small breasts or those in whom a large amount of breast tissue is excised. Therefore, we used an acellular dermal matrix (ADM) when the volume was insufficient after tissue rearrangement. Patients who underwent breast reconstruction using the ADM with the RBT after breast-conserving surgery (BCS) were included. The ADM graft was performed in two layers. First, it was placed on the glandular flap, and the patient was then seated to ascertain the degree of deformity. If the volume was insufficient, a graft was also performed under the skin flap. Overall, 107 oncoplastic surgeries were performed. Tumors were most commonly located in the upper outer quadrant of the breast, and the mean resected breast tissue was 27.1 g. Seroma was the most common complication, but it improved with several aspirations. There were no major complications or cosmetic problems requiring reoperation. Therefore, if the ADM was used for defects that could not be reconstructed with the RBT alone, safe and cosmetically good results could be obtained.
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- 2022
246. Effect of standardised surgical assessment and shared decision-making on morbidity and patient satisfaction after breast conserving therapy: A cross-sectional study
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Iliana Aristokleous, Johanna Öberg, Eirini Pantiora, Olivia Sjökvist, Jaime E. Navia, Maria Mani, and Andreas Karakatsanis
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Patient experience ,Breast cancer ,Shared decision -making ,Oncology ,Upper -extremity morbidity ,Kirurgi ,Surgery ,Breast conservation ,General Medicine ,Patient -reported outcomes ,Oncoplastic surgery - Abstract
Background: The role of oncoplastic breast conserving therapy (OPBCT) on physical function, morbidity and patient satisfaction has yet to be defined. Additionally, technique selection should be individualised and incorporate patient preference. The study aim was to investigate differences between "standard" (sBCT) and oncoplastic breast conservation (OPBCT) in patient-reported outcomes (PROs) when patients have been assessed in a standardised manner and technique selection has been reached through shared decision-making (SDM). Methods: This is a cross-sectional study of 215 women treated at a tertiary referral centre. Standardised surgical assessment included breast and lesion volumetry, definition of resection ratio, patient-related risk factors and patient preference. Postoperative morbidity and patient satisfaction were assessed by validated PROs tools (Diseases of the Arm, Shoulder and Hand-DASH and Breast-Q). Patient experience was assessed by semi-structured interviews. Results: There was no difference of the median values between OPBCT and sBCT in postoperative morbidity of the upper extremity (DASH 3.3 vs 5, p = 0.656) or the function of the chest wall (Breast-Q 82 vs 82, p = 0.758). Postoperative satisfaction with breasts did not differ either (Breast-Q 65 vs 61, p = 0.702). On the individual level, women that opted for OPBCT after SDM had improved satisfaction when compared to baseline (+3 vs -1, p = 0.001). Shared decision-making changed patient attitude in 69.8% of patients, leading most often to de-escalation from mastectomy. Conclusions: These findings support that a combination of standardised surgical assessment and SDM allows for tailored treatment and de-escalation of oncoplastic surgery without negatively affecting patient satisfaction and morbidity. De två första författarna delar förstaförfattarskapet.
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- 2022
247. Oncoplastic Surgery and the Clinical Features of Breast Cancer—Relevant Factors Associated with Reoperation in Breast Oncoplastic Surgery
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Alicja Forma, Robert Sitarz, Jacek Baj, Krzysztof Sołowiej, Sergiusz Łukasiewicz, and Andrzej Stanisławek
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breast cancer ,treatment ,breast-conserving surgery ,reoperation ,oncoplastic surgery ,oncoplasty ,Medicine ,General Medicine ,skin and connective tissue diseases - Abstract
Oncoplastic breast surgery slowly becomes a part of routine breast cancer surgical management but evidence with regard to oncological safety remains limited. The aim of this study was to compare relevant factors associated with the particular type of breast carcinoma and the applied surgical techniques either with or without oncoplastic surgery. This retrospective study enrolled the breast cancer female patients who underwent breast-conserving therapy alone or with the oncoplastic surgery in the Department of Surgical Oncology at the Center of Oncology of the Lublin Region St. Jana from Dukli in the years 2008–2011. The study involves 679 breast cancer patients who underwent oncoplasty (n = 81) and the control group (n = 598). There is a significant relationship between the histological type of breast cancer (p = 0.00000) along with the expression of estrogen and/or progesterone receptors (p = 0.01285) and the usage of oncoplastic surgery in breast cancer patients. Interestingly, in the majority of cases, there was no need to conduct a reoperation. Oncoplastic surgery is an effective and safe strategy that might be favorable especially for those patients who are potential candidates for more invasive surgical methods. High-quality evidence to support the oncological safety and benefits of oncoplastic breast surgery is lacking.
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- 2022
248. Oncoplastic surgery for inner quadrant breast cancer: fish-hook incision rotation flap.
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Lee, Seokwon, Lee, Jeeyeon, Jung, Younglae, and Bae, Youngtae
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- *
MASTECTOMY , *BREAST surgery , *SURGICAL flaps , *MAMMAPLASTY ,TUMOR surgery - Abstract
Background In oncoplastic breast surgery, the size and location of the defect are two of the major factors affecting the post-operative cosmetic outcome after partial mastectomy. We introduce a modified superior-based dermoglandular rotation flap technique, which can be applied for relatively large tumours and in cases of inner quadrant defects of the breast without surgery of the contralateral breast. Methods Between January 2007 and December 2012, a total of 34 female patients with breast cancer underwent breast-conserving surgery using the 'fish-hook incision rotational flap'. A fish-hook-shaped skin incision line was designed from an axillary site to the tumour, about 2-3 cm below the skin crease of the inframammary fold. After partial mastectomy, a superior-based dermoglandular tissue flap was mobilized off the pectoralis major muscle and the lower abdominal flap was dissected downward. The dermoglandular flap was then rotated and the lower dissected lower abdominal flap was advanced in the upward direction to fill the defect and restore the breast shape. The cosmetic results were self-estimated 12 months after surgery. Results Mean excised volume of the breast was 23.2 ± 6.1%. The location of the tumours was as follows: upper inner ( n = 13, 38.2%) and lower inner quadrant ( n = 21, 61.8%). The overall cosmetic satisfaction was self-estimated as follows: excellent ( n = 19, 55.9%); good ( n = 10, 29.4%); fair ( n = 4, 11.8%); poor ( n = 1, 2.9%). Conclusions The 'fish-hook incision rotation flap' is a feasible, effective oncoplastic technique that can be applicable to a relatively large defect located in the inner quadrant of the breast. [ABSTRACT FROM AUTHOR]
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- 2017
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249. First international consensus conference on standardization of oncoplastic breast conserving surgery.
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Weber, Walter, Soysal, Savas, El-Tamer, Mahmoud, Sacchini, Virgilio, Knauer, Michael, Tausch, Christoph, Hauser, Nik, Günthert, Andreas, Harder, Yves, Kappos, Elisabeth, Schwab, Fabienne, Fitzal, Florian, Dubsky, Peter, Bjelic-Radisic, Vesna, Reitsamer, Roland, Koller, Rupert, Heil, Jörg, Hahn, Markus, Blohmer, Jens-Uwe, and Hoffmann, Jürgen
- Abstract
Purpose: To obtain consensus recommendations for the standardization of oncoplastic breast conserving surgery (OPS) from an international panel of experts in breast surgery including delegates from the German, Austrian and Swiss societies of senology. Methods: A total of 52 questions were addressed by electronic voting. The panel's recommendations were put into context with current evidence and the report was circled in an iterative open email process until consensus was obtained. Results: The panelists considered OPS safe and effective for improving aesthetic outcomes and broadening the indication for breast conserving surgery (BCS) towards larger tumors. A slim majority believed that OPS reduces the rate of positive margins; however, there was consensus that OPS is associated with an increased risk of complications compared to conventional BCS. The panel strongly endorsed patient-reported outcomes measurement, and recommended selected scales of the Breast-Q™-Breast Conserving Therapy Module for that purpose. The Clough bi-level classification was recommended for standard use in clinical practice for indicating, planning and performing OPS, and the Hoffmann classification for surgical reports and billing purposes. Mastopexy and reduction mammoplasty were the only two recognized OPS procedure categories supported by a majority of the panel. Finally, the experts unanimously supported the statement that every OPS procedure should be tailored to each individual patient. Conclusions: When implemented into clinical practice, the panel recommendations may improve safety and effectiveness of OPS. The attendees agreed that there is a need for prospective multicenter studies to optimize patient selection and for standardized criteria to qualify and accredit OPS training centers. [ABSTRACT FROM AUTHOR]
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- 2017
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250. Standardization of oncoplastic breast conserving surgery.
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Weber, W.P., Soysal, S.D., Fulco, I., Barandun, M., Babst, D., Kalbermatten, D., Schaefer, D.J., Oertli, D., Kappos, E.A., and Haug, M.
- Subjects
BREAST cancer surgery ,NIPPLE (Anatomy) ,STANDARDIZATION ,MAMMAPLASTY ,PATIENT satisfaction ,PHYSIOLOGY - Abstract
The emphasis on esthetic outcomes and quality of life after breast cancer surgery has motivated surgeons to develop oncoplastic breast conserving surgery (OPS). Training programs are still rare in most countries, and there is little standardization, which challenges the scientific evaluation of the techniques. The present article attempts to standardize OPS nomenclature, indications, and reconstruction choice selection embedded in a thorough review of the literature. We propose four breast conserving surgery (BCS) categories: Conventional tumorectomy, oncoplastic mastopexy, oncoplastic tumorectomy and oncoplastic reduction mammoplasty. The main volume displacement techniques are glandular re-approximation, use of tailored glandular or dermoglandular flaps and nipple–areola complex pedicles. We developed an indication algorithm based on the size and shape of the breast as well as the size and location of the tumor. A reconstruction algorithm suggests a selection of suitable tailored flaps and pedicles based on tumor location and vascular supply of the breast. The application of these algorithms results in known and novel OPS techniques, which are presented here with long-term results. We designed the algorithms to help tailor every operation to the individual patient in a standardized manner, since OPS is now on the rise, more than two decades after the publication of the first techniques. A rapidly increasing body of observational evidence suggests comparable rates of local recurrence between OPS and conventional BCS. Importantly, the rates of clear resection margins are in favor of OPS despite extended indications to larger tumors. Finally, OPS optimizes patient satisfaction by improving esthetic outcomes after BCS. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
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